Nr574 Final Exam, Week 1 Content Gi/Gu Emergencies Final Exam Questions With Correct Verified Answers | 100% Pass (A+ Certified)

NR574 FINAL EXAM, WEEK 1 CONTENT GI/GU EMERGENCIES FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. Hepatorenal syndrome (HRS) Correct Answer functional form of renal failure that occurs primarily in pt with cirrhosis and ascites. 2. Type 1 hepatorenal syndrome is characterized by.. Correct Answer -rapidly progressive renal impairment -doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2 weeks -without liver transplant prognosis is very poor 3. Type 2 hepatorenal syndrome is characterized by.. Correct Answer -moderate form of renal failure -serum Cr levels between 1.5 to 2.5 mg/dL reduction in GFR with elevation in serum creatinine -associated with a more indolent course and improved survival compared to type 1 4. Risk Factors of hepatorenal syndrome Correct Answer Dilutional hyponatremia Previous episodes of ascites Presence of esophageal varices Poor nutritional status Infections such as spontaneous bacterial peritonitis Severe urinary sodium retention (urine sodium 5 milliequivalents/liter [mEq/L]) Large-volume paracentesis without albumin replacement Acute alcoholic hepatitis Low mean arterial blood pressure (map 80 mm Hg) 5. subjective clinical presentation of hepatorenal syndrome: Most clients with HRS have a known diagnosis of acute or chronic liver disease and present with nonspecific symptoms including Correct Answer dysgeusia (altered taste perception) -malaise -fatigue -decreased urine output. 6. objective clinical presentation of hepatorenal syndrome Correct Answer HRS has no characteristic physical exam findings. It is important to assess the client for stigmata of chronic liver disease including: -spider nevi -scleral icterus -lower extremity edema -asterixis -abdominal distention -fluid wave -paraumbilical hernia -bruits. 7. Dx criteria in hepatorenal syndrome Correct Answer 8. 1. cirrhosis with ascites 2. increase in Cr 0.3 mg/dL within 48 hrs or 50% increase from baseline within a 7 day period response to a 2 consecutive day diuretic withdrawal and volume expansion w/ albumin 1g/kg body wt 4. absence of shock 5. no nephrotoxic drug use 6. no macroscopic signs of structural kidney injury (proteinuria 500 milligrams/deciliter[(mg/dL], microhematuria with 50 red blood cells per high-power field, and/or abnormal renal ultrasonography) What is the Creatinine criteria when diagnosing hepatorenal syndrome Correct Answer increase in serum creatinine of -greater than or equal to 0.3 mg/dL or -greater than or equal to 50% increase from baseline Cr this is within a 7 day period. 9. What surgical intervention is used to treat hepatorenal syndrome Correct Answer TIPS Procedure 10. What is a TIPS procedure Correct Answer The TIPS procedure bypasses a portion of the hepatic circulation by shunting blood flow from the portal vein to the hepatic vein -This reduces portal pressure and minimizes back pressure on the splanchnic organs. This also decreases the likelihood of bleeding from the esophageal varies and reduces the amount of ascites *Hemorrhage is a significant risk during TIPS 11. What is the treatment of choice for both type 1 and type 2 HRS Correct Answer Liver transplant. 12. What medications are used to tx type 2 HRS Correct Answer vasoconstrictors (terlipressin, midodrine in combination with octriotide, norepinephrine) combined with albumin. 13. Bridge to transplant in Hepatorenal syndrome Correct Answer The combination of octreotide, midodrine, and albumin (triple therapy) is used to treat hepatorenal syndrome (HRS) often as a bridge to liver transplantation (LT). 14. Module ** Bridge to transplant** Correct Answer In clients who do not respond to medical therapy, are not candidates for TIPS but are candidates for liver transplantation or recovery for their liver disease, continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation. HRS clients typically do not tolerate hemodialysis well. 15. Joaquin is a 22-year-old male who presents to the emergency department (ED) with a 1-week history of headache, concentration difficulty, fatigue, nausea, and vague abdominal pain. He became concerned this morning when he noticed that the whites of his eyes appeared yellow. History is significant for epilepsy, which he has had since childhood but is well controlled with antiepileptic medication. There is no known history of liver disease. Notable physical exam findings include scleral icterus, generalized abdominal tenderness, and new-onset ascites. Urine alcohol and drug screen were negative. Labs reveal severe transaminitis, hyperbilirubinemia, hyperammonemia, and coagulopathy. The most likely diagnosis is: a. Cirrhosis b. Acute liver failure c. Acute hepatitis A d. Acute gastroenteritis Correct Answer Acute liver failure Rationale: Acute liver failure is an abrupt onset of liver failure, characterized by hepatic encephalopathy, jaundice, and coagulopathy in the absence of pre-existing liver disease which has been present for less than 26 weeks. Joaquin's symptoms are classic for that of acute liver failure with antiepileptic medication as his biggest risk factor. For causes other than acetaminophen toxicity, the onset of symptoms may be gradual and non-specific such as fatigue, malaise, and changes in behavior or concentration. Asymptomatic jaundice and new onset ascites may also be present. Cirrhosis is a chronic disorder and is considered an end-stage liver disease. 16. Chadwick presents to the ED following a suicide attempt. He reports swallowing approximately 10,000 milligrams (mg) of acetaminophen 4-hours ago. An hour ago, he began to develop generalized abdominal pain, nausea, and vomiting at which time he asked his brother to take him to the hospital. Shortly after arrival, he becomes confused and agitated. Labs reveal INR of 3.0, acute kidney injury (AKI) with creatinine 2.0, severe transaminitis, and lactic acidosis. Urine toxicology showed an acetaminophen level of 200 milligrams per kilogram. Serum alcohol was negative. The AGACNP knows that the best initial treatment for Chadwick is: a. Administer fresh frozen plasma (FFP) to reverse the coagulopathy b. Consult nephrology to begin hemodialysis c. Administer N-acetylcysteine (Mucomyst) d. Consult the liver transplant team Correct Answer 17. Administer N-acetylcysteine (Mucomyst) Rationale: All clients with ALF should receive N-acetylcysteine (NAC), regardless of its etiology, upon admission as it has been shown to improve transplant-free recovery. In this case, N acetylcysteine is the treatment for acetaminophen toxicity. While the client has a coagulopathy, there are no signs that Chadwick is actively bleeding. Consulting nephrology and gastroenterology is important but administering Mucomyst is a higher priority. Consulting the liver transplant team before administering or assessing response to treatment is inappropriate. Continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation. HRS clients typically do not tolerate hemodialysis well.