NR574 FINAL EXAM, Week 1 content GI/GU emergencies * UPDATED
ACTUAL Questions and CORRECT Answers
1. Hepatorenal syndrome (HRS) functional form of renal failure that oc-
curs primarily in pt with cirrhosis and as-
cites.
2. Type 1 hepatorenal syndrome is character- -rapidly progressive renal impairment
ized by... -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 character- -moderate form of renal failure
ized by... -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 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 albu-
min replacement
Acute alcoholic hepatitis
, Low mean arterial blood pressure (map
<80 mm Hg)
5. subjective clinical presentation of hepatore- Most clients with HRS have a known di-
nal syndrome agnosis of acute or chronic liver disease
and present with nonspecific symptoms
including:
-dysgeusia (altered taste perception)
-malaise
-fatigue
-decreased urine output.
6. objective clinical presentation of hepatorenal HRS has no characteristic physical exam
syndrome findings.
It is important to assess the client for stig-
mata 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 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
3. no response to a 2 consecutive day di-
uretic withdrawal and volume expansion
w/ albumin 1g/kg body wt
, 4. absence of shock
5. no nephrotoxic drug use
6. no macroscopic signs of structur-
al kidney injury (proteinuria >500 mil-
ligrams/deciliter[(mg/dL], microhema-
turia with >50 red blood cells per
high-power field, and/or abnormal renal
ultrasonography)
8. What is the Creatinine criteria when diagnos- increase in serum creatinine of
ing hepatorenal syndrome -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 TIPS Procedure
hepatorenal syndrome?
10. What is a TIPS procedure? 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 min-
imizes 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
ACTUAL Questions and CORRECT Answers
1. Hepatorenal syndrome (HRS) functional form of renal failure that oc-
curs primarily in pt with cirrhosis and as-
cites.
2. Type 1 hepatorenal syndrome is character- -rapidly progressive renal impairment
ized by... -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 character- -moderate form of renal failure
ized by... -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 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 albu-
min replacement
Acute alcoholic hepatitis
, Low mean arterial blood pressure (map
<80 mm Hg)
5. subjective clinical presentation of hepatore- Most clients with HRS have a known di-
nal syndrome agnosis of acute or chronic liver disease
and present with nonspecific symptoms
including:
-dysgeusia (altered taste perception)
-malaise
-fatigue
-decreased urine output.
6. objective clinical presentation of hepatorenal HRS has no characteristic physical exam
syndrome findings.
It is important to assess the client for stig-
mata 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 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
3. no response to a 2 consecutive day di-
uretic withdrawal and volume expansion
w/ albumin 1g/kg body wt
, 4. absence of shock
5. no nephrotoxic drug use
6. no macroscopic signs of structur-
al kidney injury (proteinuria >500 mil-
ligrams/deciliter[(mg/dL], microhema-
turia with >50 red blood cells per
high-power field, and/or abnormal renal
ultrasonography)
8. What is the Creatinine criteria when diagnos- increase in serum creatinine of
ing hepatorenal syndrome -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 TIPS Procedure
hepatorenal syndrome?
10. What is a TIPS procedure? 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 min-
imizes 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
