NSG 555 Quiz 2 module 3 GI/GU
LATEST QUESTIONS AND
VERIFIED ANSWERS
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
Mgt: incision and drainage is first line treatment
pharm mgt: abx usually not needed unless infection. if infection with cellullitis or
immunosuppression cipro or metronidazole
cirrhosis - correct answer end stage consequence of hepatic fibrosis.
Irreversible
commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH
apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause.
portal hypertension - correct answer the elevation of blood pressure within the portal
venous system due to shunting of portal/arterial blood supplies
fibrosis in the liver causes - correct answer portal HTN, obstructive biliary channels,
destruction of liver cells, liver cancer, liver failure
, As increased portal pressure occurs new collateral circulation/vascular channels created
in peritoneum, retroperitoneum, thorax, esophagus, etc. This can cause ascites, splenomegay,
esophageal varices and can rupture-->death
primary biliary cirrhosis - correct answer autoimmune destruction of bild ducts
pathophys cirrhosis - correct answer hepatocellular injury-->inflammation-->new liver
cells generated by fibrotic scar tissue00>nodules which deform normal hepatic dissue--
>increased resistance to circulation, decreased blood flow, obstruction to portal vein and
decreased liver function
early symtoms of primary biliary cirrhosis - correct answer itching, weight loss, fatigue
general cirrhosis s/s - correct answer weakness, malaise, dark urine, pale stools,
anorexia, n/v, hematemesis, abdominal pain because of stretching of muscled d/t enlarged liver,
chest pain d/t cardiomegalyk
physical exam cirrhosis - correct answer jaundice, spider angiomata, gynecomastia,
ascites, enlarged spleen, palmar erythema, digital clubbin, asterixis
low grade fever, RUQ pain,
Liver may be nodular, firm, large or shrunk, spleen may be enlarged.
Fluid wave may be present. varices may be present. may be fluid shifts to legs, hands,
feet
dupuytren contracture - correct answer flexion contracture of the fingers due to chronic
hyperplasia of the palmar fascia
, fetor hepaticus - correct answer sweet, slightly fecal odor to the breath due to liver
disease
Asterixis - correct answer aka Liver Flap, a flapping tremor of the hands. When the client
extends the arms & hands in front of the body, the hands rapidly flex & extend.
Cruveilhier-Baumgarten Syndrome - correct answer the development of paraumbilical
collateral flow in cases of portal hypertension. sounds like a venous hum over epigastrum
dx of cirrhosis: labs - correct answer in early stages no diagnostic findings.
Low albumin
High serum protein
Hi bilirubin
High liver enzymes (AST, ALT)
Pltlts are often low
ANA high (inflammation)
can check hepatitis surface antigens
PT/PTT and albumin should be assessed to determine hepatic synthesis and clotting
function
these mean liver injury or inflammation, use these values to determine if biopsy needed
, ALT - correct answer used to assess acute vs chronic liver injury
ALP and transpeptidase levels - correct answer elevated in cirrhosis
MELD score - correct answer Uses Bilirubin, Creatinine and INR to predict survival in pts
w/ liver disease
<14 TIPs is useful
>24 TIPS placement wouldn't be useful
Imaging for cirrhosis - correct answer liver ultrasound will show liver size, portal
circulation, presence of ascites or tumor, portal HTN, portal vein thrombosis
Fibroscan: pulse echo that calculates liver stiffness
CT: NOT USED
MRI: NOT USED
liver biopsy if needed
What test to use if a patient has chronic hepatitis C and cirrhosis is suspected - correct
answer MRI (magnetic resonance elastography) measures liver stiffness
Differentiatls for cirrhosi - correct answer primary biliary cholangitis
secondary biliary cirrhosis
LATEST QUESTIONS AND
VERIFIED ANSWERS
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
Mgt: incision and drainage is first line treatment
pharm mgt: abx usually not needed unless infection. if infection with cellullitis or
immunosuppression cipro or metronidazole
cirrhosis - correct answer end stage consequence of hepatic fibrosis.
Irreversible
commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH
apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause.
portal hypertension - correct answer the elevation of blood pressure within the portal
venous system due to shunting of portal/arterial blood supplies
fibrosis in the liver causes - correct answer portal HTN, obstructive biliary channels,
destruction of liver cells, liver cancer, liver failure
, As increased portal pressure occurs new collateral circulation/vascular channels created
in peritoneum, retroperitoneum, thorax, esophagus, etc. This can cause ascites, splenomegay,
esophageal varices and can rupture-->death
primary biliary cirrhosis - correct answer autoimmune destruction of bild ducts
pathophys cirrhosis - correct answer hepatocellular injury-->inflammation-->new liver
cells generated by fibrotic scar tissue00>nodules which deform normal hepatic dissue--
>increased resistance to circulation, decreased blood flow, obstruction to portal vein and
decreased liver function
early symtoms of primary biliary cirrhosis - correct answer itching, weight loss, fatigue
general cirrhosis s/s - correct answer weakness, malaise, dark urine, pale stools,
anorexia, n/v, hematemesis, abdominal pain because of stretching of muscled d/t enlarged liver,
chest pain d/t cardiomegalyk
physical exam cirrhosis - correct answer jaundice, spider angiomata, gynecomastia,
ascites, enlarged spleen, palmar erythema, digital clubbin, asterixis
low grade fever, RUQ pain,
Liver may be nodular, firm, large or shrunk, spleen may be enlarged.
Fluid wave may be present. varices may be present. may be fluid shifts to legs, hands,
feet
dupuytren contracture - correct answer flexion contracture of the fingers due to chronic
hyperplasia of the palmar fascia
, fetor hepaticus - correct answer sweet, slightly fecal odor to the breath due to liver
disease
Asterixis - correct answer aka Liver Flap, a flapping tremor of the hands. When the client
extends the arms & hands in front of the body, the hands rapidly flex & extend.
Cruveilhier-Baumgarten Syndrome - correct answer the development of paraumbilical
collateral flow in cases of portal hypertension. sounds like a venous hum over epigastrum
dx of cirrhosis: labs - correct answer in early stages no diagnostic findings.
Low albumin
High serum protein
Hi bilirubin
High liver enzymes (AST, ALT)
Pltlts are often low
ANA high (inflammation)
can check hepatitis surface antigens
PT/PTT and albumin should be assessed to determine hepatic synthesis and clotting
function
these mean liver injury or inflammation, use these values to determine if biopsy needed
, ALT - correct answer used to assess acute vs chronic liver injury
ALP and transpeptidase levels - correct answer elevated in cirrhosis
MELD score - correct answer Uses Bilirubin, Creatinine and INR to predict survival in pts
w/ liver disease
<14 TIPs is useful
>24 TIPS placement wouldn't be useful
Imaging for cirrhosis - correct answer liver ultrasound will show liver size, portal
circulation, presence of ascites or tumor, portal HTN, portal vein thrombosis
Fibroscan: pulse echo that calculates liver stiffness
CT: NOT USED
MRI: NOT USED
liver biopsy if needed
What test to use if a patient has chronic hepatitis C and cirrhosis is suspected - correct
answer MRI (magnetic resonance elastography) measures liver stiffness
Differentiatls for cirrhosi - correct answer primary biliary cholangitis
secondary biliary cirrhosis
