| What gives bile it's yellow-orange color? | Bilirubin |
| What are the normal values for direct bilirubin? | 0.1-0.4 mg/dL |
| What are the normal values for indirect bilirubin? | 0.2-0.8 mg/dL |
| List the normal values for total bilirubin. | 0.3-1.2 mg/dL |
| When is jaundice visible? | When total serum bilirubin exceeds 2.4 mg/dL |
| What is the normal value for albumin? | 3.5-5 g/dL |
| Which diagnostic test should not be used in the jaundiced patient? | Intravenous cholangiography (IVC) |
| Ultrasound waves do not pass through structures that contain _____. | Air |
| What is the preferred diagnostic imaging exam for those that are pregnant or allergic to contrast mediums? | Ultrasound |
| How does the patient lie during a needle liver biopsy? | Supine with right arm over head |
| What is the normal level for ammonia? | 10-80 mcg/ dL |
| Ammonia is a biproduct of ________ _________. | Protein metabolism |
| Ammonia is normally converted into ______ in the liver, and excreted by the kidneys. | Urea |
| What can cause decreased ammonia levels | Antibiotics; neomycin |
| Which serum levels rise within 2 hours of onset of pancreatic disease? | Amylase |
| Levels of amylase remain elevated for how long after the onset of pancreatitis? | 7-10 days |
| How should an amylase urine specimen be stored? | Refrigerated or on ice |
| What are the normal values for serum lipase? | 10- 140 units/L |
| Which levels peak later and remains elevated longer than amylase? | Lipase |
| What happens to the lobes of the liver in cirrhosis? | They become covered with fibrous tissue, the parenchyma and lobules become infiltrated with scar tissue or fat |
| What is biliary atresia? | Absence or underdevelopment of biliary structures |
| What causes biliary cirrhosis? | Destruction of the bile ducts |
| What is cardiac cirrhosis caused by? | Longstanding, severe right sided heart failure |
| Postnecrotic cirrhosis is caused by which 3 factors? | Viral hepatitis
Hepatotoxins
Infection |
| Define ascites: | Accumulation of fluid and albumin in the peritoneal cavity |
| Hepatic insufficiency causes distention of which veins? | Veins in the upper body |
| The cirrhotic liver cannot absorb which vitamin? | Vitamin K;
cannot produce clotting factors VII, IX, X |
| Spider telangiectasia may be present in the later stages of ___________. | Cirrhosis |
| What causes the yellowing of the skin, sclera of the eyes and mucous membranes known as jaundice? | Greater than normal amounts of bilirubin |
| Which procedure may relieve ascites while providing fluid for laboratory examination? | Paracentesis |
| Which common antiemetic is contraindicated in sever liver dysfunction? | Zofran (ondansetron hydrochloride) |
| What should the patient do immediately before pacentesis? | Urinate |
| What are esophageal varices? | Longitudinal, tortuous veins at the end of the esophagus |
| A ruptured esophageal varix is a medical _______. | Emergency |
| Which hormone is administered to decrease or stop the hemorrhaging of an esophageal varix? | Vasopressin (VP) |
| Which drug is usually administered alongside vasopressin? | Nitroglycerin (NTG) |
| In which patient should vasopressin be avoided or used cautiously? | Older adult; risk of cardiac ischemia |
| Which drug is administered 5days after esophageal hemorrhage? | Sandostatin (octreotide) |
| Ammonia build up can lead to what type of brain damage? | Hepatic encephalopathy |
| What the a hand flapping tremor associated with damage to the liver? | Asterixis |
| Which diet used to be prescribed to a patient with cirrhosis? | Low-protein was prescribed;
protein should NOT be restricted |
| Which drug can decrease the bowel's pH from 7 to 5, reduce production of ammonia, and helps to expel the ammonia from the colon? | Lactulose |
| Which medication is preferred over neomycin for a patient with cirrhosis? | Lactulose |
| Which diet is implemented for a patient with impending liver failure? | Protein and fluid restriction; usually sodium restriction |
| What can slow or even stop the progression of cirhosis? | Discontinuing drinking alcohol
Treating the hepatitis |
| What are high-risk factors for liver cancer? | Cirrhosis
Hepatitis C or B |
| What are primary sites of cancer that metastasize to the liver? | Pancreas
Colon
Stomach
Breast
Lung |
| Early signs of lover cancer are similar to _________. | Cirrhosis of the liver |
| What is the incubation period for hepatitis A? | 10 to 40 days |
| What is the incubation period for hepatitis B? | 28-60 days |
| What is the incubation period for hepatitis C? | 2 weeks to 6 months |
| When does hepatitis D occur? | In people with hepatitis B;
may progress to cirrhosis and chronic hepatitis |
| How is hepatitis E contracted? | Through fecal contamination of water |
| What are the basic pathological findings in all forms of hepatitis? | Inflammation occurs
Liver cells degenerate or die
Liver's function slows down |
| How will urine and stool appear in a patient with hepatitis? | Urine- dark, tea-colored
Stool- clay-colored |
| What is a serious side effect associated with the antiviral medications prescribed for HBV? | Lactic acidosis |
| Half of all liver recipients are ____ positive. | HCV |
| What does the hepatitis B protection program consist of? | An initial vaccination
Vaccination 1 month later
Vaccination 6 months after initial injection |
| What is the leading indication for liver transplantation? | Chronic viral hepatitis |
| The liver is less susceptible to rejection than which organ? | Kidney |
| Which drug has improved the success rate of liver transplantation? | Cyclosporine |
| 20% - 30% of transplanted livers develop _______ by the fifth year. | Cirrhosis |
| How are feces-soiled articles disinfected? | Boil for one minute |
| Which form of hepatitis has the highest mortality rate? | Hepatitis C |
| What are the common sources of liver abscess? | Abdominal infections;
appendicitis
diverticulitis
perforated colon |
| How long is antibiotic therapy continued for a patient with a liver abscess? | 4-6 weeks |
| What are the two most common disorders of the biliary system? | Cholecystitis (inflammation of the gallbladder)
Cholelithiasis (gallstones in the gallbladder) |
| Altered lipid metabolism and the female sex hormone play a role in which disease? | Cholelithiasis (gallstones)/ Cholecystitis (inflammation of gallbladder) |
| Eating foods high in fat will cause ________ in a person with cholecystitis. | Indigestion |
| What medication is generally administered to a patient with cholecystitis/cholelithiasis? | Morphine |
| What are the advantages of a laparoscopic cholecystectomy? | Less invasive
No unsightly scar
Less pain; rapid return to normal |
| During laparoscopy, the abdomen is inflated with how much carbon dioxide? | 3 - 4L |
| In regard to a laparoscopic cholecystectomy, what is given preoperatively to prevent hemorrhage and infection? | Vitamin K and antibiotics |
| Where is a T tube placed? | Below the common bile duct |
| During the first 24 hours after a cholecystectomy, how much fluid can the T tube drain? | 500 mL |
| What are the two common factors associated with pancreatitis? | Alcoholism
Biliary tract disease |
| Which serum levels are definitive for pancreatitis? | Amylase and lipase levels 3 times above normal |
| How long do lipase levels remain elevated with pancreatitis? | 12 days |
| With pancreatitis, which type of feeding is preferred to the IV route? | Enteral |
| What does pancreatitis pain feel like? | Severe abdominal pain radiating to the back |
| What is the fourth leading cause of cancer death in the US? | Pancreatic cancer |
| What is the most common environmental risk factor for pancreatic cancer? | Smoking |
| Pain associated with cancer of the pancreas worsens during which part of the day? | Night |
| Which tumor marker is elevated in pancreatic cancer and helps to stage and monitor the patient post treatment? | CA 19-9 |
| What is the median survival rate after diagnosis of cancer of the pancreas? | 5 to 12 months |
| What is a cholecystectomy? | Removal of the gallbladder |
| Pancreatic disorders may lead to _________ because of interference with insulin production. | Diabetes mellitus |
| How is bilirubin formed? | When old or damaged red blood cells release their hemoglobin |
