Patho CH 43 Disorders of the Exocrine Pancreatic and Hepatobiliary Systems
Which factor should the nurse anticipate finding when reviewing the medical history of a client diagnosed with acute pancreatitis? (Select all that apply.) A. Gallstones B. Viral infection C. Nutritional deficiencies D. Autoimmune disorder E. Taking acetaminophen
A. Gallstones B. Viral infection E. Taking acetaminophen Rationale: The most common risk factors for acute pancreatitis include gallstones, pregnancy, drugs (e.g., acetaminophen or thiazide diuretics), heavy alcohol intake, viral infection, and genetic predisposition. Nutritional deficiencies and autoimmune response are risk factors for chronic, not acute, pancreatitis.
The nurse is teaching a class about the etiology of cholecystitis. Which information should the nurse include? A. The disorder is associated with abnormal bile composition, such as calcium. B. The retention of bile may cause chemical irritation of the gallbladder wall. C. The tone of the sphincter of Oddi affects the emptying of the gallbladder. D. The disorder is associated with prior gallbladder surgery and stress.
B. The retention of bile may cause chemical irritation of the gallbladder wall. Rationale: Cholecystitis refers to inflammation of the gallbladder and occurs when the tissues of the gallbladder are irritated. Contributing factors include gallstones obstructing the cystic duct, chemical irritation by bile, and bacterial inflammation. Biliary dyskinesia refers to an uncommon set of symptoms that affect the tone of the sphincter of Oddi, which affects the motility and subsequent emptying of the gallbladder. Biliary dyskinesia is associated with prior gallbladder surgery. Cholelithiasis develops as a result of abnormal bile composition.
A patient with cholelithiasis, pancreatitis, and acute abdominal pain asks the nurse, "Why am I in so much pain?" Which response by the nurse is accurate? "Your cystic duct is blocked by a gallstone." "A gallstone has lodged in your common bile duct." "Your gallbladder is full of gallstones." "A gallstone has lodged in your liver."
"A gallstone has lodged in your common bile duct." Obstruction of the common bile duct by a gallstone results in pain and pancreatitis from the reflux of enzymes to the pancreas. Cholecystitis can cause pain no matter the location of the stone.
A patient with cholelithiasis, pancreatitis, and acute abdominal pain asks the nurse, "Why am I in so much pain?" Which response by the nurse is accurate? "Your cystic duct is blocked by a gallstone." "A gallstone has lodged in your common bile duct." "Your gallbladder is full of gallstones." "A gallstone has lodged in your liver."
"A gallstone has lodged in your common bile duct." Obstruction of the common bile duct by a gallstone results in pain and pancreatitis from the reflux of enzymes to the pancreas. Cholecystitis can cause pain no matter the location of the stone.
The patient with mucinous pancreatic cysts asks the nurse, "Why do I need surgery?" Which is the nurse's best response? "Mucinous cysts are a serious type of pancreatic cyst that may develop into cancer." "Surgery will allow the doctor to get a more definitive biopsy of the cyst." "Your insurance provider allows coverage for mucinous cyst removal." "Mucinous cysts will eventually cause you a great deal of pain."
"Mucinous cysts are a serious type of pancreatic cyst that may develop into cancer." Mucinous cysts are a serious type of pancreatic cyst that may develop into pancreatic cancer. Coverage of the procedure cost is not more important than the medical necessity to prevent disease. Pancreatic cysts are often asymptomatic and may cause discomfort only after significant growth. Mucinous cysts are biopsied through fine-needle aspiration and removed surgically. Lifestyle factors that lead to pancreatic cancer include the following: Diet Obesity Cigarette smoking Diets that include nitrates, preservatives, and high fat—which are characteristic of processed meats such as bacon—are associated with higher rates of pancreatic cancer. Cigarette smoking, the most significant risk factor, doubles the risk of pancreatic cancer.
The nurse is caring for a patient suspected of having cholelithiasis. Which question related to the patient's health history should the nurse ask? "What types of food do you most often eat?" "Have you been infected by hepatitis C?" "Do you smoke?" "How much alcohol do you drink?"
"What types of food do you most often eat?" A diet high in fat and cholesterol is a risk factor for cholelithiasis. 80% of stones are formed from cholesterol. Excess cholesterol is noted in obesity, in patients whose diets are high in fat and cholesterol, and in patients who take medications that lower serum cholesterol. A low-fat, low-cholesterol diet will help manage and avoid future biliary tract alterations. Cigarette smoking is a risk factor for pancreatic cancer. Alcohol and hepatitis C are risk factors for liver cancer. Most stones form in the gallbladder, then migrate to the bile ducts, causing obstruction and inflammation. Stones in the gallbladder obstructing flow are formed from cholesterol or pigment. 80% of stones are formed from cholesterol. Precipitating factors in the formation of gallstones include the following: Changes in metabolism Biliary stasis Obstruction Hypertriglyceridemia Infection Other risk factors include: Sedentary lifestyle. Diabetes mellitus. Regional enteritis. Having family members who have had cholelithiasis.
Which question should the nurse ask the client when assessing risk factors for pancreatic cancer? A. "Do you have a history of chronic pancreatitis?" B. "What was your recent blood cholesterol level?" C. "How much alcohol do you drink each day?" D. "Are you recovering from a recent viral infection?"
A. "Do you have a history of chronic pancreatitis?" Rationale: A history of chronic pancreatitis increases the client's risk for pancreatic cancer by 26%. Alcohol and caffeine consumption do not appear to be risk factors for pancreatic cancer. Hyperlipidemia is a risk factor for chronic pancreatitis, and a viral infection is a risk factor for acute pancreatitis.
The nurse is teaching a patient with a history of alcoholism and cirrhosis of the liver lifestyle changes to manage and possibly repair the liver damage. Which change is a priority for the nurse to include? Self-denial from cigarette smoking Adopting a low-fat, high-fiber diet Initiating a daily exercise program Abstinence from drinking
Abstinence from drinking Liver damage from cirrhosis can be managed or even repaired if alcohol consumption is eliminated through abstinence. Abstaining from cigarette smoking, adopting a low-fat diet, and initiating an exercise program are all advantageous to good health, but will not repair damage due to cirrhosis if drinking continues.
The nurse should recognize that which condition often causes dyspnea in patients with liver cirrhosis? Ascites Cystic duct obstruction Reflux of pancreatic enzymes Common bile duct obstruction
Ascites Dyspnea is often noted on patient assessment and is caused by ascites related to portal hypertension. The increased abdominal fluid puts pressure on the diaphragm, making it difficult for the person to breathe, even at rest. The abdomen appears swollen and protrudes as a result of the accumulation of fluid. Obstructions of the cystic duct or common bile duct will cause pain, but not dyspnea. Reflux of pancreatic enzymes can lead to acute pancreatitis which would cause pain, but not dyspnea.
The nurse is teaching a class about common risk factors of chronic pancreatitis. Which should the nurse include? (Select all that apply.) A. Muscular dystrophy B. Ethnicity C. Cystic fibrosis D. Excessive alcohol intake E. Gender
B. Ethnicity C. Cystic fibrosis D. Excessive alcohol intake E. Gender Rationale: Common risk factors for chronic pancreatitis include gender, ethnicity, cystic fibrosis, and excessive alcohol intake. Muscular dystrophy is not a factor in chronic pancreatitis.
The nurse providing care for a client with suspected pancreatitis should monitor which laboratory value for signs of additional complications? A. Serum creatinine and BUN levels B. Serum amylase and lipase levels C. Fasting glucose and HbA1c levels D. Pancreas-associated antigen CA 19-9
B. Serum amylase and lipase levels Rationale: Serum amylase and lipase levels are increased due to the release of enzymes from the pancreas as a result of inflammation. Pancreas-associated antigen CA 19-9 is a tumor marker for diagnosing pancreatic cancer. Serum creatinine and BUN levels are monitored for clients in kidney failure. Fasting glucose and HbA1c levels are monitored for clients with diabetes mellitus.
A patient with cholelithiasis has an elevated conjugated bilirubin. Which finding should the nurse expect from this result? Gallbladder cancer Hemochromatosis Involvement of the pancreas Biliary obstruction
Biliary obstruction Patients with cholelithiasis and an elevated conjugated bilirubin indicates an obstruction of bile ducts. Bladder cancer is diagnosed through biopsy. Amylase and lipase would be elevated if the pancreas was involved. Hemochromatosis results from iron accumulating in the liver. Treatment for cholelithiasis is conservative if the patient is asymptomatic and has a low risk of complications from the presence of stones. Medications such as ursodiol and chenodiol can be used to decrease cholesterol production in the liver and dissolve the stone. This form of treatment can take up to two years to dissolve the stone, and the stone can reoccur once the medication has been discontinued.
The nurse is assessing a client who presents with symptoms of acute pancreatitis. Which risk factor should the nurse expect to find in the client's history? A. Difficulty in getting pregnant B. Mechanical obstruction to the liver C. Heavy alcohol intake D. Antibiotic use
C. Heavy alcohol intake Rationale: The most common risk factors for acute pancreatitis are heavy alcohol intake, gall bladder attacks, gallstones, and a genetic predisposition. Drugs, such as antibiotics and steroids, do not affect the pancreas. Endometriosis and difficulty in getting pregnant are not causes for acute pancreatitis. Mechanical obstruction to the liver would not cause acute pancreatitis.
Which condition becomes an immediate concern when a gallstone becomes impacted in the bile duct and causes inflammation? Cholecystitis Choledocholithiasis Cholangitis Pancreatitis
Cholangitis Cholangitis is a serious condition in which the gallstone becomes impacted in the bile duct with resulting inflammation. Pancreatitis can result from a stone in the common bile duct due to pancreatic enzymes being refluxed back into the pancreas. Cholecystitis is due to a stone in the cystic duct. Choledocholithiasis is a gallstone in the common bile duct without inflammation.
Which substance comprises the formation of up to 80% of the gallstones that are formed in the gallbladder? Pigment Carbohydrates Protein Cholesterol
Cholesterol Stones in the gallbladder, obstructing flow, are formed from cholesterol or pigment. Some 80% of these stones are formed by cholesterol. Pigments are involved in the formation of gallstones, but far less frequently than cholesterol. The two main types of gallstones are: Cholesterol stones These are usually yellow-green in color and are the most common kind, accounting for 80% of gallstones. Pigment stones These stones are smaller and darker and are made of bilirubin, which comes from bile, a fluid your liver makes and your gallbladder stores.
The nurse is assessing laboratory data of a patient with suspected cholelithiasis. Which value should the nurse expect will be elevated? White blood cells Lipase Conjugated bilirubin Amylase
Conjugated bilirubin Diagnosis for cholelithiasis is based on symptoms. Diagnostic tests may include an abdominal x-ray, ultrasound, oral cholecystogram, or a gallbladder scan. The conjugated bilirubin may be elevated if there is bile obstruction. Inflammation and infection would be noted with elevated white blood cells. Elevated amylase and lipase would indicate involvement of the pancreas. Treatment for cholelithiasis is conservative if the patient is asymptomatic and has a low risk of complications from the presence of stones. Medications such as ursodiol and chenodiol can be used to decrease cholesterol production in the liver and dissolve the stone. This form of treatment can take up to two years to dissolve the stone, and the stone can reoccur once the medication has been discontinued.
The nurse should expect which diagnostic test to be ordered to confirm a diagnosis of gallbladder cancer? Ultrasound exam of the gallbladder Serum CA 19-9 level Fine-needle aspiration Hepatobiliary iminodiacetic acid scan
Fine-needle aspiration Early diagnosis improves the outcome of gallbladder cancer. The use of cytopathology with either fine-needle aspiration or biopsy is considered the gold standard for diagnosis. Serum CA 19-9 will often be elevated in patients with bile duct cancer and other cancers, so a definitive diagnosis must be made by a more invasive method to directly obtain cells. An ultrasound exam of the gallbladder and hepatobiliary iminodiacetic acid scan are better suited for diagnosing cholecystitis than gallbladder cancer.
Which laboratory value should the nurse know helps determine the presence of biliary duct disorders or obstructions? Alkaline phosphatase (ALP) Albumin Gamma-glutamyl transpeptidase (GGT) Alanine aminotransferase (ALT)
Gamma-glutamyl transpeptidase (GGT) Increased values of gamma-glutamyl transferase (GGT) aid in determining the presence of biliary duct disorders or obstruction. GGT is often evaluated in patients with chronic alcohol abuse. Increased levels of albumin indicate dehydration. Increased values of alkaline phosphatase indicate biliary obstruction or tissue damage. Certain medications can also increase values. Increased values of alanine aminotransferase indicates damage to the liver. Hepatitis and infection are the most common reasons. Certain medications can also cause increased values of alanine aminotransferase.
A patient has a 12-cm liver tumor. Which method of treatment should the nurse expect the patient to undergo? Hepatic resection Cryotherapy Chemoembolization Radiofrequency ablation
Hepatic resection Treatment depends on the stage and size of the tumor. Surgery offers a chance for a cure. Hepatic resection is the preferred method of treatment for tumors that are 10 cm in diameter and larger. Cryotherapy, radiofrequency ablation, and chemoembolization are all forms of local therapy that is appropriate for tumors below 10 cm in diameter.
The nurse is interviewing a patient and determining the risk of chronic pancreatitis. Which condition in the family history genetically predisposes a patient to chronic pancreatitis? Hypertension Cirrhosis Diabetes mellitus Hyerlipidemia
Hyerlipidemia Genetics can contribute to chronic pancreatitis with familial hyerlipidemia. The tissues of the pancreas experience irreversible damage, which causes pancreatic dysfunction, increasing the risk for future pancreatic cancer. Familial hypertension, diabetes mellitus, and cirrhosis are not precursors for chronic pancreatitis. In addition to alcoholism, any condition that causes an obstruction or strictures of the pancreatic duct can cause chronic pancreatitis including calculi (stones), pseudocysts, or tumors. Other causes of pancreatic dysfunction include the following: Smoking Cystic fibrosis Primary sclerosing cholangitis Exposure to toxic metabolites Inflammatory bowel disease
Which medical condition should the nurse know poses increased risks when the liver is aggravated by an excessively high caloric intake that leads to fat deposits? Metabolic syndrome Choledocholiasis Cholangitis Cholecystitis
Metabolic syndrome The patient with metabolic syndrome and obesity has an increased risk of damage, because the liver is aggravated by the higher caloric intake, which naturally leads to fat deposits. Cholangitis, cholecystitis, and Choledocholiasis are all conditions that can cause the liver to malfunction; however, these are primarily due to obstruction, not metabolic disorders. Metabolic syndrome is a group of five risk factors that increase the likelihood of developing heart disease, diabetes, and stroke. These include: Increased blood pressure (greater than 130/85 mmHg). High blood sugar levels (insulin resistance). Excess fat around the waist. High triglyceride levels. Low levels of good cholesterol, or HDL.
A patient with pancreatic cancer is scheduled to meet with the general surgeon. Which procedure does the nurse anticipate scheduling for this patient? Pancreatectomy Cholecystectomy Pancreatic biopsy Gastrectomy
Pancreatectomy Pancreatectomy is performed for the patient with pancreatic cancer in order to achieve the goal of removing all tumor material. Cholecystectomy removes the gallbladder. Pancreatic biopsy would be performed to diagnose pancreatic cancer. Gastrectomy is removal of the stomach.
The nurse should recognize that which substance is most likely responsible for an abscess that formed as the result of corrosive action related to a pancreatic cyst? Pancreatic enzymes Liver enzymes Bile salts Stomach acids
Pancreatic enzymes Serious complications can develop for patients with pancreatic cysts, many related to the corrosive action of the pancreatic enzymes. Obstruction fistula and abscess formation can result, forming tissue damage. Bile salts in the tissues could cause jaundice. Neither liver enzymes nor stomach acids would contribute to abscess formation secondary to pancreatic cysts. Serious complications can develop for patients with pancreatic cysts, many related to the corrosive action of the pancreatic enzymes. Obstruction fistula and abscess formation can result, forming tissue damage. Bile salts in the tissues could cause jaundice. Acute pancreatitis is inflammation or necrosis of the pancreas. It is most often a mild disease known as edematous pancreatitis. Acute pancreatitis can contribute to pancreatic ischemia. The more serious and often painful inflammation of the pancreatic tissue happens in 20% of pancreatitis cases. Early treatment is essential to prevent serious complications.
A client has symptoms consistent with cholecystitis. The nurse anticipates that diagnostic tests will show that which area affected by a stone is causing the client's condition? A. Common bile duct B. Sphincter of Oddi C. Cystic duct D. Pancreatic duct
Rationale: Cholecystitis is most often caused by a cystic duct stone. Other, less common, causes include trauma, infection of the gallbladder, and sepsis. Stones in the pancreatic duct cause pancreatitis. A gallstone in the common bile duct is referred to as choledocholithiasis. Stones cannot actually occur in the sphincter of Oddi; however, by surgically expanding the sphincter of Oddi, stones can be eliminated through the common bile duct.
Which location should the nurse examine first when assessing a patient for jaundice? The palmar surface of the hands The plantar surface of the feet Skin of the face and upper torso Sclera of the eye
Sclera of the eye Jaundice (a yellowish discoloration of the whites of the eyes, skin, or mucous membranes caused by the bile salts in the tissues) is one clinical symptom of an elevated bilirubin level. Jaundice is best assessed in natural daylight. The sclera of the eye is often the first place the yellow discoloration is noted in patients with fair skin. This is called icteric sclera. Assessment of jaundice also includes the palms of the hands and the plantar surfaces of the feet. The skin of the face and upper torso is not usually involved in an assessment for jaundice.
Which condition should the nurse know results from the lack of bile to digest fats in the duodenum? Pruritis Biliary colic Bleeding and easy bruising Steatorrhea
Steatorrhea steatorrhea (greasy, foul-smelling feces containing undigested fats) is often reported and results from the lack of bile to digest the fat in the duodenum. Biliary colic is due to distention and pressure when bile cannot flow into the duct. Pruritus is caused by bile salts accumulating in the blood and finally being eliminated through the integumentary system. Bleeding and bruising is caused by the lack of bile impairing the ability to absorb fat-soluble vitamins, including vitamin K.
The nurse is reviewing patient charts in preparation for today's clinic. The nurse should identify that which patient is most at risk for acute pancreatitis? The patient with insulin-controlled diabetes The patient who is a heavy drinker The patient who is obese The patient who recently quit cigarette smoking
The patient who is a heavy drinker Alcohol and gallstones are the most common causes of acute pancreatitis. Other causes include the following: Viral infections Trauma Abdominal surgery Hyperlipidemia Medications such as acetaminophen or thiazide diuretics
Which health information does the nurse expect to find in the medical history of a female patient diagnosed with cholelithiasis? Asian descent Nulligravida Use of oral contraceptives Recent gastrointestinal infection
Use of oral contraceptives The incidence of cholelithiasis is increased in women who have taken oral contraceptives; the nurse may therefore expect to find this information in the patient's chart. Patients who have never been pregnant are less likely to develop cholelithiasis. The incidence of cholelithiasis in women increases with pregnancy and having borne several children. Incidence of cholelithiasis is not associated with gastrointestinal infection. Individuals of Asian descent have a lower incidence of cholelithiasis than other groups.
Which laboratory or diagnostic test should the nurse anticipate being ordered for a client with suspected pancreatic cancer? (Select all that apply.) A. Alkaline phosphatase levels B. Percutaneous fine-needle biopsy C. Magnetic resonance cholangiopancreatography (MRCP) D. Fasting plasma glucose level (FPG) E. Blood cultures and white blood count
A. Alkaline phosphatase levels B. Percutaneous fine-needle biopsy C. Magnetic resonance cholangiopancreatography (MRCP) Rationale: In clients with pancreatic cancer, alkaline phosphatase levels are elevated due to bile duct obstruction or liver metastasis. Magnetic resonance cholangiopancreatography (MRCP) can show tumors or size changes in the pancreas and dilation of the main pancreatic duct that occur in pancreatic cancer. Percutaneous fine-needle biopsy is used to obtain a sample tissue from the tumor for pathology. Fasting plasma glucose level (FPG) is a lab test used to assist in the diagnosis of diabetes mellitus. Blood cultures and white blood count are lab tests used to assist in the diagnosis of acute pancreatitis.
The nurse is monitoring a client with cholelithiasis for complications related to cholestatic hepatitis. Which laboratory value should the nurse monitor? A. Alanine aminotransferase B. Alkaline phosphatase C. Serum lipase D. Serum bilirubin
B. Alkaline phosphatase Rationale: An increase in alkaline phosphatase levels could indicate cholestatic hepatitis in clients with cholelithiasis. Elevated serum bilirubin levels indicate obstructed bile flow in the biliary duct system. An elevated ALT indicates possible liver injury/inflammation related to obstruction of the common bile duct by gallstones. An elevated serum lipase indicates possible pancreatitis related to common bile duct obstruction.
While assessing a client, the nurse observes the Cullen sign. Which medical condition should the nurse suspect? A. Cholangitis B. Hemorrhagic pancreatitis C. Pancreatic cancer D. Choledocholithiasis
B. Hemorrhagic pancreatitis Rationale: Hemorrhagic pancreatitis causes bruising and edema to the subcutaneous layer surrounding the umbilicus, known as the Cullen sign. Grey-Turner sign is another specific, clinical sign, in which the flank area appears bruised, with bluish discoloration from bleeding behind the peritoneum. Cullen sign is not associated with cholangitis, pancreatic cancer, or choledocholithiasis.
A patient diagnosed with pancreatic cancer has dull epigastric discomfort that radiates to the back. Which explanation should the nurse provide to the patient for this discomfort? "Back pain is usually worse when lying on the right side." "Back pain is usually worse when lying in the supine position." "Back pain is usually worse when lying in the prone position." "Back pain is relieved when lying in the supine position."
"Back pain is usually worse when lying in the supine position." Back pain is noted to be worse for pancreatic cancer patients when the person is laying supine. Back pain is not worse when laying in the prone position or on the right side. Back pain is not relieved when laying in the supine position. Symptoms of pancreatic cancer are slow to develop, contributing to the delay in diagnosis and treatment. Vague abdominal discomfort and weight loss are often observed first. However, it is the jaundice from bile duct obstruction that often causes the person to initially seek medical care. Dark urine, steatorrhea, jaundice, and pruritis result from the obstruction of the bile duct. Late stages of pancreatic cancer involve ascites, hepatomegaly, splenomegaly, and esophageal varices from increased pressure causing portal vein hypertension.
The nurse is planning to assess a patient to determine risk factors for acute pancreatitis. Which question should the nurse ask? "Do you take any vitamins or herbal supplements?" "How much alcohol do you drink each week?" "When was your last bowel movement?" "What does your daily diet usually consist of?"
"How much alcohol do you drink each week?" One of the most common risk factors for acute pancreatitis is heavy alcohol intake; therefore, assessing the patient's alcohol intake or pattern is most appropriate. Nutritional deficiencies are a risk factor for chronic, not acute, pancreatitis. Drugs that are known to cause acute pancreatitis include thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors. In addition, acetaminophen, which is sold over the counter, can lead to acute pancreatitis.
The nurse is teaching a patient with pancreatic cancer positioning to relieve pain. Which patient statement requires further teaching? "I will sit in the chair." "I will lie on my back." Unselected "I will lie on my side." "I will lie on my belly."
"I will lie on my back." Back pain associated with pancreatic cancer worsens when the person is lying supine. Back pain is not less when the patent is in the prone position or on the right side. Sitting would be more comfortable than lying supine. Symptoms of pancreatic cancer are slow to develop, contributing to the delay in diagnosis and treatment. -Vague abdominal discomfort and weight loss are often observed first. However, it is the jaundice from bile duct obstruction that often causes the person to initially seek medical care. -Dark urine, steatorrhea, jaundice, and pruritis result from the obstruction of the bile duct. -Late stages of pancreatic cancer involve ascites, hepatomegaly, splenomegaly, and esophageal varices from increased pressure causing portal vein hypertension.
The nurse recognizes that a multiparous 58-year-old woman with a history of estrogen replacement therapy is at increased risk for which health condition? A. Cholelithiasis B. Acute pancreatitis C. Cholecystitis D. Pancreatic cancer
A. Cholelithiasis Rationale: Risk factors for cholelithiasis specific to women include multiparous, users of estrogen replacement therapy, oral contraceptives, and the Five Fs: female, fair, fat, fertile, and forty. Other risk factors include a sedentary lifestyle, diabetes mellitus, regional enteritis, and having family members who have had cholelithiasis. Cholecystitis is most often caused by a cystic duct stone. Alcohol abuse and gallstones are the most common causes of acute pancreatitis. Cigarette smoking and diabetes mellitus are the greatest risk factors for pancreatic cancer.
The nurse providing care for a client with cirrhosis should monitor for which complication? (Select all that apply.) A. Liver cancer B. Hepatic encephalopathy C. Portal hypertension D. Hepatitis A E. Hepatitis C
A. Liver cancer B. Hepatic encephalopathy C. Portal hypertension Rationale: Cirrhosis is the extensive scarring of the liver caused by necrotic injury or a chronic reaction to inflammation over a prolonged period of time. Cirrhosis can lead to liver cancer, portal hypertension, and liver failure, which in turn can lead to hepatic encephalopathy. Hepatitis A and hepatitis C are caused by a viral infection and are therefore not complications of cirrhosis.
After eating a high fat meal a patient reports upper right abdominal quadrant pain radiating to the right scapula, nausea, fever, and chills. Which biliary tract alteration should the nurse suspect? Chronic cholecystitis Pancreatic cysts Acute pancreatitis Acute cholecystitis
Acute cholecystitis Stones can become lodged in the duct, causing severe and sudden onset of midepigastric pain that radiates to the right upper quadrant and right subscapular region. Biliary colic is due to the distention and pressure to the gallbladder when bile is not allowed to flow in the duct. The patient often experiences nausea, vomiting, sweating, and tachycardia when in severe pain. Acute cholecystitis can cause biliary colic. Chronic cholecystitis is ruled out because the patient states this is the first occurrence of this pain. Patients with acute pancreatitis generally present with a knifelike pressure in the upper abdomen, abdominal distention and tenderness, tachycardia, hypotension, and jaundice. Patients with pancreatic cysts are generally asymptomatic. Colicky pain is caused by the obstruction of bile flow. These symptoms can last up to 18 hours and are often more vague with chronic cholecystitis. Biliary obstruction causes clay-colored stools or steathorrhea, the urine color is amber, and the patient may experience jaundice, and pruritus. Fever and chills accompany cholecystitis as a result of an inflammation of the gallbladder and possible sepsis.
Which statement by the nurse is true about acute pancreatitis? (Select all that apply.) A. "Distinct chemokines are involved in the initiation of acute pancreatitis." B. "Digestive enzymes are prematurely activated within the acinar cells." C. "Protein plugs from prolonged alcohol use may activate enzymatic processes." D. "Persistent inflammation results in permanent damage to the pancreas." E. "Early trypsin activation by cathepsin B leads to pancreatic autodigestion."
B. "Digestive enzymes are prematurely activated within the acinar cells." C. "Protein plugs from prolonged alcohol use may activate enzymatic processes." E. "Early trypsin activation by cathepsin B leads to pancreatic autodigestion." Rationale: Prolonged alcohol intake (more than 100 g/day for more than 3dash5 years) may cause the protein of pancreatic enzymes to precipitate within small pancreatic ductules. Ductal obstruction by these protein plugs may cause the premature activation of pancreatic enzymes. Regardless of the etiology, the final common pathway in acute pancreatitis is the premature activation of digestive enzymes within the acinar cells. Exposure of trypsinogen to lysosomal enzymes, such as cathepsin B, has recently been elucidated as a mechanism for early trypsin activation. The early activation of pancreatic enzymes leads to autodigestion of the pancreas and surrounding tissues. Chronic pancreatitis consists of persistent inflammation of the pancreas that results in permanent structural damage with fibrosis and ductal strictures. Evidence indicates involvement of distinct chemokines in the initiation and perpetuation of chronic pancreatitis.
A client has right upper quadrant pain, fever, dark-colored urine, jaundice, clay-colored stools and an increased bilirubin level. Which diagnosis should the nurse expect for this client? A. Bile duct cancer B. Hemorrhagic pancreatitis C. Cholangitis D. Pancreatic cancer
C. Cholangitis Rationale: Clients with cholangitis present with symptoms similar to those of cholelithiasis and acute cholelithiasis. These symptoms include RUQ pain, fever, jaundice, abdominal tenderness, and pruritis. As a result of elevated bilirubin, the client will have dark-colored urine and clay-colored stools. The client with advanced cholangitis will have clinical signs consistent with sepsis, such as hypotension and changes in mental status. Symptoms of bile duct cancer include intense RUQ abdominal pain, jaundice, weight loss, and a palpable gallbladder. Pancreatic cancer symptoms include vague abdominal discomfort, jaundice, back pain, dark urine, steatorrhea, and pruritus. Hemorrhagic pancreatitis causes bruising and edema to the subcutaneous layer surrounding the umbilicus, known as the Cullen sign. The Grey-Turner sign is another specific clinical sign, in which the flank area appears bruised, with bluish discoloration from bleeding behind the peritoneum.
A patient reports right upper quadrant pain after eating, and increased incidences of flatulence, belching, and regurgitation. Which medical condition should the nurse suspect? Acute pancreatitis Choledocholithiasis Cholecystitis Cholangitis
Cholecystitis Patients with cholecystitis generally have a history that includes intolerance of dietary fat with epigastric heaviness or right upper quadrant (RUQ) abdominal pain after eating. The patient may also complain of flatulence, belching, and regurgitation. Patients with cholangitis and choledocholithiasis present with RUQ pain, fever, jaundice, abdominal tenderness, and pruritus. Patients with acute pancreatitis generally present with a knifelike pressure in the upper abdomen, abdominal distention and tenderness, tachycardia, hypotension, and jaundice.
Which chronic liver disorder should the nurse know causes 23% of liver cancer cases worldwide by damaging the cells and the deoxyribonucleic acid? Hepatitis C Hepatitis B Hemochromatosis Cirrhosis
Hepatitis B Hepatitis is known to cause liver cancer in up to 85% of patients with hepatocellular carcinoma. The hepatitis B virus causes liver cancer by damaging the cells and their DNA. Worldwide, hepatitis B accounts for 23% of liver cancer cases. Individuals with cirrhosis, vinyl chloride, hemochromatosis, and carriers of hepatitis B or hepatitis C virus have a higher risk of hepatocellular carcinoma. In the United States, hepatitis C is responsible for the increased rates and incidence of liver cancer and mortality in recent years. Factors that increase the risk of primary liver cancer include: Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases the risk of liver cancer. Cirrhosis, a progressive and irreversible condition, causes scar tissue to form in the liver and increases your chances of developing liver cancer. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson disease. Diabetes, as people with this blood sugar disorder have a greater risk of liver cancer than those who don't have diabetes. Nonalcoholic fatty liver disease, which is an accumulation of fat in the liver, increases the risk of liver cancer. Exposure to aflatoxins, which are poisons produced by molds that grow on poorly stored crops. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made from these products. In the United States, safety regulations limit aflatoxin contamination. Aflatoxin contamination is more common in certain parts of Africa and Asia. Consuming more than a moderate amount of alcohol daily, over many years, can lead to irreversible liver damage and increase the risk of liver cancer. Other liver cancer lifestyle-related risk factors include: Excess alcohol consumption. Coffee consumption. Exposure to aflatoxins. Obesity. Oral contraceptive use.
Which condition should the nurse suspect in a patient who has abdominal pain from a common bile duct obstruction? Cholecystitis Pancreatitis Biliary colic Spider angioma
Pancreatitis If the obstruction is located in the common bile duct, the pancreas can also be involved. Pancreatic enzymes reflux to the pancreas, causing pancreatitis. Biliary colic and cholecystitis are both conditions associated with a cystic duct obstruction. Spider angioma occurs secondary to portal hypertension. Steps leading to the inflammatory response in acute pancreatitis include: Alcohol initiates pancreatitis when the ethanol is metabolized, injuring the tissues with the toxic metabolites that release activated enzymes. The result is partial sphincter obstruction and tissue irritation. Pancreatitis that results from gallstone obstruction of the pancreatic ducts causes trapped digestive enzymes, usually trypsin, to autodigest the pancreatic tissue, activating an acute inflammatory response. Pain results from the stretching of the edematous tissues, enzymatic chemical irritation, and obstruction of the biliary tract. The inflammatory process can progress beyond the pancreas to other organs, creating conditions for systemic inflammatory response syndrome (SIRS) and multiple organ failure.
The nurse should understand that which is a primary function of the liver? Digestion of carbohydrates Storage of vitamins Digestion of proteins Production of bicarbonate
Storage of vitamins The liver is responsible for the storage of vitamins. The exocrine pancreas aids in the digestion of carbohydrates, fats, and proteins with the production of enzymes as well as bicarbonate, which is needed to neutralize chime in the duodenum. The liver produces bile, which is stored in the gallbladder. It is released via the common bile duct to the duodenum. Food entering the small intestine stimulates the hormone secretin in the duodenum to produce bile. Bile breaks fat into small globules, thus making more surface area available for chemical digestion to finish the digestive process. The liver is also responsible for numerous other functions in the body, including: Synthesis of plasma proteins. Metabolism and elimination of drugs and toxins. Storage of vitamins, glucose, and blood.
The nurse is caring for a patient with a mucinous pancreatic cyst. Which treatment should the nurse expect to be recommended to the patient? Chemotherapy Monitoring for changes in the cyst Surgical removal Radiation therapy
Surgical removal Mucinous cysts, the more serious type of pancreatic cyst, are often malignant. These include intraductal papillary mucinous neoplasms, peripheral mucinous cystic neoplasms, and cystic islet-cell neoplasms. They have the potential to become malignant, prompting treatment with surgical intervention. Chemotherapy is not indicated for mucinous cysts. There is a lack of consensus regarding the use of ionizing radiation in the treatment of mucinous cysts. Pseudocysts, not mucinous cysts, should be continuously monitored for any changes.
A patient with a history of alcoholism has paresthesia of the feet, toes, and legs. Which treatment should the nurse expect will be ordered by the healthcare provider? Potassium supplements Calcium supplements Thiamine supplements Iron supplements
Thiamine supplements Paresthesia, a prickly pins-and-needles sensation, is noted most in alcoholics and is related to a vitamin B1 deficiency affecting the feet, toes, and legs. Thiamine supplements help reverse these symptoms. Iron, calcium, or potassium supplements would not be useful in treating paresthesia. Patients with acute pancreatitis usually present with pain to the upper abdomen with a knifelike pressure. The pain is often deep epigastric pain or is referred to the umbilical chest, or flank area. Abdominal distention and tenderness often accompany acute pancreatitis. Changes in vital signs related to pain and fluid shifts include tachycardia and hypotension. Fever results from the inflammatory process. Jaundice, which is common in accessory organ dysfunction, is caused by the obstruction of the bile duct. Hemorrhagic pancreatitis causes bruising and edema to the subcutaneous tissue surrounding the umbilicus, known as Cullen sign. Grey-Turner sign is another specific clinical sign in which the flank area appears bruised, with bluish discoloration from bleeding behind the peritoneum.
The nurse suspects that a client has acute pancreatitis. Which elevated laboratory result will help confirm this diagnosis? (Select all that apply.) A. Lipase B. Bilirubin C. Amylase D. White blood cells E. Alkaline phosphatase
A. Lipase C. Amylase Rationale: Acute pancreatitis is initially diagnosed on the basis of abnormal laboratory results. Lipase and amylase are the results that help guide diagnosis, because they are often elevated to 3 times the normal limit. Serum amylase lacks specificity; therefore, lipase is often collected with amylase to help make a diagnosis of pancreatitis. Clients with acute pancreatitis may also have elevated levels of bilirubin, alkaline phosphatase, and white blood cells, but not to 3 times the normal limit.
The nurse recognizes that 10% of acute pancreatitis caused by etiologies other than gallstones and alcohol consumption are related to which factor? (Select all that apply.) A. Post-cardiac bypass B. Trauma C. Diabetes D. Medications E. Hypercalcemia
A. Post-cardiac bypass B. Trauma D. Medications E. Hypercalcemia Rationale: Etiology of acute pancreatitis is most often associated with gallstones and alcohol consumption. Other causes include medications, hypercalcemia, post-ERCP, trauma, and post-cardiac bypass. Diabetes is not considered a cause of acute pancreatitis.
The client reports that which symptom, associated with pancreatic cancer, prompted the initial visit for medical care? A. Passage of clay-colored stools B. Dull pain in the upper abdomen C. Jaundice D. Weight loss
C. Jaundice ationale: Symptoms of pancreatic cancer are slow to develop, contributing to the delay in diagnosis and treatment. Vague abdominal discomfort and weight loss are often observed first; however, it is the jaundice from the bile duct obstruction that often causes the individual to initially seek medical attention. Passage of clay-colored stools is normally associated with a gallbladder issue, such as cholelithiasis. Dull pain in the upper abdomen is associated with chronic pancreatitis.
Which clinical manifestation should the nurse expect to find on assessment of a client with chronic pancreatitis? A. Report of being asymptomatic B. Report of fleeting pain C. Severe pain in the mid-abdomen radiating in a band-like fashion to the mid-back D. A time frame of about 18 months from onset of symptoms to diagnosis
C. Severe pain in the mid-abdomen radiating in a band-like fashion to the mid-back Rationale: Chronic pancreatitis can present with intermittent attacks of severe pain, often in the mid-abdomen or left upper abdomen, and occasionally radiating in a band-like fashion or localized to the mid-back. The pain may occur either after meals or independently of meals, but it is not fleeting or transient and tends to last for at least several hours. Clients are often symptomatic for years before the diagnosis is established; the average time from the onset of symptoms until a diagnosis of chronic pancreatitis is 62 months. The delay in diagnosis is even longer in nonalcoholic people, in whom the average time is 81 months from the onset of symptoms to diagnosis.
Which factor should the nurse providing care for a client with liver cancer anticipate finding on assessment? (Select all that apply.) A. Inverted sleep-wake pattern B. Exaggerated deep tendon reflexes C. White, chalky stools D. Hepatomegaly E. Unintentional weight loss
C. White, chalky stools D. Hepatomegaly E. Unintentional weight loss Rationale: Clinical manifestations of liver cancer include hepatomegaly (enlarged liver); white, chalky stools; and unintentional weight loss. An inverted sleep-wake pattern and exaggerated DTRs (deep tendon reflexes) are clinical manifestations of hepatic encephalopathy in clients with cirrhosis of the liver.
A client has intense right upper quadrant abdominal pain, jaundice, weight loss, and an elevated serum CA 19-9. Which condition does the nurse suspect? A. Cholangitis B. Hemorrhagic pancreatitis C. Chronic pancreatitis D. Bile duct cancer
D. Bile duct cancer Rationale: The CA 19-9 radioimmunoassay (RIA) is a simple blood test that measures the level of tumor-associated antigens found in the blood. Antigens are substances that cause the immune system to make a specific immune response. CA 19-9 antigens are foreign substances released by pancreatic tumor cells. Late symptoms of bile duct cancer include RUQ pain, abdominal pain, jaundice, weight loss, and a palpable gallbladder. Early diagnosis improves the outcome. Serum CA 19-9 will often be elevated in clients with bile duct cancer and other cancers, so a definitive diagnosis must be made by a more invasive method to directly obtain cells. Cholangitis serum tests include an increased alkaline phosphatase and GGT, as well as supporting laboratory tests of elevated AST, ALT, bilirubin, amylase, and lipase. Leukocytosis will be noted with cholangitis. A client with chronic pancreatitis will present with weight loss and abdominal pain, but it radiates to the left upper quadrant or epigastric area. Warning signs of hemorrhagic pancreatitis can include low urine output, hypoxemia, restlessness, confusion, and worsening tachypnea and tachycardia. Clients with hemorrhagic pancreatitis may also present with a Cullen sign or Grey-Turner sign.