Wedneday

Percutaneous Trans-hepatic Cholangiography (PTC)

involves the injection of dye directly into the biliary tract.

Cholecystitis

(inflammation of the gallbladder which can be acute or chronic) causes pain, tenderness, and rigidity of the upper right abdomen that may radiate to the midsternal area or right shoulder and is associated with nausea, vomiting, and the usual signs of an acute inflammation

A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?

A liver biopsy which reveals hepatic fibrosis is the most conclusive diagnostic procedure. Coagulation studies provide information about liver function but do not definitively confirm the diagnosis of cirrhosis. Magnetic resonance imaging and radioisotope liver scan help to support the diagnosis but do not confirm it. These tests provide information about the liver's enlarged size, nodular configuration, and distorted blood flow

Pancreatitis

Auto-digestion of the pancreas by pancreatic enzymes activated prior to release in the small intestine

Cullen's Sign

Hemmorage to the belly buttin. Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.

A client has worked for a company that produces paint and varnishing compounds for 24 years. She is visiting the clinic with complaints of chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of her skin and sclera. She reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis would the nurse suspect is the cause of the client's symptoms?

Postnecrotic cirrhosis Explanation: Postnecrotic cirrhosis results from destruction of liver cells secondary to infection (e.g., hepatitis), metabolic liver disease, or exposure to hepatotoxins or industrial chemicals. Alcoholic cirrhosis develops as a consequence of long-term alcohol abuse. Respiratory cirrhosis is a distractor for this question. Biliary cirrhosis is less common than other types and is associated with scarring in the bile ducts.

After undergoing a liver biopsy, a client should be placed in which position

Right lateral decubitus position Explanation: After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location

Right lower quadrant Explanation: The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

Peritonitis S/S

Rigid, board-like abdomen -hallmark sign! N/V VS-Fever, tachycardia Rebound tenderness

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for?

Ultrasonography Explanation: Ultrasonography has replaced cholecystography as the diagnostic procedure of choice because it is rapid and accurate and can be used in patients with liver dysfunction and jaundice. It does not expose patients to ionizing radiation.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery

Vitamin K Explanation: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency.

Murphy's sign

a test for gallbladder disease in which the patient is asked to inhale while the examiner's fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed.

When is Percutaneous transhepatic cholangiography (PTC) used

is rarely used for diagnostic purposes alone due to the multitude of other less invasive and reliable imaging studies. PTC is reserved for those patients in whom an ERCP may be unsafe due to previous surgery involving the biliary tract. The use of PTC has mainly been replaced by ERCP and magnetic resonance

ERCP is helpful in evaluating

jaundice, pancreatitis, pancreatic tumors, common bile duct stones, and biliary tract disease

Rovsing's Sign

may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant

Blumbergs sign

referred pain or rebound tenderness, is a clinical sign that is elicited during physical examination of a patient's abdomen. It is indicative of peritonitis and Cholecystitis.

pancreaticoduodenectomy/Whipple procedure

used for potentially resectable cancer of the head of the pancreas . This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. Reconstruction involves anastomosis of the remaining pancreas and stomach to the jejunum

ERCP

uses the endoscope in combination with x-rays to view the ductal structures of the biliary tract

The nurse admits a woman reporting severe right upper quadrant pain after eating Christmas dinner. The nurse suspects gallbladder disease. Statistics show that incidence of gallbladder disease is greater for women who are

• Multiparous • Obese • Older than 40 years Explanation: Two to three times more women than men develop cholesterol stones and gallbladder disease; affected women are usually older than 40 years, multiparous, and obese.