Frage 1
Frage
You have a patient who is an alcoholic and doesn't quite understand why she should quit drinking. She asks you "what exactly is going to happen if I don't stop?"
Select the correct statement you can give to her about cirrhosis.
Antworten
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"Alcoholic cirrhosis is indirectly related to the amount of alcohol consumed, the number of years of excessive alcohol consumption, and blood alcohol levels."
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"Men will develop cirrhosis faster than women, but that doesn't mean you aren't at risk."
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"Cirrhosis at any stage cannot be reversed."
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"Malnutrition commonly accompanies alcoholic cirrhosis."
Frage 2
Frage
Select the EARLY clinical manifestations of cirrhosis.
Antworten
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Dull, aching pain in the upper right quadrant
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Dull, aching pain in the upper left quadrant.
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Weight loss
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Weakness
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Anorexia
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Diarrhea or constiparion
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Portal systemic encephalopathy.
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Esophageal varices
Frage 3
Frage
Early in the course of cirrhosis, few manifestations are present. The liver may be palpable and tender. A dull aching pain may be present in the [blank_start]upper right quadrant[blank_end] of the abdomen. Weight loss, weakness, anorexia, and bowel disruption may occur. As cirrhosis progresses, however, manifestations relate to liver cell failure and portal hypertension.
[blank_start]Portal hypertension[blank_end] is the shunting of blood to lower-pressure vessels. Some of the collateral veins that are affected are located in the esophagus, causing large, thin-walled, esophageal [blank_start]varices[blank_end]. These vessels can rupture and cause massive hemorrhaging, especially if the liver damage causes [blank_start]thrombocytopenia[blank_end] and impaired production of [blank_start]clotting factors[blank_end].
In addition to being shunted to the esophagus, blood can be shunted to the [blank_start]spleen[blank_end], causing it to enlarge. Enlargement of the [blank_start]spleen[blank_end] can lead to anemia, leukopenia, and thombocytopenia due to increased destruction of blood cells.
Because portal hypertension increases hydrostatic pressure, it can also cause [blank_start]ascites[blank_end], which is the accumulation of plasma-rich fluid in the abdominal cavity. In relation to this is the ability to develop [blank_start]spontaneous bacterial peritonitis[blank_end].
Cirrhosis can even cause psychological manifestations. Without functioning liver tissue, [blank_start]ammonia[blank_end] is not converted to uera, causing it to build up in the blood and cause [blank_start]portal systemic encephalopathy[blank_end]. The primary manifestation of this is [blank_start]asterixis[blank_end], which is a muscle tremor that interferes with the ability to maintain a fixed position of the extremities.
Antworten
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upper right quadrant
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upper left quadrant
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lower right quadrant
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lower left quadrant
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Portal hypertension
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Ascites
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varices
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ascites
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aneurysms
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breaks
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thrombocytopenia
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leukopenia
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anemia
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clotting factors
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platelets
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spleen
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kidneys
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abdominal wall
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heart
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spleen
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kidneys
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lungs
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heart
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ascites
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varices
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spontaneous bacterial peritonitis
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spontaneous hyperthermia
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acute kidney failure
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ammonia
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bilirubin
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portal systemic encephalopathy
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portal systemic neuropathy
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portal systemic peritonitis
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portal systemic meningitis
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asterixis
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Parkinsonism
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Tourette's
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aphasia
Frage 4
Frage
Edema and ascites are manifestations of what issues caused by cirrhosis?
Antworten
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Hypoalbuminemia
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Disrupted hormone balance and fluid retention
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Increased pressure in portal venous system
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Decreased clotting factor synthesis
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Impaired vitamin K absorption
Frage 5
Frage
Decreased clotting factor synthesis, increased platelet destruction by enlarged spleen, and impaired vitamin K absorption and storage cause what clinical manifestations of liver disease?
Antworten
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Bleeding and bruising
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Edema
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Ascites
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Esophageal varices
Frage 6
Frage
What are esophageal varices caused by?
Antworten
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Portal hypertension causing collateral vessel development
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Impaired vitamin K absorption and storage
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Thrombocytopenia
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Decreased clotting factor synthesis
Frage 7
Frage
Gastritis, anorexia, and diarrhea are caused by what?
Antworten
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Engorged veins in the gastrointestinal system
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Alcohol ingestion
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Impaired bile synthesis and fat absorption
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Impaired bilirubin metabolism and secretion
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Ascites
Frage 8
Frage
Jaundice is caused by impaired bilirubin metabolism and excretion
Frage 9
Frage
Malnutrition and muscle wasting are caused by impaired nutrient metabolism, impaired fat absorption, and impaired hormone metabolism.
Frage 10
Frage
Select the clinical manifestations of accumulated metabolic toxins and impaired ammonia metabolism and secretion.
Antworten
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Asterixis
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Encephalopathy
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Jaundice
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Gastritis
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Hepatorenal syndrome
Frage 11
Frage
Match each diagnostic test with its description.
[blank_start]Esophagoscopy[blank_end]: Used to determine the presence of upper esophageal varices.
[blank_start]Bilirubin[blank_end]: Both conjugated and unconjugated versions of this are elevated with severe cirrhosis.
[blank_start]Liver function studies[blank_end]: Includes alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase. These will be elevated in patients with cirrhosis, but will not be as severely in patients with severe hepatitis.
[blank_start]Liver biopsy[blank_end]: May be done to distinguish cirrhosis from other forms of liver disease. May be deferred if bleeding is prolonged.
[blank_start]Serum electrolytes[blank_end]: Hyponatremia is common, resulting in hemodilution. Hypokalemia, hypophosphatemia, and hypomagnesemia are also frequently seen, r/t malnutrition and altered renal excretion.
[blank_start]Serum albumin[blank_end]: This value decreases due to impaired liver production of the protein.
[blank_start]Serum ammonia[blank_end]: This value elevates because the liver cannot convert ammonia into urea.
[blank_start]CBC w/platelets[blank_end]: Low RBC, hemoglobin, and hematocrit demonstrate anemia r/t bone marrow suppression, increased RBC destruction, bleeding, and deficiencies of folic acid and vitamin B12. Thrombocytopenia and leukopenia occurs because platelets are destroyed by the spleen.
[blank_start]Coagulation studies[blank_end]: Prolonged prothrombin time results from impaired production of coagulation proteins and lack of vitamin K.
[blank_start]Serum glucose and cholesterol[blank_end]: These 2 values are frequently abnormal in patients with cirrhosis.
[blank_start]Abdominal ultrasound:[blank_end] Used to evaluate liver size, detect ascites, and identify liver nodules. It may be used with Doppler studies to evaluate blood flow through the liver and spleen.
Antworten
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Esophagoscopy
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Colonoscopy
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Bilirubin
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Calcium
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Liver function studies
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Liver biopsy
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Serum electrolytes
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Serum albumin
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Serum bilirubin
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Serum ammonia
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Serum urea
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CBC w/platelets
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Coagulation studies
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aPTT
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INR
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Serum glucose and cholesterol
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Serum glucose and calcium
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Serum cholesterol and albumin
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Abdominal ultrasound:
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Palpation
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Percussion
Frage 12
Frage
Which of the following medications might you give to a patient experiencing edema and ascites from hypoalbuminemia, hyperaldosteronism, and/or portal hypertension?
Frage 13
Frage
What two medications are commonly prescribed to treat the accumulation of metabolic toxins due to impaired ammonia metabolism and excretion?
Frage 14
Frage
What medication combination would you give to a patient with portal hypertension that is causing esophageal varices?
Antworten
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Nadolol (Corgard) and isosorbide mononitrate (Ismo).
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Ferrous sulfate and folic acid
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Ferrous sulfate and vitamin K
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Furosemide (Lasix) and spironolactone (Aldactone)
Frage 15
Frage
What medications would you give to a patient suffering from bleeding and bruising due to decreased clotting factor synthesis, thrombocytopenia, and impaired vitamin K absorption and storage?
Antworten
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Ferrous sulfate
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Folic acid
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Vitamin K
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Oxazepam (Serax)
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Lactulose
Frage 16
Frage
Diazepam (Valium) is the one benzodiazepine that is not metabolized by the liver, and is therefore safe to treat acute agitation.
Frage 17
Frage
You are teaching a cirrhosis patient and his wife about diet and liver failure. Which of the following statements, made by the patient, shows that more teaching is needed?
Antworten
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"I need to restrict my sodium to less than 2 grams per day because sodium causes fluid retention."
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"As a general rule, I need to restrict my fluid intake to about 1,500 mL a day to reduce the risk of ascites and edema."
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"I must restrict my protein intake at all times."
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"When I do eat protein, I should get most of it from plants."
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"My diet should be high in calories and include about 66 grams of fat."
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"I need to supplement my diet with B-complex and vitamins A, D, and E."
Frage 18
Frage
Select appropriate interventions to enact for a patient with severe liver disease.
Antworten
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Monitor I & O and weigh daily
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Provide a diet with a sodium intake of 2,000-3,000 mg/day and enact fluid restrictions.
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Control pain with morphine.
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During each interaction, observe for asterixis and changes in speech.
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Assess vital signs every hour or so if the patient has had bleeding esophageal varices.
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Turn the patient once every 4 hours.
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Use hot water and alcohol-free soap when bathing, then apply an emollient or lubricant to the skin after.
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Provide small meals and between-meal snacks
Frage 19
Frage
What is the FIRST intervention to enact for a patient with active bleeding esophageal varices?
Antworten
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Insert a central line
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Administer blood and frozen plasma
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Administer IV somatostatin
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Perform a gastric lavage
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Order an endotrachial tube for the patient
Frage 20
Frage
Which of the following is NOT a potential complication for patients receiving a transjugular intrahepatic portosystemic shunt (TIPS)?