GI Chat 4060 MOD 3

What is the primary function of albumin produced by the liver?

Maintains oncotic pressure, helping keep fluid inside blood vessels.

A patient with cirrhosis has increased abdominal girth, edema, and low albumin. What complication is occurring?

Ascites caused by portal hypertension, decreased albumin, and sodium/water retention.

What is the primary cause of portal hypertension in cirrhosis?

Scar tissue increases resistance to blood flow through the liver.

What two major complications result from portal hypertension?

Ascites and esophageal varices.

What are the priority nursing assessments for a patient with ascites?

Daily weights, abdominal girth, strict I&O, edema, BP, and electrolytes.

What medication is commonly prescribed for ascites, and how does it work?

Spironolactone; blocks aldosterone to promote sodium and water excretion.

What dietary modification is recommended for patients with cirrhosis and ascites?

Low-sodium diet, commonly less than 2,000 mg/day as indicated.

A patient with cirrhosis suddenly vomits bright red blood. What complication should the nurse suspect?

Ruptured esophageal varices causing an upper GI hemorrhage.

What is the PRIORITY nursing concern with bleeding esophageal varices?

Airway protection, aspiration risk, and hemorrhagic hypovolemic shock.

What findings suggest hemorrhagic shock from ruptured esophageal varices?

Hematemesis, tachycardia, hypotension, pallor, altered LOC, and decreased urine output.

What procedure is commonly used to control bleeding esophageal varices?

Urgent endoscopy with variceal band ligation.

Why are nonselective beta blockers prescribed for patients with esophageal varices?

To reduce portal pressure and prevent variceal bleeding.

What causes hepatic encephalopathy?

Impaired liver detoxification and blood bypassing the liver allow ammonia and other toxins to affect the brain.

What is the hallmark neurological sign of hepatic encephalopathy?

Asterixis (flapping tremor) with confusion or altered mental status.

A patient with cirrhosis develops confusion and asterixis. What complication should the nurse suspect?

Hepatic encephalopathy.

What medication is FIRST-LINE for hepatic encephalopathy?

Lactulose.

How does lactulose treat hepatic encephalopathy?

Reduces intestinal ammonia absorption and promotes ammonia elimination through stool.

What should the nurse monitor when administering lactulose?

Bowel movements, mental status, hydration, and electrolytes.

Why is rifaximin prescribed for hepatic encephalopathy?

Reduces ammonia-producing intestinal bacteria.

What laboratory finding indicates impaired clotting factor production in liver disease?

Prolonged PT/INR.

Why are patients with cirrhosis at increased risk for bleeding?

The damaged liver produces fewer clotting factors.

What is the difference between fibrosis and cirrhosis?

Fibrosis is scar tissue formation; cirrhosis is advanced scarring that disrupts liver structure and function.

What is the difference between compensated and decompensated cirrhosis?

Compensated has no major complications; decompensated involves ascites, variceal bleeding, or encephalopathy.

Which hepatitis virus spreads primarily through the fecal-oral route?

Hepatitis A.

Which hepatitis virus does NOT cause chronic infection?

Hepatitis A.

What are the main nursing interventions for hepatitis A?

Supportive care, hydration, nutrition, rest, and strict hand hygiene.

How is hepatitis B transmitted?

Blood, semen, other infectious body fluids, needlesticks, and perinatal exposure.

Can hepatitis B become chronic?

Yes; chronic hepatitis B can progress to cirrhosis and hepatocellular carcinoma.

What medications are used to treat chronic hepatitis B?

Tenofovir or entecavir when antiviral treatment is indicated.

How is hepatitis C primarily transmitted?

Blood exposure, especially shared needles or contaminated injection equipment.

What is the major long-term concern with untreated hepatitis C?

Chronic infection progressing to fibrosis, cirrhosis, and hepatocellular carcinoma.

Which hepatitis viruses have vaccines?

Hepatitis A and B; there is no vaccine for hepatitis C.

What is the difference between cholelithiasis and cholecystitis?

Cholelithiasis is gallstones; cholecystitis is gallbladder inflammation, often caused by cystic duct obstruction.

What is the hallmark symptom of cholecystitis?

Persistent RUQ abdominal pain and tenderness, often with a positive Murphy sign.

What is a positive Murphy sign?

Pain and inspiratory arrest when the examiner palpates under the right costal margin during inspiration.

What diagnostic test is typically FIRST for suspected gallstones or cholecystitis?

Right upper quadrant ultrasound.

What are the priority nursing interventions for acute cholecystitis?

NPO initially, IV fluids, pain management, antiemetics, antibiotics if infection is suspected, and preparation for possible cholecystectomy.

What procedure can remove gallstones obstructing the common bile duct?

ERCP.

What are the two most common causes of acute pancreatitis?

Gallstones and alcohol.

What is the HALLMARK symptom of acute pancreatitis?

Severe epigastric pain radiating to the BACK, often with nausea and vomiting.

Which laboratory test is most specific for acute pancreatitis?

Serum lipase.

What IV fluid is commonly preferred during initial resuscitation for acute pancreatitis?

Lactated Ringer's solution.

What are the priority nursing interventions for acute pancreatitis?

IV fluids, pain management, antiemetics, monitor VS/UO/electrolytes, and early oral or enteral nutrition as tolerated.

Why can acute pancreatitis cause hypovolemic shock?

Inflammation increases capillary permeability and third spacing, reducing circulating blood volume.

What electrolyte imbalance is associated with severe acute pancreatitis?

Hypocalcemia.

What serious respiratory complication can develop from acute pancreatitis?

ARDS (acute respiratory distress syndrome).

What is the major difference between acute and chronic pancreatitis?

Acute is sudden inflammation; chronic involves repeated injury, permanent fibrosis, and loss of pancreatic function.

Why does chronic pancreatitis cause steatorrhea?

Decreased pancreatic digestive enzymes cause fat malabsorption, resulting in greasy, foul-smelling stools.

Why can chronic pancreatitis cause diabetes?

Damage to pancreatic endocrine cells decreases insulin production.

What medication is given for pancreatic enzyme replacement, and when should it be taken?

Pancrelipase (Creon); take WITH meals and snacks.

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