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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
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 levelsAntibiotics; 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