NUR 631 Exam 2 - Answer Intestine, biliary tree, liver disease 2...

NUR 631 Exam 2

• What are examples of things that can cause visceral pain?

Answer Intestine, biliary tree, liver disease

• What are examples of things that can cause parietal pain?

Answer Appendicitis, peritonitis

• What are examples of things that can cause referred pain?

Answer Cholecystitis

• What are examples of things that can cause colicky pain?

Answer Renal stones

• What is the order in which you should perform an abdominal physical exam?

Answer

• inspection

• auscultation
• percussion
• palpation

• What diagnosis would you consider for a 30 year old with heart burn, early satiety, burping

and generalized abdominal pain?

Answer Dyspepsia related to gastritis

• What diagnosis would you consider for a 50YEAR OLD SMOKER with heart burn and

abdominal pain? 1 / 4

Answer Colon cancer

• How high is the bilirubin level when the patient is starting to develop physical jaundice?

Answer 2.5 or higher

• bilirubin is unconjugated, which means that it has not been metabolized

by the liver or made into a water soluble form of bilirubin

Answer Indirect bilirubin

• is processed bilirubin that is water soluble

Answer Direct biliru- bin

• What are some of the causes of elevated indirect bilirubin levels?

Answer

• hemol- ysis

• heart failure
• Gilbert syndrome
• neonates
• hyperthyroidism
• chronic hepatitis & advanced liver cirrhosis

• What are some of the causes of elevated direct bilirubin levels?

Answer

• choledo- cholithiasis

• tumors

- AIDS

• acute/chronic pancreatitis
• viral hepatitis
• alcoholic hepaitits
• biliary tree cholangitis
• sepsis 2 / 4

• TPN
• postoperative cholestasis
• sickle cell disease
• pregnancy
• end stage liver disease

• What does a history of fever, chills and RUQ pain indicate?

Answer Acute cholan- gitis

• What does RUQ pain with a history of anorexia, malaise and myalgias indicate?

Answer Viral hepatitis

• What is the terminology for when the gallbladder is so distended that you can palpate it?

Answer Courvoiser Sign

• What is the terminology for inspiratory arrest that occurs when you are putting pressure on

the RUQ due to inflammed gallbladder?

Answer Murphey's Sign

• Which liver enzyme is specific for hepatocytes?

Answer ALT

• Which liver enzyme is more specific to alcohol, statins and tylenol use?

Answer - AST

• If the ratio of AST to ALT is 2 to 1, what does this indicate? 3 / 4

Answer Liver damage due to alcohol, statins or tylenol

• If the ratio of ALT is twice as high as AST, what does this indicate?

Answer Viral hepatitis

• What is the normal range for ALT and AST?

Answer 30-40

• What does an elevated ALT, AST and Alk Phos indicate?

Answer Gallbladder ob- struction

• What are the signs and symptoms in a patient that has MILD melena?

Answer -

Resting tachycardia

• What are the signs and symptoms in a patient that has melena with a blood volume loss of at

least 15%?

Answer Orthostatic hypotension

• What are the signs and symptoms of a patient that has melena with a blood volume loss of at

least 40%?

Answer Supine hypotension + abdominal pain

• What type of anemia would someone with melena have?

Answer Iron deficiency anemia

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