NUR 631 Exam 1 Test 2
1. When differentiating dyspepsia from heartburn, the NP knows that heart- burn (2)
Answer
1) is commonly relieved by the ingestion of alkali (antacids)
2) is precipitated and aggravated by supine position.
2. What are the 4 most common causes of dyspepsia?
Answer
1. medication-induced (salicylates, corticosteroids, NSAIDs, erythromycin, theophylline)
2. H. pylori
3. Gardiasis
4. Carcinoma
3. When do you refer a patient with dyspepsia to a gastroenterologist?
Answer
When other symptoms are present such as unexplained weight loss.
4. What causes Jaundice?
Answer
an accumulation of bilirubin in the blood
5. jaundice is apparent when the serum bilirubin rises above what value?
Answer
-
2.5-3.0 (normal = 0.3 - 1.0)
6. Hyperbilirubinemia may be caused by a number of conditions / diseases such as anemias,
thalassemia, polycythemia, lead poisoning, CHF, contrast agents, neonatal liver, rare syndromes,
hepatitis, pancreatitis, pancreatic can- cer, and many drugs. But the most common causes are
directly due to (2)
,Answer
- Cholestasis, either because of impaired bile formation and/or bile flow, which can be the
result of
1) extrahepatic biliary tract obstruction
2) hepatic parenchymal disease
7. Initial bilirubin is unconjugated and NOT .W
and conjugated with glucuronic acid.
Answer
water soluble
8. Only bilirubin, by nature of its water solubility, is found in the
urine.
Answer
CONJUGATED (direct)
9. Serum levels of these transaminases are good indicators of hepatocyte damage from a
variety of causes
Answer
aspartate aminotransferase (AST), normal = 5-60
alanine aminotransferase (ALT), normal = 5-43
10. Because AST is also found in non-hepatic tissues such as skeletal muscle, heart, and brain
tissue, it is not as specific of a marker for hepatocyte damage as
Answer
ALT
11. When AST & ALT are elevated, but AST is higher, think
Answer
"Acetaminophen, Statins, Tequila"
, 12. Levels of AST & ALT below 300 U/L are nonspecific; however, some ex- treme
elevations can be diagnostic. For example, ALT/AST > 1,000 occur in patients with (3)
Answer
1. acute viral hepatitis
2. toxin or drug-induced hepatitis
3. ischemic liver injury
13. If the ratio of AST to ALT is 3-5x the norm, it generally indicates severe hepatic necrosis,
most often caused by
Answer
alcoholic hepatitis
(or skeletal muscle injury secondary to seizure, protracted immobilization)
14. The liver panel test includes AST, ALT, bilirubin and which other 4 labs?
Answer
-
albumin, alkaline phosphatase, PT/INR, aPTT
15. Simply stated, a serum bilirubin test shows if the liver is able/not able to
Answer
rid itself of byproducts
16. Jaundice + Pruritus + Dark Urine + Light-colored Stools + RUQ pain => intra or extra
hepatic cholestasis such as
Answer
1. Cholelithiasis (gallstones)
2. Cirrhosis
3. Other biliary obstruction
17. An enlarged but non-painful gallbladder + jaundice is called what sign?
Answer
-