NSG 231 Exam 2 Big set wih
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Etiology of Jaundice
✓~ results from an alteration in normal bilirubin metabolism or flow of bile into the
hepatic/ biliary duct system
Structure and function of gallbladder
✓~ pear-shaped sac located below the liver. Concentrates and stores bile
Diagnositic studies for gallbladder
✓~ Hx and physical exam, ultrasound, ERCP, percutaneous transhepatic
cholangiography, liver function studies, WBC count, serum bilirubin
Manifestations of obstructed bile flow
, ✓~ Obstructive jaundice, dark amber urine, no urobilinogen in urine, clay-colored
stools, pruritis, intolerance for fatty foods, bleeding tendencies, statorrhea
Chronic cholecystitis
✓~ May be asymptomatic or hx of fat intolerance, dyspepsia, heartburn, flatulence,
spasms result when a stone gets stuck (biliary colic).
Cholelithiasis
✓~ Gallstones, unknown cause upsets balance between cholesterol, bile salts, and
calcium in solution.
Cholecystitis
✓~ acute or chronic inflammation of the gallbladder, usually caused by obstruction,
or trauma, extensive burns, recent surgery, prolonged immobility, fasting, DM,
bacteria.
S/S of Cholecystitis
, ✓~ indigestion, moderate to sever pain, fever, jaundice, tenderness RUQ possible
referred to R shoulder/ scapula. Possible N&V, restlessness, diaphoresis, leukocytosis,
fever.
Functions of the Liver
✓~ Metabolic: Carb/ prot/ fat, Detox, steroid metabolism, bile synthesis, fat soluble
vitamin storage, mononuclear phagocyte system
Biilirubin
✓~ Pigment derived from breakdown of hemoglobin. Insoluble in water/ bound to
protein. Unconjugated: bound to albumin => go to liver. Conjugated by liver:
gluuronic acid = soluble, excreted in bile.
Liver metabolic functions Carbs
✓~ glycogenesis (glucose to glycogen), glycogenolysis (glycogen to glucose),
gluconeogenesis (glucose FROM amino/ fatty acids)
Liver protein function
, ✓~ synthesis: non-essential aminos, plasma proteins, clotting factors. Urea formation
from ammonia.
Liver function Fat
✓~ Synthesis: lipoproteins, fatty acids, cholesterol. Breakdown: triglycerides,
cholesterol. Formation of ketone bodies
Other liver functions
✓~ Detox: inactivation of drugs/ harmful substances. Steroids: conjugation and
excretion of corticosteroid hormones
Hemolytic Jaundice
✓~ Increased breakdown in RBCs, which produces more unconjugated bilirubin in
the blood, liver unable to handle increased load. Cause: transfusion reactions, sickle
cell, hemolytic anemia
Hepatocellular Jaundice
