WEEK 5.docx - Advance Med Surge Week 5 Notes...

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Advance Med Surge Week 5 NotesGastrointestinalHepatitis:Hepatomegaly- FEEL ENLARGED LIVER, TENDERNESS, PAINLIVER HELPS WITH DIGESTION AND FAT DIGESTION#1 sign: FATIGUE***#2 sign: poor appetite/ANOREXIA – give them antiemetic for n/v#3 sign: jaundice – African American and ASIAN Pt, check ORAL mucus membranes***oYELLOWISH SKIN/SCLERA, CLAY-COLORED STOOL, DARK CONCENTRATED URINE (B/C BILIRUBIN INCREASED), AND PRURITUS-itching (GIVE BENADRYL). Before patient with hepatitis goes on dialysis, you run all hepatitis panel. ACUTE HEPATITISoPath #1: acute phase of hepatitis, after a couple of months they will get totally cured. USUALLY TAKES 1 YEAR TO TREAT. Thus, they will develop NATURAL IMMUNITY/antibodies. Better to have natural immunity vs. vaccinationANTIGEN- DISEASE MARKER STILL INFECTEDANTIBODY- IMMUNEGIVE ANTIVIRALS BUT NO TREATMENToPath #2: developed hepatitis, but did not develop a cure. They might go from acute liver failure Hepatic encephalopathychange in LOC, comatose, lethargic, unconscious – due to increased ammonia levels because ammonia crossed the blood brain barrier. Tx: give Lactuloseto get rid of ammonia levelsTHEY WILL WAKE UPoPath #3: To go from acute hepatitis to chronic hepatitis. oChronic liver cirrhosis liver cancer hepatic encephalopathy Major reason for liver cirrhosis: ALCOHOL AND HEPATITIS CTx: liver transplantHEP A- ANUS/ORALHEP B- BLOOD/SEXHEP C- COCKHepatitis A Virus (HAV): ORAL/FECAL. From contaminated food or dirty places oSomeone who got vaccine for hep B is not the PROTECTED from hep A.oCAUSES ACUTE LIVER FAILURE
Hepatitis B Virus (HBV):infectious blood, blood products, or other bodily fluids (semen, vaginal secretions, and saliva). NO TRANSMISSION VIA URINE, BREAST MILK, SWEAT, BOWELoVery common with pts with hemodialysis b/c they require a lot of blood products. When giving HEMODIALYSIS Pts blood, you give them packed RBCs during dialysis because you don’t want to give them extra volume. oPatient with GI bleed, stool will have a way of transmitting HEP B because it involves blood.oCan transmit perinatally and percutaneuously oAt risk: homosexuals, household contacts of chronically infected, pts undergoing HD, health care and public safety workers, and transplant recipients.

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