NR574 FINAL EXAM, WEEK 1 CONTENT GI/GU EMERGENCIES FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

NR574 FINAL EXAM, WEEK 1 CONTENT GI/GU EMERGENCIES FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. Hepatorenal syndrome (HRS) Correct Answer functional form of renal failure that occurs primarily in pt with cirrhosis and ascites. 2. Type 1 hepatorenal syndrome is characterized by.. Correct Answer -rapidly progressive renal impairment -doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2 weeks -without liver transplant prognosis is very poor 3. Type 2 hepatorenal syndrome is characterized by.. Correct Answer -moderate form of renal failure -serum Cr levels between 1.5 to 2.5 mg/dL reduction in GFR with elevation in serum creatinine -associated with a more indolent course and improved survival compared to type 1 4. Risk Factors of hepatorenal syndrome Correct Answer Dilutional hyponatremia Previous episodes of ascites Presence of esophageal varices Poor nutritional status Infections such as spontaneous bacterial peritonitis Severe urinary sodium retention (urine sodium 5 milliequivalents/liter [mEq/L]) Large-volume paracentesis without albumin replacement Acute alcoholic hepatitis Low mean arterial blood pressure (map 80 mm Hg) 5. subjective clinical presentation of hepatorenal syndrome: Most clients with HRS have a known diagnosis of acute or chronic liver disease and present with nonspecific symptoms including Correct Answer dysgeusia (altered taste perception) -malaise -fatigue -decreased urine output. 6. objective clinical presentation of hepatorenal syndrome Correct Answer HRS has no characteristic physical exam findings. It is important to assess the client for stigmata of chronic liver disease including: -spider nevi -scleral icterus -lower extremity edema -asterixis -abdominal distention -fluid wave -paraumbilical hernia -bruits. 7. Dx criteria in hepatorenal syndrome Correct Answer 8. 1. cirrhosis with ascites 2. increase in Cr 0.3 mg/dL within 48 hrs or 50% increase from baseline within a 7 day period response to a 2 consecutive day diuretic withdrawal and volume expansion w/ albumin 1g/kg body wt 4. absence of shock 5. no nephrotoxic drug use 6. no macroscopic signs of structural kidney injury (proteinuria 500 milligrams/deciliter[(mg/dL], microhematuria with 50 red blood cells per high-power field, and/or abnormal renal ultrasonography) What is the Creatinine criteria when diagnosing hepatorenal syndrome Correct Answer increase in serum creatinine of -greater than or equal to 0.3 mg/dL or -greater than or equal to 50% increase from baseline Cr this is within a 7 day period. 9. What surgical intervention is used to treat hepatorenal syndrome Correct Answer TIPS Procedure 10. What is a TIPS procedure Correct Answer The TIPS procedure bypasses a portion of the hepatic circulation by shunting blood flow from the portal vein to the hepatic vein -This reduces portal pressure and minimizes back pressure on the splanchnic organs. This also decreases the likelihood of bleeding from the esophageal varies and reduces the amount of ascites *Hemorrhage is a significant risk during TIPS 11. What is the treatment of choice for both type 1 and type 2 HRS Correct Answer Liver transplant. 12. What medications are used to tx type 2 HRS Correct Answer vasoconstrictors (terlipressin, midodrine in combination with octriotide, norepinephrine) combined with albumin. 13. Bridge to transplant in Hepatorenal syndrome