CGRN Hepatobiliary and Pancreatic Disorders 1 — Questions and Answers
Question 1: A patient with cirrhosis develops confusion, asterixis, and an elevated ammonia level. Which intervention is the priority?
- Administer lactulose as ordered (Correct answer)
- Restrict all dietary protein
- Prepare for emergent liver transplant
- Administer IV thiamine
Correct answer: Administer lactulose as ordered
Lactulose reduces ammonia absorption in the colon by acidifying the gut lumen, making it the first-line treatment for hepatic encephalopathy.
Question 2: Which finding on a liver biopsy is most characteristic of primary biliary cholangitis (PBC)?
- Centrilobular necrosis
- Granulomatous destruction of bile ducts (Correct answer)
- Steatosis with lobular inflammation
- Bridging fibrosis without bile duct changes
Correct answer: Granulomatous destruction of bile ducts
PBC is characterized by autoimmune granulomatous destruction of interlobular and septal bile ducts, which is pathognomonic for this condition.
Question 3: A patient presenting with severe epigastric pain radiating to the back, elevated lipase, and grey-Turner sign most likely has which condition?
- Acute cholecystitis
- Peptic ulcer perforation
- Acute hemorrhagic pancreatitis (Correct answer)
- Mesenteric ischemia
Correct answer: Acute hemorrhagic pancreatitis
Grey-Turner sign (flank ecchymosis) indicates retroperitoneal hemorrhage, which combined with elevated lipase and epigastric pain is consistent with acute hemorrhagic pancreatitis.
Question 4: Which lab abnormality pattern is most consistent with obstructive jaundice from a common bile duct stone?
- Elevated indirect bilirubin, normal ALP, elevated LDH
- Elevated direct bilirubin, markedly elevated ALP and GGT (Correct answer)
- Elevated AST/ALT with mild direct bilirubin elevation
- Elevated ammonia with normal bilirubin
Correct answer: Elevated direct bilirubin, markedly elevated ALP and GGT
Obstruction of bile flow leads to conjugated (direct) hyperbilirubinemia along with marked elevation of cholestatic markers ALP and GGT.
Question 5: During ERCP for suspected choledocholithiasis, the nurse notices the patient's oxygen saturation drops to 88%. What is the first action?
- Pause the procedure and administer reversal agents
- Increase IV fluid rate
- Document the finding and continue monitoring
- Notify the physician and apply supplemental oxygen (Correct answer)
Correct answer: Notify the physician and apply supplemental oxygen
Desaturation during ERCP is a sedation-related adverse event; the nurse must immediately notify the physician and apply supplemental oxygen to prevent hypoxic injury.
Question 6: A patient with autoimmune hepatitis is most likely to have which serologic marker?
- Anti-mitochondrial antibody (AMA)
- Anti-smooth muscle antibody (ASMA) (Correct answer)
- Anti-neutrophil cytoplasmic antibody (ANCA)
- Hepatitis B surface antigen (HBsAg)
Correct answer: Anti-smooth muscle antibody (ASMA)
Anti-smooth muscle antibody (ASMA) is the hallmark serologic marker of type 1 autoimmune hepatitis, often accompanied by elevated IgG levels.
Question 7: Which complication of acute pancreatitis involves liquefied necrotic pancreatic tissue enclosed in a fibrous wall?
- Pancreatic pseudocyst
- Walled-off necrosis (WON) (Correct answer)
- Peripancreatic abscess
- Pancreatic ductal disruption
Correct answer: Walled-off necrosis (WON)
Walled-off necrosis (WON) is a mature, encapsulated collection containing both liquid and solid necrotic debris that develops after necrotizing pancreatitis, distinct from a pseudocyst which contains only fluid.
CGRN Hepatobiliary and Pancreatic Disorders 1
A patient with cirrhosis develops confusion, asterixis, and an elevated ammonia level.
Which intervention is the priority?