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Inside autoimmune liver disease

doi: 10.1097/01.NME.0000550563.26254.55
CE Connection

GENERAL PURPOSE: To provide information about the pathology, diagnosis, treatment, and nursing care of three types of AILD. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Describe the pathology, epidemiology, and risk factors of three types of AILD. 2. Explain the signs and symptoms and diagnosis of the three types of AILD. 3. Illustrate the treatment and nursing care of the three types of AILD.

  1. Destruction of the bile ducts causes
    1. cholestasis.
    2. hypercholesterolemia.
    3. venous stasis.
  2. Bilirubin arises from the breakdown of
    1. muscle.
    2. damaged WBCs.
    3. damaged red blood cells (RBCs).
  3. PBC presents as inflammation of the
    1. intrahepatic bile ducts.
    2. liver parenchyma.
    3. portal blood vessels.
  4. Cirrhosis causing blockage of blood flow through the portal venous system
    1. triggers vasodilation and low BP.
    2. increases the risk of esophageal and stomach hemorrhage.
    3. produces edema in the legs known as ascites.
  5. Regarding the signs and symptoms of PBC,
    1. most patients are symptomatic at diagnosis.
    2. fatigue, jaundice, and pruritus are common symptoms.
    3. ALP is lower than normal.
  6. If your patient with PBC has changes in mental status, it may indicate
    1. vascular dementia.
    2. a brain tumor.
    3. hepatic encephalopathy.
  7. The presence of xanthelasma indicates
    1. biliary blockage.
    2. cholesterolemia.
    3. ESLD.
  8. The first-line treatment for patients with PBC is
    1. UDCA.
    2. MTX.
    3. interferon.
  9. Treatment using UDCA for PBC
    1. may cause an increase in WBCs.
    2. normalizes liver enzymes in 20% to 30% of patients with PBC.
    3. is most effective in Stages 1 and 2.
  10. Which treatment is used to decrease pruritus?
    1. cholestyramine
    2. colchicine
    3. budesonide
  11. A lab finding consistent with primary PSC is
    1. RBCs disproportionately elevated to hemoglobin.
    2. WBCs disproportionately elevated to neutrophils.
    3. ALP disproportionately elevated to ALT.
  12. A diagnostic test used to identify PSC and evaluate bile duct strictures or damage is
    1. ERCP.
    2. computerized tomography of the abdomen with contrast.
    3. exploratory laparoscopic exam.
  13. One treatment strategy for bile duct strictures in patients with PSC is
    1. liver lobectomy.
    2. bile duct balloon dilation.
    3. bile duct bypass surgery.
  14. AIH is an autoimmune disease that causes dysregulation of
    1. platelets and macrophages.
    2. T and B lymphocytes.
    3. neutrophils and eosinophils.
  15. A blood test result indicating liver failure in AIH is a/an
    1. elevated serum albumin.
    2. shortened prothrombin time.
    3. elevated serum bilirubin.
  16. The prognosis in AIH is favorable when immediate
    1. immunosuppression is instituted before the cirrhosis stage.
    2. prednisone and vancomycin are instituted in Stages 1 to 2.
    3. prednisone and serotonin reuptake inhibitors are instituted at diagnosis.
  17. Which statement about remission in AIH is accurate?
    1. Induce it using prednisone and taper as liver enzymes decrease.
    2. Forty percent of patients achieve full remission in 18 to 24 months.
    3. The relapse rate is only about 20% when immunosuppressive therapy ends.
  18. Assessment findings in AILD are likely to include all of the following except
    1. pale mucous membranes.
    2. dark, blood-tinged stools.
    3. bruising.
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