LIVER A&P
Name the pathophysiologic cause of shock liver in patients with different forms of shock.
What is.....when the blood flow, and therefore blood pressure, in the body is reduced significantly. Also called ischemic hepatitis or hepatic ischemia
Name the root operation for a CABG
What is bypass
A 19 yo female was admitted to the ED on January 6th for vomiting and diarrhea. According to her mother, she has been treating her for 3 days for a "stomach bug." She is extremely weak and lethargic; her skin turgor is very poor and her mucus membranes are dry. She was admitted to the medical floor with “severe dehydration” and is currently undergoing IVF resuscitation. Upon admission, WBC was noted to be 11.1, creatinine 1.6 and BUN of 25. She was treated with IVF resuscitation and by discharge creatinine decreased to 0.8. and BUN to 12. What query opportunity is present with this case?
AKI (retrospective abnormal creatinine—use the 1.5 times baseline rule)
ABG:
PH:7.23
PCO2: 57
PaO2:68
What is respiratory acidosis?
What is the usual cause of hepatic encephalopathy in patients with liver failure?
Increased ammonia levels.
This organ transports bile to the gallbladder and the duodenum.
What is the hepatic duct.
Your patient has a fall with a head injury. CT scan shows a subdural hematoma with 3cm shift from midline and vasogenic edema. What are your 2 query potentials on this case.
What is brain compression and cerebral edema.
A 53 yo male was directly admitted from the physician’s office late yesterday afternoon on March 11th with a diagnosis of chest pain, nausea/vomiting and abnormal EKG. His troponin was normal upon admission. Creatinine x3 days post admission was noted to be 1.4 which is an increase from 0.8 noted on admission. His treatment regimen includes an IVF bolus followed by IVFs at 125cc/hr, lab monitoring, and strict I&O’s. What query opportunity is present with this case?
AKI (prospective abnormal creatinine—use the 0.3 increase rule)
What is No
We should mark the PSI as exclusion present
Write a clin val to rule out respiratory failure while getting acute pulmonary insufficiency following surgery ruled in.
Your patient is admitted with ascites from liver failure and requires a paracentesis. How is this encounter coded?
What is liver failure as pdx. Ascites is a secondary symptom from the liver failure. Paracentesis is your PCS code.
This vessel carries blood through the liver and back to the heart.
What is the inferior vena cava
Your CABG patient is 12 hours post op and noted with an EF of 45%. They are on a Levophed drip with a BP noted at 94/61. They have been successfully extubated and are up in the chair. Based on the CI above what should the CDS do?
What is LET IT GO... the above indicators are normal for a patient that is post cabg.
A 72 yo male was admitted the evening of February 17th with increasing lethargy and a temp of 104.1, resp 24, P102, WBC 15. He completed a round of PO Bactrim 2 days ago for a urinary tract infection. According to the H&P, patient has a chronic foley and his admitting diagnosis is CAUTI. He required fluid resuscitation in the ED and is responding well to the IV Vancomycin and Levaquin during admission. What query opportunity is noted?
Sepsis due to CAUTI
According to the updated Coding Clinic, what should be coded when a patient presents both COPD and emphysema.
What is emphysema?
What drug would you anticipate give for the treatment of hepatic encephalopathy?
What is lactulose.
Name of liver cells.
What are hepatocytes.
Your patient has gone to the OR for treatment of necrotizing soft tissue infection of the left buttock. Your op notes states: "Using a sharp scalpel , I first connected the abscess sites and excised down through the subcutaneous tissue with electrocautery. The tissue was in the process of liquefying and was non viable. The wound measured 8 x 4 cm and 2.5cm deep and was extensively excised" what is the query potential that will impact your case.
This 64 yo female was admitted to the emergency department earlier today April 13th, from home. She was found to have a large intracranial hemorrhage involving the entire right frontal lobe. Her symptoms include increasing drowsiness and a thready pulse. The stat CT of the head also showed a "significant midline shift." She has been taken urgently to the OR for surgical intervention.What query opportunitiy is available?
Brain compression
Are lungs the same size? Yes or No. If yes, why?
No. The right is larger than the left. The left makes room for the heart.
Your patient is admitted with RUQ pain. Liver enzymes are elevated. His BMI is 35, and her is noted to be overweight. He has PMH of high cholesterol and is taking simvastatin. RUQ U/S shows fatty liver disease. What disease process is suspected?
What is NASH.
Describe the main function of the liver.
What is blood filtration to metabolize drugs and toxins.
A patient in MVC is admitted. He is unconscious and goes to the OR for a craniotomy for hematoma evacuation. The MD documents "Brain compression due to subdural hematoma." What is your query potential on this case.
What is send a query for traumatic brain compression.
A 45 yo female has been admitted an LTCH facility following a long acute care hospitalization for a spontaneous subarachnoid hemorrhage and brain surgery. She is still on mechanical ventilation (MV) and remains in a coma. A CT of the head was performed at the hospital prior to transfer which showed “edema, improving.” She is currently on IV mannitol with MV settings as controlled hyperventilation. What query opportunity is available?
Cerebral edema
A patient comes in to the ED s/p seizure. Emesis noted during seizure. Vitals HR:62 RR:18 B/P: 132/68 Sp02 92% on 5Lpm NC. ABG PH: 7.36 PCO2 46 PaO2:135. Patient is intubated and placed on mechanical ventilation for acute respiratory failure. Is there a query opportunity?
What is clinical validation of acute respiratory failure?
Your patient is admitted with liver failure from chronic cirrhosis from alcoholism. He is noted with abdominal ascites, and jaundice. The ascites has been non-responsive to IV Lasix. On day 3 of admit, you see that his total urine output for the day is documented at 200cc. What condition do you suspect in this patient?
What is hepatorenal syndrome.