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HPB Flashcards

1
Q

What are the four types of liver functions?

A

endocrine, exocrine, digestive, and hematologic

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2
Q

What is the largest internal organ?

A

liver

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3
Q

What are the 4 types of tissue found in the liver?

A

hepatocytes, Kupffer cells, Spaces of Disse, & endothelial cells, Pit cells, Stellate cells

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4
Q

How does the liver function in a digestive sense?

A

creation of bile salt, vitamin/mineral storage and processing, process and store CHO, fats, and proteins (albumin)

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5
Q

What is the endocrine function of the liver?

A

metabolism of glucocorticoids, mineralcorticoids, and sex hormones

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6
Q

What is the exocrine function of the liver?

A

Excretion of bile pigment
Excretion of cholesterol via bile
Synthesis of urea
Detoxification of drugs & foreign substance

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7
Q

What is the hematologic function of the liver?

A

Storage of blood
Removal of Bilirubin
Hematopoiesis
Synthesis of clotting factors

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8
Q

What are the two inputs of the liver and what percentage of blood goes to each of these vessels?

A

Hepatic artery (25% of oxygenated blood supply) and the portal vein (75% of oxygenated blood supply)

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9
Q

What does the portal vein do?

A

carries nutrients from stomach, pancreas, sm&large intestine, spleen, major nutrient & blood supply, 1st pass effect of oral medications

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10
Q

What effect does the portal vein cause for medications?

A

first pass effect

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11
Q

How many outputs does the liver have? What is the vessel?

A

1 output, the hepatic vein

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12
Q

What percentage of the liver needs to be viable for it to regenerate?

A

25%

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13
Q

What is the portal triad?

A

bile duct, portal vein, and hepatic artery

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14
Q

What are the parts of a hepatic lobule?

A

portal trial, sinusoids, central vein (hepatic vein), hepatocyte, and kupffer cell

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15
Q

What labs should be done to assess liver function?

A

LFT, coags, ammonia, cardiac/renal function tests

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16
Q

What labs are done in a liver function test?

A

total protein, albumin, AST, ALT, Alk Phos, Bilirubin, Ammonia, and GGT

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17
Q

If AST/ALT ratio is greater than 1, what is that indicative of?

A

cirrhosis

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18
Q

Is AST/ALT ratio is less than 1, what is that indicative of?

A

hepatitis

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19
Q

Which levels would be high and which levels would be low in liver failure?

A

total protein and albumin low
ALT/AST/Alk phos./bilirubin/ammonia high

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20
Q

How is bilirubin produced?

A

RBC breakdown into heme into unconjugated bilirubin and then into the liver for processing

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21
Q

What does the liver do to bilirubin?

A

Conjugates the bilirubin

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22
Q

What are the two routes that bilirubin can take once processed in the liver?

A

excreted with feces or reabsorbed into the portal system

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23
Q

What kind of bilirubin can the renal system excrete?

A

conjugated

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24
Q

How is Hepatitis A treated?

A

it is self-limiting

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25
Q

How is hepatitis C commonly trasmitted?

A

IV drug users, high-risk behavior, healthcare. It has a 15-20 year delay

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26
Q

How long does the prodromal phase of acute hepatitis last?

A

until jaundice shows up

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27
Q

What are the signs of the icteric phase of acute hepatitis?

A

jaundice develops and lasts up to 6 weeks

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28
Q

What happens during the post-icteric phase of acute hepatitis?

A

jaundice will begin to resolve and this happens 6-8 weeks post exposure

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29
Q

If acute hepatitis is not resolved within __ months, it is considered chronic hepatitis

A

6

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30
Q

What strains of hepatitis is there a vaccine for?

A

Hepatitis A and B

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31
Q

What are the keys to symptom management for hepatitis?

A

rest, nutrition, fluids, medication

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32
Q

What are 6 things that contribute to liver cirrhosis?

A

Degeneration + destruction of hepatocytes
Fibrosis/scarring
Regeneration nodules
Portal HTN
LFT elevated then “normal”
Liver function decreased

33
Q

Which stage of liver cirrhosis can be reversed?

A

Stage 1 and there is some in stage 2

34
Q

What stage of liver cirrhosis is when ascites begins to develop?

A

stage 3

35
Q

which stage of liver cirrhosis is completely irreversible?

A

stage 4

36
Q

A pt comes in with liver cirrhosis, the pt is itchy, anorexic, has edema all over the body, especially in the abdomen, and feels SOB, sleepy, and the family has said that the pt is starting to have personality changes. What stage of liver cirrhosis is this patient in?

A

stage 3

37
Q

Which other organ may fail during stage 4 of liver cirrhosis?

A

kidney

38
Q

What kind of patients are normally diagnosed with primary biliary cirrhosis?

A

women aged 30-65

39
Q

What kind of hepatitis causes post-necrotic liver cirrhosis?

A

hep b and c

40
Q

When can post-necrotic liver cirrhosis become cancerous?

A

When accompanied with hepatitis B

41
Q

What kind of liver cirrhosis results from prolonged obstruction to bile flow because of scarring and damage?

A

Secondary

42
Q

How many drinks a day can cause alcoholic cirrhosis for men? and women?

A

more than 4 and more than 3

43
Q

What percentage of alcohol is metabolized in the liver?

A

80-90%

44
Q

What is the most common reason for liver disease in Western nations?

A

alcohol

45
Q

What is the second most common indication for a liver transplant?

A

alcoholism

46
Q

How is alcoholic cirrhosis treated?

A

stop all alcohol and use corticosteroids

47
Q

What can happen if alcoholic cirrhosis is not treated?

A

full cirrhosis then portal HTN then liver failure

48
Q

What are the 4 stages for alcoholic cirrhosis progression?

A

alcoholic fatty liver then alcohol steathepatitis then fibrosis alcoholic cirrhosis

49
Q

What is the acronym for the assessment used for alcoholism?

A

CAGE

50
Q

What does halt stand for in an alcoholism assessment?

A

hungry, angry/annoyed/agitated, lonely, tired

51
Q

What causes peripheral neuropathy?

A

deficient thiamine, folic acid, cobalamin

52
Q

What is the most common liver disease?

A

non-alcoholic fatty liver

53
Q

What causes non-alcoholic fatty liver?

A

fat deposits

54
Q

What are three elevated lab values associated with non-alcoholic fatty liver disease?

A

glucose, lipids, serum insulin

55
Q

How can non-alcoholic fatty liver disease be treated?

A

Obesity & insulin resistance tx!!!!
Lifestyle changes: e.g. exercise, diet, weight loss
Vit E = some improvement

56
Q

What are problems that lead to decompensated cirrhosis?

A

portal HTN, ascites, hepatic encephalopathy, hepatorenal syndrome, HF

57
Q

What are the 5 acute liver issues?

A

Hep A, B, and C, ETOH, ischemic hypoprofusion

58
Q

What are 4 chronic liver issues?

A

NASH, ETOH cirrhosis, Autoimmune, Hemachromatosis

59
Q

3 roles of the gallbladder

A

store, concentrate, release bile

60
Q

What happens with cholelithiasis?

A

gallstones will create an obstruction in a bile duct and this leads to inflammation and damage

61
Q

What are the diagnostic tests for cholelithiasis?

A

U/S and labs that show elevated WBC and Bili

62
Q

What are some dietary changes that can be done to treat cholelithiasis?

A

water w vinegar or lemon juice, hydration, reduced fat intake, frequent and small meals, digestive enzymes, increase in fiber

63
Q

What is cholecystitis?

A

Inflammation in gallbladder r/t stone obstruction in cystic duct

64
Q

When would you see Murphy’s sign when assessing a pt?

A

cholecystitis

65
Q

How is cholecystitis diagnosed?

A

HIDA scan, U/S, CT

66
Q

What is lactulose used for?

A

to treat constipation associated with liver disease

67
Q

What kind of liver cirrhosis has elevated ANA?

A

primary

68
Q

What is choledocholithiasis?

A

obstruction of common bile duct

69
Q

What issue is associated with Charcot’s triad and Reynold’s Pentad?

A

Cholangitis

70
Q

What is cholangitis?

A

infection ascending the biliary tree

71
Q

What percentage of pancreatic function is exogenous? Endogenous?

A

exo: 90% and endo: 10%

72
Q

3 reasons that acute pancreatitis may be triggered

A

stimulant/irritants, enzymes activated in the pancreas, autodigestion

73
Q

What do the labs look like for someone with pancreatitis?

A

elevated amylase, lipase, WBC, glucose. Low Ca

74
Q

How is pancreatitis treated?

A

H2 blockers and enzymes

75
Q

What drug aids in reducing ammonia levels in the blood?

A

lactulose

76
Q

Which cancer is considered the most painful?

A

pancreatic

77
Q

Where does pancreatic cancer typically start?

A

at the head

78
Q

What is the treatment for ascites?

A

reduce sodium intake, reduce fluid intake, increase potassium levels, increase albumin levels, potentially do a paracentesis

nurs 366 (29 decks)

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