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4th Semester > Cirrhosis And Hepatic Failure/ pancreatitis > Flashcards

Cirrhosis And Hepatic Failure/ pancreatitis Flashcards

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1
Q

What is cirrhosis

A

Severe scarring of the liver which in turn alters the function of the liver

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2
Q

How does the function of the liver deteriorate

A

Altered bile duct flow and stasis
Impaired hepatic venous outflow
Decreased blood flow to and through the liver

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3
Q

What are complications of portal hypertension

A

Ascites
Hemmorhage of varices
Hepatic encephalopathy (HE)
Hepato renal syndrome

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4
Q

What is the only feasible treatment for end stage liver cirrhosis

A

Liver transplant

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5
Q

What is albumin

A

A blood protein with a long 1/2 life of 20 days is a late indicator
Of malnutrition

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6
Q

If albumin is decreased what will result

A

Poor wound healing due to decreased zinc levels

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7
Q

Prealbumin

A

1/2 life of 2-3 days

Sensitive indicator of nutritional status with treatments

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8
Q

What deficiency is common in liver disease

A

Thiamine related to poor diet, impaired GI absorption

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9
Q

What is this one needed for

A

This one is needed to maintain cerebral and nerve impulse function

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10
Q

What does alcohol do to the liver

A

Alcohol depletes the liver from gluconeogenesis

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11
Q

What are causes of acute liver failure

A

Toxins, drugs especially acetaminophen
Viral hepatitis
Hypoperfusion / shock due to ischemia

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12
Q

What are ALF signs and symptoms

A 
N/V 
Malaise 
Evidence of coagulopathy ( bruising, bleeding, lab abnormalities, DIC,)
Decreased LOC
HEPATIC ENCEPHALOPATHY
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13
Q

What is collaborative management of ALF

A

Obtain detailed history focused on viral infections, drugs, toxins, direct injury, acetaminophen intake
Prevent cerebral edema and MODS

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14
Q

What are complications of ALF

A 
Respiratory insufficiency/ failure 
Hemodynamic instability 
Infection/ sepsis 
Hypoglycemia 
Electrolyte imbalances
Renal failure 
Malnutrition
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15
Q

Acetaminophen

A 
Readily absorbed from G.I tract 
Primarily metabolized by the liver 
Half life 2-4 hours 
Peaks levels 4 hours after overdose 
90% excreted by the kidneys 
Unintentional poisoning may result from repeated high doses
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16
Q

What exacerbates acetaminophen toxicity

A

Fasting

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17
Q

What is treatment of acetaminophen toxicity

A

If less than 4 hours perform gastric lavage
Draw serum acetaminophen levels between 4 hrs and 24 hrs post ingestion
Promptly administer actetylcysteine I.V in 3 separate infusions over 20-24 hours
Can be given PO
GIVE REGARDLESS OF TIME OF INGESTION based on weight
Can give activated charcoal is ingested within 2 hours

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18
Q

What is considered toxic for acetaminophen

A

INGESTION of 7-10 grams is toxic over 8 hrs or less

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19
Q

What are additional complications of acetaminophen toxicity

A

Seizures that are usually well controlled with benzodiazepines

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20
Q

What are signs and symptoms of hepatic encephalopathy

A

Can start with forgetfulness, mild confusion, poor judgement, wandering, inappropriate behavior or language, poor sleep patterns, worsening handwriting, tremors, slow movement

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21
Q

Can hepatic encephalopathy recur

A

It can recur after treatment due to various triggers

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22
Q

What drug can be used to reduce the risk of recurrence of hepatic encephalopathy

A

Xifaxan-rifaximin

These are drugs that alter the bacterial content of the G.I tract

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23
Q

What is portal hypertension

A

Abnormally high blood pressure in the portal venous system due to resistance to portal blood flow

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24
Q

What are consequences of portal hypertension

A

Varices in the lower esophagus, stomach, rectum,
Splenomegaly
Ascites
Hepatic encephalopathy

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25
What is hepatic encephalopathy
The accumulation of toxins related to liver failure causes disruption of neurotransmission
26
What are symptoms of hepatic encephalopathy
Personality changes Confusion Memory loss Stupor, coma, death
27
What is hepatorenal syndrome
Renal failure demonstrating oliguria, sodium and water retention, hypotension, and peripheral vasodilation due to advanced liver disease
28
What is a way cirrhosis is caused
Biliary channels become obstructed and cause portal hypertension, blood is shunted away from the liver and a hypoxic necrosis develops
29
What is secondary biliary cirrhosis
Obstruction
30
What is primary biliary cirrhosis
Autoimmune
31
What is pancreatitis
Inflammation of the pancreas Associated with several clinical disorders ( alcohol intake and cholelithiasis, caused by injury or damage to pancreatic cells and ducts causing a leakage of pancreatic enzymes into the pancreatic tissue)
32
What are manifestations of pancreatitis
Epigastric pain radiating to the back Fever and leukocytosis Hypotension and hypovolemia Characterized by a increase in amylase
33
What is chronic pancreatitis related to
Chronic alcohol abuse
34
What is albumin administered for
To expand blood volume Helps maintain vascular fluid volume Tells if liver is damaged and if so how much
35
What are causes of hypoalbuminemia
Severe burns | Trauma
36
What are cause of hyperalbuminemia
They are not associated with hepatic disease it is associated with dehydration
37
What is ammonia
Waste product of protein metabolism | The liver converts ammonia to urea. In liver disease the conversion doesn't take place thus increasing ammonia levels
38
Hepatic encephalopathy is the result of what
High ammonia levels in the brain | The brain is very sensitive to ammonia levels
39
What is treatment for high ammonia levels
Medications ( lactulose, enemas) | Diet (protein intake)
40
What does lactulose do
It eliminates ammonia through the feces, it also causes hypokalemia as k+ is excreted through the stool
41
Signs and symptoms of hepatic encephalopathy
Confusion | Affects fine motor control such as writing
42
If a patient has liver disease, what happens to bilirubin levels
They increase
43
In liver disease, how does coagulation studies relate
PT, INR aPTT will be increased because the liver synthesizes clotting factors 2,7,9,10. The blood will be unable to clot quickly leading to increased risk of bleeding
44
What are hepatic enzymes
ALP, GGT, AST, are enzymes produced mainly in the ,over. These enzymes help identify is the liver is diseased and how badly. The higher the levels the worse the liver prognosis
45
Manifestations of liver disease
Portal HTN ascites Hepatic encephalopathy hepatorenal syndrome
46
What is portal HTN
Elevated pressure within the portal system due to resistance to portal blood flow
47
Varices
Develops on stomach, lower part of esophagus, and rectum, due to built up pressure in the portal system. They can be so distended that they rupture. A person can hemmorhage and die before they reach medical treatment
48
What does rectum varices manifest as
Hemmorhoids
49
Consequences of portal HTN
Splenomegaly Ascites Hepatic encephalopathy
50
Symptoms of hepatic encephalopathy
``` Usually happens over hours to days Personality changes Confusion Hallucinations Loose fine motor skills Memory loss, stupor, coma, death ```
51
What are signs and symptoms of hepatorenal syndrome
``` Oliguria Na and H2O retention Hypotension Peripheral vasodilation Ascites Peripheral edema Electrolyte fluid shifts Hypovolemia Decreased renal blood flow Decreased GFR and urine output ```
52
Cirrhosis
Irreversible | Can only manage and prevent further damage
53
Can the liver regenerate itself
Yes it can
54
How does jaundice occur
Biliary channels are blocked
55
Who is more prone to cirrhosis
Woman
56
What is biliary cirrhosis
Auto immune | Obstruction in bile duct
57
What is post necrotic cirrhosis
Results from chronic disease
58
What is treatment for end stage cirrhosis
Liver transplant
59
What lab tells if HRS is developing
Creatinine
60
Thiamine deficiency
Common in liver disease due to impaired GI absorption
61
What does alcohol do in regards to the liver
Alcohol depletes the liver from the ability to provide gluconeogenesis
62
What electrolytes are decreased in cirrhosis and hepatic failure
k+, Na, Mg, phosphorus
63
What are causes of ALF
Acetaminophen | Viral Hep B
64
What are signs and symptoms of ALF
N/V Malaise Decreased LOC
65
What's the toxic range of acetaminophen
7-10 gms
66
What's the antedote to acetaminophen
Acetylcysteine
67
For acetaminophen poisoning what should you do
Give acetylcysteine regardless of when poisoning occurred Activated charcoal if ingested within 2 hrs Gastric lavage if ingested with 4 hrs
68
What are complications of ALF
``` Respiratory failure Cardiac arrest Infection/ sepsis Hypoglycemia Renal failure Hemodynamic instability electrolytes Seizures ```
69
MAT
Medication assisted treatment
70
MAT 4 opioids
Methadone Buprenorphine Naltrexone
71
MAT 4 alcohol use disorder
Disulfiram ( Antabuse, makes person violently ill if they try to sneak alcohol) Acomprosate Naltrexone
72
When do mild symptoms of alcohol withdrawal occur
Within 6-12 hrs of last drink
73
When do peak symptoms of alcohol withdrawals occur
They appear in 24-48 hrs
74
What are nutritional needs for alcohol withdrawal
Thiamine Folic SCIs B12
75
Who is at risk for acute pancreatitis
Alcoholics
76
What labs diagnose pancreatitis
Increased lipase | Increased calcium
77
What is trypsin
It protects cells by preventing avtivation of enzymes until they reach the duodenum. During inflammation trypsin activates enzymes early this basically digesting the pancreas in a process called autodigestion
78
If pancreatitis is left untreated p, what complications can occur
``` SIRS MODS SEPSIS COAGULOPATHY DIC ```
79
What is tx of pancreatitis
``` Vasopressors AGGRESSIVE fluid rescusitation O2 Keep NPO provide enteral TPN feedings, watch for,fluid overload IV abx, tele, ```
80
What are signs and symptoms of acute pancreatitis
Severe abdominal pain Hypovolemia from dehydration Hypoperfusion
81
What is Cullen's sign
Bluish color Around the umbilicus | Sign of pancreatitis
82
What is turners sign
Bluish brownish color around the flank area
83
What is pain mgmt of acute pancreatitis
Morphine sulfate Meperidine decrease spasms of pancreatic duct Insulin drip( sliding scale isn't effective, monitor glucose Q2 hrs Give zofrna for n/v PPI or H2 antagonist
84
What does PPIs and H2 antagonist do
They reduce gastric and pancreatic secretions
85
What is a appropriate diet for pancreatitis
High carb Low fat Low protein
86
What are complications of pancreatitis
``` MODS HYPOXEMIA RESPIRATORY COMPROMISE ARDS EDEMA PULMONARY EDEMA SIRS esp 7-14 days after dx ```
87
What are meds for pancreatitis
Pancrealipase
88
What is pancrealipase
It contains lipase, amylase, and protease which are supplemental enzymes needed for life
89
Pancreatitis leads to an increased risk for what
SEPSIS
90
What should a person report while in pancrealipase therapy
Report diarrhea, or abdominal cramping
91
What does pancrealipase tend to increase
Uric acid levels leading to gout
92
What can pericarditis lead to
SEPSIS
93
What are signs and symptoms of endocarditis
``` Murmurs Fever Tachycardia SOB fatigue Dysrthymias ```
94
What is tx of endocarditis
IV abx | May need valves replaced
95
What is dx for endocarditis
Echocardiogram | Increased WBC
96
What is serum procalcitonin
Early dx of SEPSIS
97
Serum lactate
Anaerobic metabolism is taking place now, bc the pt is critically ill, the O2 is depleted and cells go into anaerobic mode. Blood cultures will need to be drawn The higher the lactate the sicker the patient
98
SIRS is the precursor to what
SEPSIS
99
Septic shock
The presence of SEPSIS and refractory hypotension
100
What is refractory
Not responding to tx
101
D dimer
Test that determines if there is a coagulation defect
102
What fluid should be given in a fluid challenge
0.9% NS | LR
103
What is given if BP doesn't rise in SEPSIS after a fluid challenge
Vasopressors, the goal is to achieve a MAP of 65 or above Norepinephrine is the drug of choice Low dose of dopamine Can be given if the pt is not tachycardic
104
In SEPSIS, how should a fever be treated
Alternate between ibuprofen and acetaminophen
105
DIC
Can develop clots, bleeding or both, give heparin to dissolve the clots, manage heparin tightly to prevent massive hemmorhaging
106
How is DIC dx
``` Decrease platelets Increased D dimer Decreased fibrinogen Increased PT/ PTT increased fibrite degradation products ```
107
Cryoprecipitate
Contains clotting factors
108
How is DIC treated
Mostly crystalloids Albumin colloids PRBCs Pain relief from ischemia
109
Cardiogenic shock
Hemodynamic problem | A problem within the heart itself
110
What are signs and symptoms of cardiogenic shock
Decrease CO, leading to decreased BP, LEADING leading to increased SVR
111
What is hypovolemic shock
A not enough fluid problem a decreased amount of fluid in the intravascular space
112
What are signs and symptoms of hypovolemic shock
Decreased CO, leading to decreased BP, leading to increased HR
113
What is distributive shock
Adequate blood flow and fluids, distributed abnormally. Still have decreased CO but not bc of decreased fluids Fluids won't help, u must correct the cause
114
What is obstructive shock
A type of shock related to the heart, the ventricles don't feel or empty adequately ( a ventricular problem)
115
What is a disease process that can lead to obstructive shock
Cardiac tamponade
116
What is spinal shock
Shock resulting form a SCI there is adequate volume nothing is wrong with the heart It is a type of distributive shock
117
What are the stages of shock
Mild- reversible Moderate- reversible Severe- body can't compensate

4th Semester (18 decks)

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