E2 326 - Liver - Gallbladder Flashcards by Stef Sis

What is the best question for a Hep A virus diagnostic question?

Travelled out of the Country?

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PT is diagnosed with cholelithiasis (Gall stones), How was it formed?

Bile Stasis do to concentration of gallbladder material

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Early Manfistation of Cirrhosis?

Either Asymptomatic or
- May have GI changes (N/V)
- Anorexia
- Liver is felt with Palpation
- Weightloss

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Later Manfistation of Cirrhosis?

Bleeding

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Why do we take lactulose for Cirrhosis?

To collect Ammonia from the gut & poop it out.

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Primary cause of bleeding after the bile duct has been blocked because of Cholelithiasis (gallstones)

Vit K isn’t absorbed (Fat Soluble Vit that the liver needs to make clotting factor development)

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Cause of bleeding for esophageal with a PT in end-stage cirrhosis?

Portal HTN causing weakening/distended veins (varices)

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Findings for Chronic Pancreatitis

Abdominal Mass
Leukocytosis
High Fever

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Pain description for Acute Pancreatitis?

Pain that radiates to the back and/or guarding of the abdomen

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Cell that removes toxins & waste from the liver?

Kupffer Cells

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The pathophysiologic basis of organ destruction in acute pancreatitis

Pancreatitis occurs when the enzymes produced by the pancreas cannot enter the duodenum & begin to digest the tissue of the pancreas.

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Cholelithiasis Risk Factor

(Fair Fat & 40)
Obesity
Female
Middle age
Oral Contraception
Rapid weight loss
Native America
Genetic
Other gastric issues

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Pt has stones in the gallbladder but hasn’t moved S/S

Typically asymptotic

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What is Biliary Colic

Pain from gallbladder 30 minutes after eating fatty foods (Cholelithiasis)

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Obstructed Bile Flow S/S -(7) (Cholelithiasis)

Jaundice (Bile block)
Dark Amber Pee & foamy if shaken (Bilirubin in pee)
Clay Stool (No Bilirubin -> Urobilinogen in small Inte.)
Steatorrhea (No fat breakdown stool fat)
Pruritus
Can’t take eating Fatty Meals
Bleeding bc of no Vit K breakdown & Absorption

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Cholecystitis

Acute or Chronic inflamed/ distention of the gallbladder
- Caused by lodged gallstone in the cystic duct
Pain similar to biliary colic

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Cholecystitis pressure against the wall of the gallbladder can cause what 3 things?

Ischemia
Necrosis
Perforation

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(4) S/s more for Cholecystitis than Cholelithiasis

Fever
Leukocytosis
Rebound Tenderness
Guarding

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Labs for Cholecystitis

Increased Bilirubin & Alk Phos

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How to treat Cholecystitis

Treat the S/s
- Analgesic - Ketorolac (Pain)
- Antiemetics - N/v
- Antichol - stop spams/decrease secretions from gallbladder
Bile acids - Dissolve stones

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If a PT can’t have surgery what is treatment for Cholecystitis?

Bile Acids to dissolve stones

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Acute Pancreatitis

Usually mild but can develop into severe 20%x
- Caused by obstruction of outflow pancreatic enzymes due to gallstones, alcohol, drugs, or viral
- Autodigestion of the pancreatic by its enzymes

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Pancreatic Enzymes (Trypsin) can cause:

Edema
Necrosis
Hemorrhage

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Pancreatic Enzymes (Elastase) can cause:

Hemorrhage

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Pancreatic Enzymes (Phospholipase A) can cause:

Fat Necrosis

Pancreatic Enzymes (Kallikrein) can cause:

Edema Vascular Permeability Muscle Contraction **(Shock)**

Pancreatic Enzymes (Lipase) can cause:

Fat Necrosis

Acute Pancreatitis Manifest:

Pain - Severe Timing - Sudden Tenderness and Guarding

Acute Pancreatitis S/s

- N/V - Abdominal Distention - Hypoactive BS - Fever - Hypoten, tachycardia - Jaundice

Lab for Acute Pancreatitis

- Glucose - Increased Amylase - Increased Lipase - Increased WBC

Severe S/s of Acute Pancreatitis

- Abdomen Discolored (Blue or Green-yellow/brown) (Ecchymoses - Rare) - Flanks (Grey Turner's) - Your Turning the Pt grey Nurse Flanks. - Periumbiical (Cullen's Sign) Vampires don't have belly buttons

What are Complications of Acute Pancreatitis

- Pseudocyst - Abscess - Breathing issues from Pain -Pleural effusion bc of permeable veins - Hypotension to Shock - Hypocalcemia Tentany

What is Pseudocyst

Fluid-filled sack outside of the pancreas. (Acute Pancreatitis)

Pseudocyst fluid is?

Necrotic (Dead) Product & Secretions (Acute Pancreatitis)

Can Pseudocyst be a palpable Epigastric Mass?

Yes it can be (Acute Pancreatitis)

If the the pseudocyst perforates what can happen?

It can become peritonitis (Dangerous - May need Surgery) (Acute Pancreatitis)

What is a Pancreatic Abscess?

A Large fluid-fill cavity **Inside the Pancreas** (Acute Pancreatitis)

What is Pancreatic Abscess fluid made of?

Necrosis of the Pancreas (Acute Pancreatitis)

what can Pancreatic Abscess lead to?

Infection or perforation (Acute Pancreatitis)

S/s of Pancreatic Abscess?

It can look like Pancreatitis - Abdominal Mass - High Fever - Leukocytosis (Acute Pancreatitis)

What is Chronic Pancreatitis

Progressive Fibrotic Disease of the Pancreas - Toxic Metabolites cause inflamed cytokine & help destroy the islet of Langerhans & damage of acinar cells

What is the primary cause of Chronic Pancreatitis?

Alcohol most common Can be: - Genetic - Smoking - Gallstone

Two Major Signs of Chronic Pancreatitis?

Pain & Weight loss

Chronic Pancreatitis can it cause?

Diabetes & Fat Absorption issues

What is the main drug for Chronic Pancreatitis?

Pancrelipase to help replace pancreatic enzyme

If a PT has Chronic Pancreatitis, what must they do every time they eat?

Take their Pancrelipase (Yes Snacks)

Liver Facts

- Largest organ in the body - 3 pounds - 5-7% of CO - RUQ - Left & Right Lobes -Central Vein - Can regenerate some

Liver Function (Metabolism & Storage)

Breakdown of: Fat, Cho, Proteins, vit & minerals Breakdown & use of Drugs

Liver Function (Blood Volume Reservoir)

Distend/ Compresses to alter the Circulation of blood

Liver Function (Blood Filter)

Helps Purify blood with Kupffer Cells to remove waste

Liver Function (Clotting Factor)

Creation of Prothrombin & Fibrinogen

Why do we care for the liver function?

Because it can affect all functions - Breakdown of Food - Clotting - Blood filtration - Circulation

Where does the liver receive blood via the Portal circulation?

To the liver from the Upper and lower GI, Spleen, and Pancreas via the portal vein and sent to the lobes. For drugs think "First pass Effect"

Liver Function Test (Labs Trends)

Increase Enzymes * ALT * AST *Alk Phos - Increased Bilirubin - Increased Serum Ammonia - Decreased Serum Protein - Decreased Albumin - Increased Prothrombin Time (PT)

Labs Trend for Bilirubin (LFT)

Increased Bilirubin

Labs Trend for Serum Ammonia (LFT)

Increased Serum Ammonia

Labs Trend for Serum Protein (LFT)

Decreased Serum Protein b/c malabsorption

Labs Trend for Serum Albumin (LFT)

Decreased Serum Albumin b/c malabsorption

Labs Trend for Prothrombin Time (PT) (LFT)

Increased Prothrombin Time (PT) b/c no clotting factor

What is Jaundice

D/t Bilirubin is increased - Hemolytic - Breaking down to many RBC - Hepatocellular - Liver can't break down Bilirubin - Obstructive - Decrease of the flow of bile (Generally Gallstones)

What is Hemolytic Jaundice

Hemolytic - Breaking down to many RBC

What is Hepatocellular Jaundice

The liver can't break down Bilirubin

What is Obstructive Jaundice

Obstructive - Decrease of the flow of bile (General Gallstones)

What is Bilirubin

By product heme from hemoglobin - Can be Direct (Conjugated) or Indirect (Unconjugated

What is Direct (Conjugated) Bilirubin

Elevated due to Liver working but can't remove bilirubin. Caused by Bile Duct obstruction (Maybe Gallstone) Made up of 30%

What is Indirect (unconjugated)

Elevated due to impaired liver or Making too much Bilirubin Made up of 70%

Where to see Jaundice in darker tone people?

- Sclera - Palms - Soles - Mucas Membranes **Urine may be Dark** in all people

S/s of Jaundice

Pruitis Dark urine Clay Stools Elevated Liver Enzymes

What is Viral Hepatitis

Causes inflammation of the liver Main types (HAV, HBV, HCV)

What is Viral Hepatitis - Pathogenesis

Virus -> immune inflammation -> Lysis of infection Cells -> Edema & Swelling of Tissue -> Tissue Hypoxia -> Hepatocyte death

Viral hepatitis S/s

Similar for all - Many Asymptomatic - No S/s -> mild -> Liver Failure

Viral hepatitis LFT lab trends

Elevated LFTs (Trend & Not All Pts)

Viral hepatitis Path of disease

Prodromal -> Icteric -> Recovery

Prodromal for Viral hepatitis S/s

2 weeks after exposure - Fatigue - Anorexia - Malaise - N/V - Ha -Feel more pain (Hyperalgesia) - Low Fever **Highly transmissible**

What stage are you highly transmissible for Viral hepatitis?

Prodromal

What stage does Jaundice begin for viral hepatitis?

Iceric

What S/s viral hepatitis in the Icteric Stage?

- Jaundice - Dark Urine - Clay stool - Enlarged liver that hurts to palpate Fatigue - Increased abdominal Pain (Last 2-6 weeks)

How long to reach the Recovery phase for Viral Hepatitis

6-8 weeks but the Liver Remains Enlarged/ tenderness

What Viral Hepatitis Complications can happen?

Chronic Hepatitis Liver Cirrhosis Liver Cancer Fulminant Viral hepatitis - Acute Liver Failure

Hepatitis A (HAV) Transmission

via Fecal-oral, Parental, Sex

Hepatitis A (HAV) S/s

Acute fever Usual Mild Severity Fatigue N/A Stomach Pain

Can Hepatitis A (HAV) become Chronic Hepatitis

No, will not lead to Chronic Hepatitis

Hepatitis A (HAV) Affects Who & how to prevent?

Kids & Adults Wash Hands & Vaccine

Hepatitis b (HBV) Transmission

Via Parental, Sex Insidious Onset 60- 100 days to see signs

Hepatitis B (HBV) Affects Who & how to prevent?

Any age but Generally not kids HBV Vaccine, Safe Sex, Hygiene

Can Hepatitis B (HBV) become chronic?

Yes, HBV can become chronic

Hepatitis C (HCV) Transmission

Via Parental, Sex, medical mistakes, Mother to fetus Insidious Onset 60- 100 days to see signs

What percent of Hepatitis C (HCV) become chronic?

80% of people affected by HCV will become chronic

Hepatitis C (HCV) Affects Who & how to prevent?

Any age, Blood Screening, Hygiene, No Vaccine New Treatment Available

Vaccine for Hep A Series

2x (6months apart) Recommend for - All kids 12 months & older - High-Risk groups

Vaccine for Hep B Series

3x (4 months apart) Recommend for All newborns

Disadvantage of drugs for HBV

- length of time on the med - cost of the med & s/e with other meds Combine the two = High rate of relapse

When do we treat HBV with drugs

High-Risk Pts only - Increase AST Levels - Hepatic Inflammation - Advanced Fibrosis

How is HCV treatable now?

New drug Direct-Acting Antiviral Therapy

Limit a day of Tylenol should a Hepatitis pt follow?

2g instead of the normal 4g

What is Cirrhosis?

Irreversible inflammatory Fibrotic Disease Structure changes & Chaotic Fibrosis obstructed biliary channels -> Jaundice & Portal HTN

Can the scarring during Cirrhosis be regenerated?

No, because regeneration is disrupted by Hypoxia, necrosis, atrophy, & liver failure

Can you stop the progression of Cirrhosis

Yes if you stop the cause. Stop drinking

What causes Cirrhosis (4)

- Hepatitis B&C - Alcohol - Idiopathic - Fatty Liver Disease (Nash - NAFLD)

Alcoholism & Liver Disease Stages

1. Alcoholic Fatty Liver - Asysmtomic (Can Fix) 2. Alcoholic Steatohepatitis - Inflamed, destroyed Hepatocytes (can't fix Damage but less) 3. Alcoholic Cirrhosis - Fibrosis & Scarring affect liver structure (Nonreversable)

Cirrhosis S/s

GI changes ~ N/V ~ Anorexia ~ Farting ~ Change in habit Fever, Weight loss Palpable Liver

Cirrhosis S/s Late

Jaundice Peripheral Edema Decreased Albumin & PT Skin Lesions Bleeding Problems Portal HTN Varices because of bleeding Ascites Etc

What is Portal Hypertension?

Resistant portal blood flow -> leads varices & Ascites

What is Hepatic encephalopathy?

30-45% of Cirrhosis Pt will develop with LOC changes from Mild Changes to Coma

What is the primary chemical driver for LOC in cirrhosis PTs.

Ammonia measured via labs

E2 326 - Liver - Gallbladder Flashcards

(105 cards)