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Nur 326 > Exam 2 - Liver Problems > Flashcards

Exam 2 - Liver Problems Flashcards

(75 cards)

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1
Q

Major Functions of the Liver

A

Metabolism and storage
Blood volume reservoir
Blood filter (cutfirst cells)
Blood clotting factors (prothrombin and fibrinogen)
Drug metabolism and detoxification

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2
Q

What does the liver metabolize and store

A

Fat, CHO, PRO, vitamins and minerals

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3
Q

Lobes of the Liver

A

Functional units of the liver. made of hepatocytes arranged around a central vein. One of only cells that can regrow and regenerate. Can regrow from healthy liver tissue

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4
Q

Cutfirst cells

A

Line inner liver capillaries (sinusoids). Responsible for removing bacteria from blood

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5
Q

Portal circulation

A

The portal circulatory system brings blood to the liver from the stomach, intestines, spleen, and pancreas

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6
Q

blood enters the liver through

A

the portal vein

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7
Q

the absorbed products of digestion

A

come directly to the liver and are sent to the lobules

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8
Q

portal circulation is

A

the first pass effect

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9
Q

Liver function tests

A

AST, ALT, alk phos

dont worry about them until over 150

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10
Q

Jaundice

A

caused by increased level of bilirubin in the bloodstream

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11
Q

Jaundice usually causes problems

A

Is noticeable with total bilirubin is greater than 2-2.5.

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12
Q

Jaundice look at

A

look at conjugated versus unconjugated to determine possible cause

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13
Q

what is jaundice

A

yellowish discoloration of skin and deep tissues

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14
Q

three classifications of jaundice

A

hemolytic, hepatocellular, obstructive

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15
Q

Hemolytic jaundice

A

from increased breakdown of RBCs

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16
Q

Hepatocellular jaundice

A

from liver unable to take up bilirubin from blood or unable to conjugate it

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17
Q

Obstructive jaundice

A

from decreased or obstructed flow of bile (gallstones)

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18
Q

Bilirubin

A

by product of heme breakdown - mainly hemoglobin

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19
Q

Direct

A

conjugated

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20
Q

Indirect

A

unconjugated

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21
Q

Elevations of indirect bilirubin

A

bilirubin overproduction or impaired liver functioning (hemolytic)

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22
Q

Elevations of direct bilirubin

A

liver working but cant get bilirubin out (obstruction, gallstones)

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23
Q

Jaundice clinical manifestations

A

darker urine
elevated liver enzymes
stools are normal or clay colored (depends on direct or indirect)
pruritis

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24
Q

Viral hepatitis

A

systemic virus that mainly affects liver - causes inflammation

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25
Various strains
HAV, HBV, HCV -- rarer viruses caused by Epsten-Barr, cytomegalovirus
26
Hepatitis can occur from other causes
Alcohol abuse, drugs, chemical, bacteria
27
Viral Hepatitis Pathogenesis
Viral infection > Immune response: inflammatory mediators > Lysis of infected cells > Edema and swelling of tissue > Tissue hypoxia > Hepatocyte death! -- Liver failure
28
Clinical manifestations of viral hepatitis
Similar between all types Many are asymptomatic - but can range from none to mild to liver failure causes abnormal elevated LFTs - but NOT consistent with cellular damage within the liver - trend and know patient
29
Prodromal phase
2 weeks after exposure fatigue, anorexia, malaise, nausea, vomiting, HA hyperalgesia, cough, low grade fever HIGHLY transmissible
30
What is hyperalgesia
increased sensitivity to pain
31
Icteric phase
begins with jaundice, dark urine, clay-colored stools liver enlarged and may be painful to palpation fatigue abdominal pain persists or increases in severity
32
Recovery
resolution of jaundice 6-8 weeks after exposure, symptoms diminish Liver remains enlarged/tender
33
Complications of viral hepatitis
most most patients recover completely with no complications overall morbidity less than 1% - higher with elderly and comorbidities
34
complications of viral hepatitis
chronic hepatitis - prolonged damage liver cirrhosis liver cancer fulminant viral hepatitis - acute liver failure
35
Hepatitis A
Food born - transmission fecal-oral, parental, sexual acute onset with fever usually mild severity does NOT lead to chronic hepattis usually affects children and adult Hand hygiene, HEP A vaccine
36
Hepatitis B
Parental, sexual insidious onset severe disease, may be prolonged course or develop into chronic (10%) any age group affected HBV vaccine and safe sex and hygiene
37
Hepatitis C
parental, sexual, mother to baby insidious onset mild to severe symptoms can develop into chronic hepatitis (80%) any age affected screening blood, hygiene, no vaccine leads to hepatocellular carcinoma or liver transplant
38
Hep A series vaccines
2 doses 6 months apart recommended for children at 12 months or special "high risk" populations
39
Hep B vaccination
3 doses at least 4 months apart recommended for all infants beginning as newborns
40
Hep C vaccination
No vaccine
41
Pharm for HBV
Two classes of drugs Interferons Nucleoside analogs
42
Treatment of HBV
for Chronic Only for high risk patients
43
who are high risk patients
increased AST levels hepatic inflammation advanced fibrosis
44
disadvantages of treatment
prolonged therapy costs and adverse effects high relapse**
45
Considerations for Pharm for HCV
Treatment is only recommended for patients with chronic disease, however this thought process is changing with the evolution of newer, very effective drugs. Now easily treatable and eliminated in most patients.
46
Pharm for HCV
Treated with direct-acting antiviral therapy and interferon-based regiments. (may also require a nucleoside analogue medication).
47
Drugs not on Matrix
Pegylated interferon-alpha Ribavirin Entacavir Tenofovir alafenamide Sofosbuvir Daclatasvir Expensive and lots of side effects!
48
Tylenol?
Recommended <2g a day
49
Serious end stage
Don't take Tylenol or NSAIDS
50
Cirrhosis
Irreversible, inflammatory, fibrotic liver disease structural changes from injury and fibrosis
51
Chaotic fibrosis leads
to obstructive biliary channels and blood flow -- jaundice and portal hypertension
52
Regeneration disrupted by
hypoxia, necrosis, atrophy, and liver failure
53
Cirrhosis common causes
Hepatitis B and C Excessive alcohol intake Idiopathic Non-alcoholic fatty liver disease (NASH, NAFLD)
54
Alcoholic cirrhosis is
most common type but only accounts for 25%
55
Alcoholic liver disease has
various stages/spectrum
56
Alcoholic fatty liver
mildest, asymptomatic, reversible
57
Alcoholic steatohepatitis
precursor to cirrhosis inflammation, degeneration of hepatocytes stimulating irrevirsible anorexia, edema, jaundice
58
Alcoholic cirrhosis
fibrosis and scarring alter liver structure
59
Cirrhosis pathogenesis - 7 steps
Liver cells destroyed cells try to regenerate disorganized process abnormal growth poor blood flow and scar tissue hypoxia liver failure
60
Early manifestations cirrhosis
slow/insidious Gi disturbances - N/v, anorexia, flatulence, change in bowel habits fever, weight loss palpable liver
61
Late manifestations cirrhosis -9
jaundice ascites endocrine problems peripheral edema (lose albumin) skin lesions esophageal and anorectal varices decreased albumin and PT hematologic problems (bleeding/anemia) encephalopathy (can't clear toxins)
62
Portal hypertension
resistant portal blood flow leads to varices and ascites (blood can't flow freely)
63
cause of portal hypertension
systemic hypotension, vascular underfilling, stimulation of vasoactive (RAAS system), plasma volume expansion, increased cardiac output -- causes varices
64
symptoms of portal hypertension
asymptomatic until complications variceal hemorrhage, ascites, peritonitis, hepatorenal syndrome, cardiomyopathy
65
hepatic encephalopathy
30-45% of cirrhosis patients
66
primary driver of diagnosis
LOC
67
Hepatic encephalopathy graded
Based on severity. Grade 1 is changes in behavior, mild confusion, slurred speech, disordered speech. Grade 4 is coma, unresponsive to pain
68
Hepatic encephalopathy is
correlated with liver labs- mainly ammonia that is primary chemical driver of LOC changes but diagnosis is not BASED on ammonia
69
Acute liver failure also called
fulminant liver failure
70
acute liver failure is
NOT caused by cirrhosis or other type of liver disease
71
Most common cause of acute liver failure
acetaminophen overdose - treated with acetylcysteine
72
patho of acute liver failure
edematous hepatocytes and patchy areas of necrosis and inflammatory cell infiltrates and disrupts the liver tissue
73
acute liver failure can happen
6-8 weeks after a viral hepatitis or metabolic liver disease -- 5-8 weeks after an acetaminophen overdose
74
signs of acute liver failure
similar to cirrhosis symptoms
75
acute liver failure treatment
not much, liver transplant

Nur 326 (6 decks)

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