Hepatic Flashcards
Anatomy and physiology of the liver
- Largest gland of the body
- Located in the upper right abdomen
- Very vascular organ that receives blood from GI tract via the portal vein and from the hepatic artery
What are the metabolic functions of the liver?
- Glucose, protein, fat, drug metabolism
- Ammonia conversion
- Vitamin and iron storage
- Bile formation
- Bilirubin excretion
These functions are essential for maintaining overall body metabolism and homeostasis.
How is glucose metabolized in the liver?
After meals glucose is taken up from portal venous blood by liver > converted to glycogen > stored in hepatocytes as glycogen > when needed glycogenolysis converts back to glucose
How is ammonia converted in the liver?
Amino acids broken down during gluconeogenesis produce ammonia by-product converts to blood urea and is excreted in urine
What is required for protein to be metabolized in the liver?
Vit K required by liver to synthesize prothrombin (protein) and other clotting factors
How is fat metabolized in the liver?
- Fatty acids used for energy & ketone bodies when glucose is limited (starvation or uncontrolled DM)
- Synthesis of cholesterol, lecithin, lipoproteins, and other lipids
How is bile formed in the liver?
formed continuously, bilirubin from breakdown of RBC is stored in Gallbladder and emptied into intestine for digestion of fats
What are common clinical manifestations of hepatic disorders?
- Jaundice
- Portal vein hypertension
- Ascites
- Varices
- Nutritional deficiencies
- Hepatic encephalopathy or coma
These manifestations indicate significant liver dysfunction and require careful assessment.
What is the significance jaundice (yellow- or greenish-yellow sclera and skin)?
Inidicates increased serum bilirubin levels exceeding 2 mg/dL?
Jaundice can be classified into hemolytic, hepatocellular, and obstructive types.
What are the types of hepatitis and their routes of transmission?
- Hepatitis A: fecal–oral route
- Hepatitis B: bloodborne, sexual contact
- Hepatitis C: bloodborne, sexual contact
- Hepatitis D: only in those with Hepatitis B
- Hepatitis E: fecal–oral route
Hepatitis G and GB virus-C are also noted but less commonly discussed.
What are the key components of a liver function study?
- Serum aminotransferases (AST, ALT, GGT)
- Serum protein studies
- Direct and indirect serum bilirubin
- Urine bilirubin and urobilinogen
- Clotting factors
- Serum alkaline phosphatase
- Serum ammonia
- Lipids
These tests help assess liver cell injury and function.
What do serum aminotransferases (AST, ALT, GGT) indicate on a liver function test?
injury to the liver cells; useful in detecting hepatitis
What dietary recommendation is made for patients with ascites?
Low-sodium diet (<2g or <500mg in extreme cases)
This helps reduce fluid retention associated with portal hypertension.
What is the primary treatment for hepatic encephalopathy?
Lactulose to reduce serum ammonia levels (normal range 15-45 mcg/dL)
Other treatments include managing electrolyte imbalances and protein restriction.
What are signs and symptoms associated with hepatocellular jaundice?
- Mild or severely ill
- Lack of appetite
- Nausea or vomiting
- Weight loss
- Malaise, fatigue, weakness
- Headache, chills, fever
These symptoms indicate liver dysfunction and require further evaluation.
What are signs and symptoms of obstructive jaundice?
- Dark orange-brown urine, clay-colored stools
- Dyspepsia and intolerance of fats, impaired digestion
- Pruritus (itchy skin)
What assessment techniques are used in patients with liver alterations?
- Health history
- Physical assessment
- Skin examination
- Cognitive status evaluation
- Palpation and percussion
These assessments help in identifying liver dysfunction and its complications.
What are the complications associated with portal hypertension?
- Ascites
- Esophageal varices
Increased pressure in the portal venous system can lead to significant morbidity.
What is the primary goal of nursing management for patients with ascites?
Assess the progression and/or response to treatment
This includes monitoring intake and output, abdominal girth, daily weight, and lab values.
What medications are used to treat ascites?
Spironolactone (K+ sparing) or furosemide (cautiously); Can cause further hypovolemia
What procedures can be done to treat ascites?
- Paracentesis (Removal of fluid from peritoneal cavity; 5-6L is safe range)
- Transjugular intrahepatic portosystemic shunt (TIPS): creates shunt between portal circulation and hepatic vein.
What is the mortality rate of the first bleeding episode in patients with esophageal varices?
10% to 30% depending on severity
This highlights the critical nature of managing varices in cirrhosis patients.
What is the initial treatment for bleeding esophageal varices?
- Treat for shock; administer oxygen
- IV fluids, electrolytes, volume expanders, blood and blood products
- Vasopressin, somatostatin, octreotide to decrease bleeding
- Nitroglycerin (isosorbide) in combination with vasopressin to reduce coronary vasoconstriction
What are the manifestations of Hepatitis A?
- Mild flu-like symptoms
- Low-grade fever
- Anorexia
- Jaundice
- Dark urine
- Indigestion
- Enlargement of liver and spleen
These symptoms can appear after an incubation period of 2 to 6 weeks.
