hepatic disorders Flashcards by Amanda S.

largest gland

liver

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blood supply to liver

portal vein, and it’s unoxygenated. gets oxygenated blood from hepatic artery.

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functions of the liver

Bile production and excretion
Excretion of bilirubin, cholesterol, hormones, and drugs
Metabolism of fats, proteins, and carbohydrates
Enzyme activation
Storage of glycogen, vitamins, and minerals
Synthesis of plasma proteins, such as albumin, and clotting factors
Blood detoxification and purification

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fats break down into

ketones

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albumin

without it leaking

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ammonia?

ammonia conversion to urea

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liver can store how much blood?

1 liter

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liver Storages what vitamins?

Storage-fat-soluble vitamins (A,D, E, K) and minerals

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Synthesis of

Synthesis-serum proteins, phospholipids, cholesterol, clotting factors

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liver immunity (my kupffer is immune to my liver)

filters blood via Kupffer cells

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increased resistance within the portal venous system results in

decreased blood flow through and out of the liver. Collateral circulation develops to help relieve pressure. doesn’t help splanchnic (digestive) circulation.

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blood backed up in the livers backs up in

splenic vein and collaterals

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portal HTN will cause (varicose)

varices in GI tract and rectum (hemorrhoids)

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portal HTN - symptoms (just if the liver doesn’t work) and what do ppl look like?

Hepatomegaly, splenomegaly
Esophageal, gastric, rectal varices (hemorrhoids)
Alterations in
Production & secretion of bile
can’t process CHO, protein, lipid fat (skinny arms and legs, big belly) metabolism
can’t clear Hormones
Detoxification

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liver labs

if liver problems - Enzyme elevation
ALT, AST, alkaline phosphatase
Bilirubin elevations
Total , indirect, direct, urine bilirubin
Protein reduced
Serum albumin, total protein low
Ammonia elevated
Coagulation prolonged PT, PTT, INR

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liver diagnostics (tips for the liver)

Liver biopsy
TIPS (rerouting)
Paracentesis
CT
MRI
PET (for liver cancer)

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gall bladder diagnostics (Erp is a good gal)

MRCP
ERCP
Ultrasonography
Cholesintigraphy
Cholangiography (dye into ducts to view biliary tract)

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liver problems - exam for resp CV renal

fluid volume deficit (3rd spacing) - flat neck veins - fluid leaks out
Edema (crackles)
Adventitious BS
BP low, pulse - high and weak
BUN, Cr, urine sodium, UO, and I & O (hepatorenal syndrome, low survival rate and can’t get a transplant)
put them in reverse trendelenberg

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liver disease - neurologic

GCS (hepatic encephalopathy) aspiration
MS
Coordination
Reflexes
Movement
Seizures

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liver disease - GI assessment

N, V, anorexia
Diarrhea or constipation, color of stool, volume, consistency
Lactulose?
Ascites- enlarging abd girth, abd fluid wave, ***if fluid it will be dullness on percussion, protruding umbilicus, assess BS, visible collateral veins on abdominal wall
Bleeding esophageal varices, CBC, hematemesis, melena
Hepatic tenderness and enlargement

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liver problems - integumentary system (liver spiders and medusa)

Jaundice
Pruritus
Spider angioma (red and purple marks)
Edema
Dry, flaky skin
Poor skin turgor
Caput medusa (circulation around belly button)
Poor wound healing, ecchymosis, petechiae, bleeding gums

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NAFLD (non-alcholic fatty liver disease)

Steatohepatitis (fatty hepatitis)
Accumulation of fat in liver causes scarring and damage leading to liver failure

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NAFLD - symptoms (just 3, fatty liver is FAR)

Symptoms include RUQ pain, fatigue and anorexia

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NAFLD - risk factors (Kel and predinsone make my liver not fat)

Gastric bypass surgery, hyperlipidemia, rapid weight loss, obesity, toxic chemicals, medications
Prednisone, amiodarone, tamoxifin, diltiazem, methotrexate

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cirrohosis

Liver cells are destroyed and replaced by connective/scar tissue that alters circulation/flow within the liver. Diffuse, fibrotic changes Destruction of hepatocytes Congested/obstructed flow Blood, lymph, bile Chronic & progressive All body systems are affected Can progress to hepatic encephalopathy/coma. only cure is transplant.

general s/sx of cirrohosis - breathing?

Firm nodular liver to palpation Abdominal pain RRQ Chronic dyspnea, Change in bowel habits Anemia/ bruising SGOT/AST and SGPT/ALT rise

early s/sx of cirrhosis (pain in RUQ and gi problems cirrose early in the morning)

Generalized weakness, malaise RUQ pain Wt. loss, A/N/V, flatulence, GI disturbances, indigestion, change in BM

late s/sx of cirrhosis (spiders cirrhose late at night)

Change in mental status, memory Spider angiomas (face, neck, shoulders) , jaundice, esophageal varices, GIB, ascites edema Coagulopathy, bruising, thrombocytopenia Splenomegaly, hepatomegaly Peripheral neuropathy

lanecc's cirrhosis (lance the drinker has cirrhosis)

ETOH induced, about 20% of alcoholics develop

billiary obstruction cirrhosis

Retention of bile/inflammation of ducts-jaundice Obstruction of common bile duct

post necrotic cirrhosis (art has necrosis)

hepatic artery is blocked and causes necrosis. shock or trauma.

cardiac passive congestion d/t CHF cirrhosis

scar tissue forms

metabolic cirrhosis (glycogen is metabolic)

glycogen storage disease, wilson's disease (copper)

primary cirrhosis (it's primary autoimmune for cirrhosis)

autoimmune disease destroys bile ducts, usually middle-aged women. main complaint is fatigue and they are jaundice.

atrophic/hypertrophic cirrhosis (it's in the name)

decrease in size, or connective tissue hyperplasia

treatment for cirrhosis - and avoid what meds (bummer if you get cirrohsis)

Antacids, vitamins and diuretics (neutralize stomach acid) NO MORE ALCOHOL Avoid narcotics I & O and daily weights REST Prevent bleeding Measure abdominal girth Monitor jaundice Good skin care

cirrhosis diet (think - too much hurts the brain)

Diet Decrease protein Low sodium

cirrhosis causes (coag in the vein causes cirrhosis)

hypercoagulability in the portal vein

Esophageal Varicies

Most common portal HTN

Esophageal Varicies - Pathophysiology

Portal HTN >obstruction > collateral circulation in esophagus/venous > increased pressure > ulceration and hemorrhage

esophageal varicies - Assessment - what does vomit look like?

Hematemesis, melena, hepatic encephalopathy, dilated abdominal veins, ascites Endoscopy, ultrasound

esophageal varicies - treatment

Fluid resuscitation, correct coagulopathies, sclerotherapy, banding, Sengstaken-Blakemore tube, vasopressin, TIPS, Warren Shunt, Partial Mesocaval Shunt

shunt

where it orginates is first word, and where it ends is the last word.

ascites

Increase in hydrostatic pressure & lymph formation

ascites - 2 main causes (think pressure)

portal HTN and decreased colloid osmotic pressure. Then Na retention and the kidneys get involved causing hepatorenal syndrome

ascites - s/sx - what about flanks?

Bulging flanks, protruding umbilicus, fluid wave, shifting dullness to percussion

ascites - treatment

Sodium restriction, diuretics, aquaretics (vasopressin V2 receptor agonists), water restriction, administration of albumin/colloids, therapeutic paracentesis, TIPS (transjugular intrahepatic porto systemic shunt, automated low flow pump system (Alfapump)

Hepatorenal Syndrome (HRS) - type 1 (#1 dies fast and first)

Severe rapidly progressing renal failure with a doubling of creatinine in 2 weeks Usually follows a precipitating event Most patient die within 2 weeks of onset

Hepatorenal Syndrome (HRS) - type 2 (too (2) slow)

Slower, chronic, more progressive increase in creatinine Patient exhibit signs of liver failure and arterial HTN Severe ascites refractory to diuretics Predisposed to developing Type 1

hepatorenal syndrome - s/sx (basic renal stuff)

Clinical characteristics Presence of liver failure Decreased GFR Reduced urine sodium Azotemia (high BUN) Oliguria or anuria High BUN/creatinine ratio

Hepatic Encephalopathy

Protein-breaks down to ammonia-liver converts to urea-excreted by kidneys

hepatic encephalopathy - s/sx (smell and energy level?)

***more and more sleepy over time. reflexes go down. Slow EEG. Foul odor - fetor. AMS, alteration in behavior, LOC changes

hepatic encephalopathy - causes

Infection, elevated protein intake, worsening hepatic function, constipation, azotemia, GI bleeding, hypovolemia, hypoxia, CNS depressants, overuse of diuretics

hepatic encephalopathy - stages 1 - 4 (don't need to memorize this)

1 - mild confusion 2 - lethargy, blindness 3 - incoordination, inactive but arousable 4 - coma, death, unresponsive

hepatitis A (A fecal)

Transmission through fecal-oral route High risk groups

hepatitis patho

Inflammation of the liver caused by a viral infection or toxins Inflammatory cells/fluid/lymphocytes > congestion > enlargement > distortion of lobular pattern > necrosis Distortion > increase pressure > portal HTN Edema of bile channels > increased bilirubin

hepatitis B (B sexually active, or virus)

DNA virus Sexually transmitted, perinatal, blood. treatment Interferon, lamivudine

Hep C

Blood, sexually, perinatal. treatment Interferon, ribavirin

need to know this - stages of hepatitis (pre ick, post)

Preicteric, Icteric, Posticteric

preicteric (P for preicteric, P for prodromal)

Prodromal (infection to start of signs and symptoms) One week Flu like Malaise, fatigue, H/A, myalgia A/N/V, diarrhea, low-grade fever, conjunctivitis, cough Aversion to odors, avoidance of protein foods Elevated LFT’s Severe Urticaria, rashes, polyarthritis, arthralgia

icteric (Ick, you have jaundice for 4 weeks?)

starts with jaundice. 4-6 week Jaundice, dark urine, light colored stools Tender enlarged liver Elevated LFT’s Severe puritis Preicteric symptoms subside

Posticteric - how long? (think of mom at 4)

recovery. Up to four months

transplant criteria

End-stage organ failure Short life expectancy Severe functional disability No other serious health problems Psychological readiness Support in place

hepatic disorders Flashcards

(63 cards)