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546 Body Systems 2 > Hepatic/Renal > Flashcards

Hepatic/Renal Flashcards

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1
Q

liver functions

A

aid in digestion with bile production
waste removal from the blood
+500 functions

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2
Q

where is pain in the liver perceived in the body?

nerves involved?

A

R shoulder
R midback
from greater splanchic and phrenic nerves

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3
Q

basic cause of liver disease

A

buildup of waste, fats blocking flow and leading to scarring

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4
Q

bile function

A

increase fat absorption
absorb fat soluble vitamins
excrete bilirubin

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5
Q

bile ducts anatomy

A

bile drains from liver into the common hepatic duct, where it is stored then drains out of the cystic duct, combining with the common hepatic duct to form the common bile duct leading into the SI

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6
Q

gallstones are:

A

hard cholesterol plaque buildups

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7
Q

complications of gallstones

A
  • can block bile duct causing pain/nausea/vominting/jaundice
  • cholecystitis: acute/chronic, R UQ pain into R shoulder and midback
  • pancreatitis
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8
Q

pancreatitis

A

inflammation/infection of the pancreas
often caused by gallstones, alc abuse
acute or chronic

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9
Q

pancreatitis s/s

A

midback and L shoulder pain, nausea, vomiting, greasy stools, tachycardia
worse in supine, better sitting up/forward

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10
Q

most common injury to liver

A

hepatitis

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11
Q

liver damage affects what body systems?

A

integumentary: nails, skin, bruising, edema, itching
MSK: thoracic, R shoulder, interscapular, subscapular pain, osteoporosis, vertebral wedge fractures, ankle, wrist pain
Neuro: confusion, tremors, hyperreflexia
GI: nausea, vomiting, anorexia, fullness

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12
Q

clinical presentation of liver disease

A

neuro: confusion, tremors, asterixis, sleep disturbance
MSK: R shoulder pain
integumentary: jaundice, itch, bruising, clubbing
hepatic: dark urine, stool color change, edema, oliguria, RUQ pain, ascites

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13
Q

asterixis

A

neuro presentation of liver disease where pt’s hand flaps when arm and wrist are fully extended

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14
Q

non alcoholic fatty liver disease

A

fat builds up in liver cells from unknown cause
- diagnosed when 5-10% of liver weight is from fat
associated with obesity and diabetes
asymptomatic until later stages

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15
Q

s/s of non alc fatty liver disease

A

fatigue, weakness, weight loss, loss of appetite, abd pain, jaundice, itching, LE edema, ac=scites, confusion

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16
Q

management of non alc fatty liver disease

A

weight loss 5-10% body weight
diet
exercise
GLP 1
reduce alc intake

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17
Q

hepatitis A transmission

A

fecal oral route through contaminated food/water or person to person

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18
Q

hep A s/s

A

extreme fatigue, anorezia, fever, arthralgia, clay color stool, RUQ pain, dark urine, jaundice, headache, altered smell/taste

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19
Q

hep A prevention

A

hand washing
immunization

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20
Q

hep B transmission

A

blood, body fluids, needle sticks, oral/sexual contact

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21
Q

hep B s/s

A

jaundice, arthralgia, rash, dark urine, anorexia, n/v, fever, painful abd bloating

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22
Q

hep B prevention

A

universal precautions
vaccine

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23
Q

Hep C transmission

A

blood, body fluids, needle sticks, oral sexual contact
needle sharing most common
also mother to baby

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24
Q

hep C prevention

A

no immunization, prevent with education and universal precautions

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25
chronic hepatitis
1/2 of hep C cases progress to chronic inflammation in the liver lasting 6+ months
26
s/s of chronic hepatitis
asymptomatic, or: fatigue, jaundice, abd pain, anorexia, arthralgia, fever, weakness, ascites, malaise, RUQ pain
27
cirrhosis
complication of liver disease due to irreversible scarring most commonly caused by hep C, second is alcoholism in US
28
risk factors for cirrhosis
alc abuse, hep B/C, fatty liver disease
29
complications of cirrhosis
edema ascites hepatic encephalopathy liver cancer progression: can block flow of nutrients and blood in/out of the liver
30
management of cirrhosis
fluid balance vitamin/electrolyte replacement diet bx mod paracentesis liver transplant
31
s/s of cirrhosis
weight change fatigue jaundice LE edema, anorexia, n/v fever, decreased urine output, bowel changes, GI bleeding, alterned mental status, RUQ pain, weakness, fever
32
PT considerations for cirrhosis
avoid valsalva don't push to point of fatigue monitor changing s/s
33
complications/progressions of cirrhosis can lead to:
esophageal varices due to increased pressure throwing up dried blood spleen enlargement blockage of portal vein, HTN increased risk of liver cancer
34
causes of portal vein HTN
cirrhosis liver scarring and fibrosis chronic alcoholism blood clots
35
s/s of portal vein HTN
GI bleeding blood in stool vomitig blood ascites encephalopathy reduced blood count splenomegaly
36
Wilson's disease
impaired copper removal affecting liver and brain teens-early 20s equal men/women
37
s/s of wilson's disease
jaundice, LE edema, ascites, fatigue, brusiing, tremors, involuntary mvmt, dysphagia, spasticity, impaired coordination, rigidity, psych symptoms, asterixis, parkinsonism
38
hemochromatosis
rare genetic disorder causing liver failure excess iron builds up in the body and is stored in the liver men over 40 and women post menopause
39
hemochromatosis s/s
fatigue, abd pain, memory fog, heart palpitations, irregular heartbear, arthralgia, hair loss, vertigo complications include: OA, osteoporosis, cirrhosis, cancer, bronze skin color, CHF, diabetes, hypothyroid, hormone imbalance
40
hepatic encephalopathy
when liver cannot filter out toxins due to liver disease, failure, dehydration, constipation, infection leads to increased ammonia levels causing impaired mental status temporary until ammonia levels decrease
41
west-haven criteria of altered mental status in hepatic encephalopathy
0: normal 1: short attn span, change in confusion, depressed, asterixis, slurred speech 2: disorietned, innappropriate, lethargy, facial grimace, asterixis, muscle tone, apraxia 3: disoriented, bizarre behavior, confusion, rigidity, clonus, hyperreflexia, Babinski 4: coma, response to pain only, decerebrate posture
42
liver cancer frequency, risk factors
freq: mainly from liver mets leading cause of death due to liver disease risk factors: Hep C, hep B, alcohol
43
s/s of liver cancer
RUQ< R scap, back pain, unexplained weight loss, hard lump under R ribs, overall muscle weakness, progressive full health, liver function impaired once 80% replaced w cancer
44
liver transplant
treatment for end stage liver disease requires life long immunosuppressants which can cause diabetes, HTN, high cholesterol, osteoporosis, kidney/GI issues post op infections also a risk
45
liver transplant precautions
infection/rejection risk - contact precautions bacterial common post op, viral months later respiratory complications post op neuro complications lifting restrictions x6 weeks diaphragmatic breathing log roll hygiene drains/catheter location for mobilization OH mental status valsalva cognition
46
outpatient liver transplant precautions
postural correction for kyphosis scar adhesions contributing to flexed posture functional activties to restore ADL independence poor balance/coordination HTN, immunosuppression, osteoporosis, lifting restrictions, AMS
47
immediate MD referral in liver transplant pt
new onset myopathy - sign of liver and renal impairment hepatic disease signs - esp if prior cancer/hepatitis arthralgia - unknown cause asterixis neuropathy new onset
48
respiratory acidosis
caused by hypoventilation, chest trauma, pulmonary edema, CHF, COPD, obstructive disorders causing CO2 to be retained
49
s/s of respiratory acidosis
headache, visual disturbance, confusion, drowsiness, temor, asterixis, depressed DTR, hyperkalemia
50
metabolic acidosis | causes
caused by diabetic ketoacidosis, diarrhea, renal failure, shock, sepsis, lactic acidosis
51
s/s of metabolic acidosis
bicarb deficit, hyperventilation, headache, mental dullness, deep respiration, stupor, coma, hyperkalemia, tachycardia, cardiac arrhythmia
52
metabolic alkalosis | causes
caused by loss of gastric secretions, antacids, diuretics, hypervolemia, CHF, cirrhosis, cushings
53
metabolis alkalosis s/s
headaches, lethargy, tetany, depressed respirations, mental condusion, dizziness, seizure, hypokalemia, cardiac arrhythmia
54
respiratory alkalosis
caused by hyperventilation due to anxiety, altitude, high altitude, pregnancy, fever, hypoxia, pneumonia, PE, sepsis, liver disease, hyperthyroidism
55
respiratory alkalosis s/s
hypocapnia, lightheaded, parasthesia, cramps, syncope, tetany, conculsions, hypokalemia, cardiac arrhythmia
56
how are kidneys involved in acidosis/alkalosis
bicarb is a base, and kidneys regulate its levels in the blood dysfunction can lead to metabolic acidosis/alkalosis also regulate pH by controlling H+ release into urine
57
most common causes of kidney disease
DM and HTN
58
renal failure (AKI)
kidneys cannot filter toxins and waste from the blood adequately
59
AKI s/s
asymptomatic or: sudden decline, oliguria, retaining sodium, anemia, change in mental status reduction in urine output, confusion, n/v, edema, fatigue
60
PT considerations for AKI
strict fluid monitoring frequenct bathroom breaks urine output measurement is critical
61
causes of AKI
hypoperfusion from HF, dehydration, surgery; obstruction from kidney stones, clots; kidney damage from trauma, infections, meds, ingested toxins
62
AKI treatment
diuretics, reverse underlying cause, temporary dialysis
63
chronic kidney disease
AKI can lead to CKD involves: glomerulonephritis - inflamed filtering units polycyustic kidney disease - genetic obstruction - stones, tumors, enlarged prostate UTI - affects kidneys when urine backflow enters ureters and kidneys lupus
64
risk factors for CKD
HTN DM heart didsease family hx obesity smoking age 60+
65
s/s of CKD
fatigue, lethargy, headacje, trouble conc, poor appetite, cramps, trouble sleeping, ankle edema, puffiness around eyes, dry skin, nocturia, peripheral neuropathy, pulmonary edema, bruising, seizures, coma
66
kidney cancer
renal cell carcinoma stages 1: <7cm 2: > 7cm 3: lymph, blood, renal system spread 4: mets to organs and distant lymph nodes
67
s/s of renal cancer
blood in urine, lump in abdomen, lateral side pain, loss of appetite, weight loss, anemia
68
risk factors for renal cancer
smoking misuse of pain meds overweight HTN family hx most 45+ y/o
69
stages of kidney disease
1: normal fx, 90% kidney functional 2: 60-89% functional kidney, mild loss 3: 30-59% functional kidney, mod loss, may need dialysis 4: 15-29% functional kidney, severe loss, requires dialysis 5: 15% kidney failure requiring treatment to live
70
hemodialysis
pts given permanent fistula, dialysis 3-4x week, 3-5 hours a session
71
peritoneal dialysis
uses abdominal cavity and can be done at home while sleeping cannot be treated at a SNF
72
PT implications for dialysis
fatigue - reduce intensity, rest breaks monitor OH no BP on shunt side monitor for infection monitor for peritonitis strengthening and CV fitness extended warm up and cooldown
73
s/s of fluid imbalance
dehydration: thirst, weight loss, poor skin turgot, dry mouth, no sweating, increase body temp, low urine, OH, dizzy staning, confusion fluid excess: decreased mental alertness, sleepiness, anorexia, poor motor coordination, confusion, sudden weight gain, convulsions, warm moist skin
74
K lab value
3.5-5.5
75
Na lab value
135-146
76
Ca lab value
8-10
77
Mg lab value
1.8-2.4
78
screening for organ involvement
SLR negative w back pain back pain in women w history of cancer changing body position doesn't relieve pain change in body position by SB to involved side is more comfortable constitutional symptoms
79
pain referral from kidney
UL pain flank into lower quadrant pressure on diaphragm causing ipsilateral shoulder pain dull, achy, boring, vague, constant dermatomes T9-10 abdominal spasms not relieved by changing position
80
immediate MD referral for kidney pt
blood in urine back or shoulder pain with abnormal urinary symptoms murphy's percussion +, esp w recent renal infection

546 Body Systems 2 (8 decks)

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