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Flashcards in Hepatic System Deck (56):
1

Hepatic Portal System

1. sm intestine absorbs products of digestion
2. Nutrient molecules travel in hepatic portal vein to liver
3. liver filters/cleanses blood content
4. blood enters general circulation by way of hepatic ven

2

Liver is responsible for:

-filtering all blood from GI system (toxins out)
-convert and excrete bilirubin
-provide albumin & other plasma proteins
-produce clotting factors
-store vitamins
-absorbs/metabolizes nutrients
-metabolize & eliminate toxins/drugs

3

Bilirubin

-breakdown product of hemoglobin

4

Aging and Hepatic System

-decreased liver function
-decreased liver enzymes
-decreased blood to liver
-increased fibrosis of liver

5

Liver Enzymes

-Aspartate Transaminase (AST)
-Alanine Transaminase (ALT)
-Gamma-Glutamyl Transpeptidase (GGTP)

6

Liver Healing

-parenchymal cells renew slowly and can renew after tissue loss
-if unable to renew-->scar tissue/fibrosis
-healing impacted by age, nutrition, vascular supply

7

Ex of Liver Patologies

-Jaundice
-ascites
-hepatitis
-cirrhosis
-liver neoplasms
-portal hypertension
-hepatic encephalopathy

8

Most common S/Sx of liver disease

-GI symptoms
-edema/ascites
-neurologic changes
-abdominal pain (RUQ)
-back/R shoulder pain
-Jaundice
-skin changes
-skin changes
-pruritis
-light colored stools
-dark-colored urine
-osteodystrophy
-coagulopathy

9

MSK Pain with Hepatic Disease

-T spine pain (between scap)
-R shoulder
-R UT
-R interscapular areas
-R subscap areas

10

Skin S/Sx Hepatic Disease

-pallor
-jaundice
-orange skin
green skin
-bruising
-spider angiomas
-palmar erythema or "liver palms"

11

Normal Bilirubin

0.1-1.0 mg/dL

12

Jaundice

-sign of hyperbilirubinemia
-yellow discoloration of skin/sclerae
-liver/gallbladder disorders

13

Jaundice Causes

-increased destruction of RBC
-damaged liver cells
-bile duct obstruction or dysfunction

14

Management of Jaundice

-refer to doc
-treat underlying cause
-resolves in 4-6 weeks
-exercise after jaundice is gone
-ex's to tolerance
-can walk/do functional activities with jaundice

15

Ascites

-presence of excess fluid in peritoneal cavity
-from portal hypertension (fluid leaks out into abdominal cavity

16

Ascites Management

-restrict Na+
-diuretics
-restrict fluid
-Therapeutic paracentesis
-monitor electrolytes

17

PT Implication of Ascites

-high Fowlers position most comfortable
-breathing techniques
-monitor signs of infection
-prevention of ulcers
-monitor fluid retention in LE
-fluid intake/output measured & restricted

18

Hepatitis

-acute/chronic liver inflammation

19

Risk Factors of Hepatitis

-unprotected sex
-injection/drug abuse
-health care workers
-living with family members with hepatitis
-travel to areas with high incidence of hepatitis
-tattoo inscription/removal
-blood clotting disorder
-blood transfusion
-liver transplant recipient
-compromised immune system

20

Types of Hepatitis

-Chronic (6 months+)
-Fulminant
-Viral (A, B, C, D, E, G)
-Toxic
-Autoimmune (idiopathic)
Alcoholic (acute/chronic)

21

Fulminant Hepatitis

-rapidly progresses and becomes hepatic encephalopathy

22

Toxic Hepatitis

-exposure to alcohol, chemicals, drugs etc

23

Types of Viral Hepatitis

-A, B, C, D, E, G

24

Hep A

-transmitted by oral-fecal route

-vaccine
-treat w/ immunoglobulins

25

Hep B

-transmitted percutaneously or through mucosal contact
-Considered an STD

-vaccine
-treat with interferon

26

Hep C

-associated with injection drug use

-no vaccine
-treat with interferon

27

Hep D

-only individuals with HBV are at risk for HDV--superinfection of Hep B

-vaccine
-treat with interferon

28

Hep E

-transmitted through contaminated water-oral/fecal route

-vaccine
-treat: prevention only

29

Hep G

-Most prevalent in African countries

30

Prevention/Management of Hepatitis

-prevent infection/toxins
-lifestyle changes
-vaccines
-medications: interferons, immunoglobulins, ribovirin
-rest to recover energy
-energy conservation/time management
-activities to prevent loss of flexibility/strength
-liver transplant

31

Cirrhosis

-scarring of liver that involves formation of fibrous tissue associated with destruction of normal architecture of organ

32

Cirrhosis is the result of:

-long-standing injury
-most commonly due to alcohol
-hepatitis C is another common cause

33

Cirrhosis S/Sx

-fatigue
-pruritis
-jaundice
-clubbed, white nails
-darkening of skin
-fluid retention in legs/abdomen
-abnormal blood vessels (caput medusae)
-easy bruising
enlargement of breats in men

34

Late stage S/Sx Cirrhosis

-vomiting blood (ulcers/leaking varicose veins in esophagus)
-require emergency care

35

Management of Cirrhosis

-medication (early stages)
-exercise
-energy conservation
-time management
-treatment of other symptoms

36

Cirrhosis may cause:

-osteoporosis 2* to impaired osteoblastic activity

37

Life Expectancy of Cirrhosis

-5-10 years after diagnosis

38

Portal Hypertension:

>25mmHg

39

Normal Portal Pressure

3-5mmHg

40

Portal Venous System carries blood from_____ to the ______

-GI, gallbladder, pancreas, spleen
-to liver

41

Portal HTN: if there is a blockage or resistance to flow the blood backs up_____

-into GI tract and pools in spleen

(new collateral channels equilize pressure)

42

Varices

-distended, tortuous veins

43

Splenomegaly

-enlarged spleen
-caused by pooling of blood

44

Management of Portal HTN

-management of Sx
-liver transplant
-stent and or shunt (TIPSS)
-education to reduce intra-abdominal pressure by PT

45

Other S/Sx of Hepatic Disease

-dark urine (abnormal excretion of bile)
-light-colored/clay-colored feces (lack of bile in stools)
-pruritis (accum of bile salts in skin)
-RUQ pain

46

Neurologic Sx of Hepatic Disease

-confusion
-sleep disturbances
-muscle tremors
-hyperactive reflexes
-asterixis (flapping tremor)

47

liver dysfunction increases:

-serum ammonia & urea levels

-->impaired nerve and brain function

48

Asterixis

-inability to mntn wrist extension with forward flexion of upper extremities
-altered neurotranmission in reticular formation alters movement
-may be seen in any skeletal muscle including tongue

49

Management of Hepatic Encephalopathy

-reduce protein intake
-antibiotics
-bowel cathartic
-peritoneal dialysis
-liver transplant
-PT (like neuro pt)

50

Hepatic Osteodystrophy

-abnormal bone development
-bone pain with osteomalacia/porosis

51

Cause of Hepatic Osteodystrophy

-production (osteoblastic) defect rather than excessive resorption

52

Hepatic Osteodystrophy can cause:

-vertebral wedging
-vertebral crush Fx
-kyphosis
-decalcification of rib cage
-pseudofractures

53

Liver Neoplasms:

-benign/malignant
-primary or metastatic site
-in parenchymal (hepatocytes) or matrix cells

54

Primary malignant liver cancer is often:

a complication of cirrhosis

55

Hepatocellular Carcinoma (HCC) clinical manifestations

-asymptomatic until late stages
-initial symptoms: abdominal pn, weight loss
-jaundice=rare
-metastases to bone/lungs common

56

Management of HCC

-transarterial chemoembolization/radioembolization
-surgical resection
-liver transplant