Hepatic System Flashcards
1
Q
Hepatic Portal System
A
- sm intestine absorbs products of digestion
- Nutrient molecules travel in hepatic portal vein to liver
- liver filters/cleanses blood content
- blood enters general circulation by way of hepatic ven
2
Q
Liver is responsible for:
A
- 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
Q
Bilirubin
A
-breakdown product of hemoglobin
4
Q
Aging and Hepatic System
A
- decreased liver function
- decreased liver enzymes
- decreased blood to liver
- increased fibrosis of liver
5
Q
Liver Enzymes
A
- Aspartate Transaminase (AST)
- Alanine Transaminase (ALT)
- Gamma-Glutamyl Transpeptidase (GGTP)
6
Q
Liver Healing
A
- 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
Q
Ex of Liver Patologies
A
- Jaundice
- ascites
- hepatitis
- cirrhosis
- liver neoplasms
- portal hypertension
- hepatic encephalopathy
8
Q
Most common S/Sx of liver disease
A
- 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
Q
MSK Pain with Hepatic Disease
A
- T spine pain (between scap)
- R shoulder
- R UT
- R interscapular areas
- R subscap areas
10
Q
Skin S/Sx Hepatic Disease
A
-pallor
-jaundice
-orange skin
green skin
-bruising
-spider angiomas
-palmar erythema or “liver palms”
11
Q
Normal Bilirubin
A
0.1-1.0 mg/dL
12
Q
Jaundice
A
- sign of hyperbilirubinemia
- yellow discoloration of skin/sclerae
- liver/gallbladder disorders
13
Q
Jaundice Causes
A
- increased destruction of RBC
- damaged liver cells
- bile duct obstruction or dysfunction
14
Q
Management of Jaundice
A
- 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
Q
Ascites
A
- presence of excess fluid in peritoneal cavity
- from portal hypertension (fluid leaks out into abdominal cavity
16
Q
Ascites Management
A
- restrict Na+
- diuretics
- restrict fluid
- Therapeutic paracentesis
- monitor electrolytes
17
Q
PT Implication of Ascites
A
- 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
Q
Hepatitis
A
-acute/chronic liver inflammation
19
Q
Risk Factors of Hepatitis
A
- 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
Q
Types of Hepatitis
A
-Chronic (6 months+)
-Fulminant
-Viral (A, B, C, D, E, G)
-Toxic
-Autoimmune (idiopathic)
Alcoholic (acute/chronic)
21
Q
Fulminant Hepatitis
A
-rapidly progresses and becomes hepatic encephalopathy
22
Q
Toxic Hepatitis
A
-exposure to alcohol, chemicals, drugs etc
23
Q
Types of Viral Hepatitis
A
-A, B, C, D, E, G
24
Q
Hep A
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
