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NSG 121 > liver > Flashcards

liver Flashcards

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1
Q

liver recycling

A

People (produce)
Drink (detox)
So (storage)
Much (metabolize)

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2
Q

Produce

A

albumin
bile
coagulation factor

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3
Q

detox

A

everything is detoxed by liver (1st pass)

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4
Q

storage

A

stores glycogen

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5
Q

metabolize

A

converting/breaking things down for bodily use

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6
Q

albumin

A

binds with calcium
attracts/transports drugs
attracts fluid to vascular space

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7
Q

bile

A

transports bilirubin and cholesterol out of system (goes unchecked causes jaundice)

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8
Q

coagulation factor

A

decreased bleeding time
PT, PTT, INR

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9
Q

cells responsible for detox

A

kupfter cells

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10
Q

wall of bricks

A

wall= glycogen
bricks= glucose

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11
Q

protein bar
wrapper gets thrown away and recycled

A

wrapper= ammonia
thrown away= metabolized
recycled= urea

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12
Q

damaged liver labs

A

al ↓
bili ↑
TC ↑(200)
LDL ↑(100)
HDL ↓ (40)
PT(12-15 sec) ↑ clotting time
PTT (<15sec) ↑ clotting time
INR (25-30sec) ↑ clotting time
ammonia ↑
total protein ↓
AST (in tissue and muscle) ↑
ALT (more liver function) ↑
ALP (muscle) ↑

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13
Q

liver
general symptoms

A

fatigue (no glycogen= no energy)
fever (inflamed liver)
jaundice (↑bili = yellowing)
itching (no protection = no bile)

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14
Q

liver
neuro symptoms

A

sleep disturbance
mood changes
confusion
coma
(build up of ammonia in system)

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15
Q

liver
cardiopulmonary symptoms

A

dyspnea (↑ fluid retention= difficulty breathing)

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16
Q

liver
GI symptoms

A

N/V
hematemesis (throwing up blood)
melena (black tarry stool)
hematochezia (stool with blood)
abd. pain
abd. girth ↑ (ascites)
actives (fluid retention, fluid leaking into third space)

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17
Q

liver
hematologic symptoms

A

↑ bruising
bleeding
dependent edema (liver makes clotting factor)
(↓ liver= ↓clotting factor)

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18
Q

liver
endocrine symptoms

A

↓libido (↓ detox ↑androgen/estrogen= affected libido)

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19
Q

hepatitis types

A

viral
non-viral
drug induced

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20
Q

hepatitis manifestations

A

jaundice
N/V
pain/tender/ enlarged liver
dark urine
anorexia
flu symptoms

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21
Q

Viral hepatitis

A

HEP A
HEP B
HEP C
HEP D
HEP E

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22
Q

HEP A
route

A

fecal- oral (contaminated food/water)

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23
Q

HEP A
acute or chronic

A

acute

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24
Q

HEP A
who is at risk

A

health care, travelers, older adults, pre-existing liver conditions, 3rd world country

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25
HEP A incubation period
15-50 days
26
HEP A vaccine?
vaccine
27
HEP B route
contact with infected body fluids
28
HEP B acute or chronic
both chronic becomes carriers
29
HEP B who is at risk
healthcare, multiple sex partners, blood transfusion, sharing razor/tooth brush, tattoo, piercing, drug users, shared needles, transplant, immunocompromised
30
HEP B incubation period
25-180 days
31
HEP B vaccine?
vaccine
32
HEP C route
contact with body fluids/ blood products
33
HEP C acute or chronic
both
34
HEP C at risk
men-men, drug users, blood transfusion, transplant, health care, prison, baby, sharing razor/tooth brush, tattoo, piercing, needle stick injury, syringe
35
HEP C incubation period
2wk-6mo
36
HEP C vaccine?
treatment only
37
HEP D route
body fluids, blood
38
HEP D acute or chronic
chronic
39
HEP D at risk
un protected sex, previously had HEP B, health care immunocompromised, parenteral routes
40
HEP D incubation period
14-56 days
41
HEP D vaccine?
no vaccine
42
HEP E route
fecal-oral (contaminated food/water) undercooked meat
43
HEP E acute or chronic
acute self limiting
44
HEP E at risk
3rd world country, poor sanitation, health care
45
HEP E incubation period
15-64 days
46
HEP E vaccine?
no vaccine
47
Non-viral hepatitis
alcoholic
48
alcoholic hepatitis
excessive ETOH consumption
49
Alcoholic hepatitis treatment
ETOH cessation, fluid management, rest, therapy
50
Drug induced hepatitis
acetaminophen
51
acetaminophen hepatitis
d/c medication
52
cirrhosis
scaring of the liver (obstructs normal blood flow, bile flow, and hepatic metabolites)
53
types of cirrhosis
alcoholic post necrotic biliary cardiac
54
alcoholic cirrhosis
reversible with alcohol cessation
55
post necrotic cirrhosis
viral hepatitis autoimmune hepatitis steato hepatitis
56
biliary cirrhosis
obstructed bile ducts = damaged hepatocytes
57
cardiac cirrhosis
right sided HF (rare)
58
NAFID
NON-FATTY LIVER DISEASE age obesity diabetes 2 metabolic syndrome
59
early manifestations of cirrhosis
GI issues abd. pain fever fatigue wt. loss enlarged liver/spleen
60
last manifestations of cirrhosis
hepatocellular failure portal hypertension jaundice
61
hepatic encephalopathy
altered LOC (portal hypertension= ↑ toxin in blood)
62
portal hypertension
↑ pressure in portal vein from black flow/blockage of liver
63
ascites
Normal: collection of fluid it peritoneal space fluid shift into third space Massive: sodium and water retention renal vasoconstriction
64
splenomegaly
enlarged spleen from backup of blood
65
hemmorrhoids
in and out of rectum
66
hepatorenal syndrome
decr. urine output (500mL> 24 hr) ↑BUN and creatinine
67
alcohol withdraw
cognitive changes tremors tachycardia
68
hepatopulmonary syndrome
dyspnea from incr. ascites
69
spontaneous bacteria peritonitis
advanced liver disease encephalopathy jaundice
70
esophageal varices
LIFE THREATENING EMERGENCY fragile listened veins decr. prothrombin, incr. bleeding
71
esophageal varices treatment
vasopressin (slows blood flow) beta blockers (prevent bleeding) ligation (bands around varies) sclerotherapy (burn bleeding) Blakemore tube(balloon, ↑mortality) TIPS (shunt, decr portal pressure)
72
metabolic syndrome ↑ risks for
diabetes, heart disease, stroke
73
high sugar in veins destroys vital organs and blood vessels
kidney failure neuropathy blindness hypertension MI
74
Types of diabetes
type 1 type 2
75
TYPE 1
type ONE we have nONE bOrn (autoimmune/ genetics) pancreas CANNOT produce insulin (the body destroyed the pancreas) insulin dependent FOR LIFE
76
TYPE 2
Terrible TWOs type TWO and YOU & FEW problem is YOU, DIET, LIFESTYLE FEW insulin receptors working (cells not responding to insulin, insulin resistance)
77
S/S of type 1
ABRUPT onset thin DKA (hyperglycemic) (can be mistaken as drunk)
78
S/S of type 2
GRADUAL onset obese fatigue HHNS (hyperglycemic) Wt loss=no diabetes
79
S/S of type 1&2
S (slow healing) U (blUrry vision) G (glycosuria) A (acetone [fruity breath]) R (retention of acetone [decr. renal function]) HTN kidney damage heart damage eye damage skin damage Stroke neuropathy (decr. mobility) ↑infection (amputation) Polyuria (urinate glucose out) Polydypsia ( thirst to dilute glucose) Polyphangia (cells starving because there is not insulin) ↑triglycerides ↑cholesterol ↑albumine in urine BUN/Cretinine
80
Type 1 treatment
LIFELONG INSULIN yearly eye exam assess feet daily A1c diet urine check finger stick continuous glucose monitoring
81
Type 2 treatment
DIET EXERCISE ORAL MEDS (metformin) INSULIN yearly eye exam assess feet daily A1c diet urine check finger stick continuous glucose monitoring diet education (watch sugar/starches, white carbs, lean meat veggies) limit alcohol consumption
82
hypoglycemia
HYPOglycemia= LOW sugar 70> low brain function=rapid brain death HYPOGLY the brain will DIE
83
hypoglycemia symptoms
HI WASH Headache Irritable Weakness Anxious Sweaty Hunger
84
hypoglycemia causes
exercise insulin peak times ETOH
85
hyperglycemia
HYPERglycemia=HIGH sugar 115< A1c 6.5+ blood is thick as MUD
86
hyperglycemia symptoms
3 P's Polyuria Polydypsia Polyphagia
87
hyperglycemia causes
4 s's Sepsis (#1 cause) Stress Skip insulin Steroids
88
Dawn phenomenon
blood sugar rises with the sun
89
Somogyi effect
hypoglycemia jumps to hyperglycemia
90
Glucagon
no sugar=liver releases glucagon GLUcagon=GLUcose GONE from liver into blood
91
insulin type
rapid acting short acting (regular) intermediate long acting
92
rapid acting example
lispro
93
rapid acting onset peak duration
O: 15min P: 1-2hr D: 3-5hr
94
What to know about rapid acting
meal tray in room units 27-29G
95
short acting example
Regular humilin R novolin R
96
short acting onset peak duration
O: 30-60min P: 2-4 hr D: 4-6hr
97
what to know about short acting
the only insulin given IV
98
Intermediate examples
NPH
99
intermediate Onset peak duration
O: 2-4hr P: 6-12ht D:<24hr
100
what to know about intermediate
cloudy
101
long acting example
Detemir (last a year) gLARgine (LARge lasting)
102
long acting onset peak duration
O: 2hr P: continuous D: 24he
103
what to know about long acting
cannot nix with anything
104
how to mix insulin
Regular first than Intermediate
105
Injection site
abd. thing underarm
106
deadly hypoglycemia
Awake=Ask to eat Sleep=Stab D50 shake, clammy give candy
107
meds for diabetes to increase insulin sensitivity
sulfonylureas biguanides meglitinide analogs
108
sulfonylureas example
glipizIDE (the heart can DIE) ONLY TYPE 2
109
when do you give sulfonlureas
30 min before meals
110
side effects of sulfonylureas
hypoglycemia
111
biguanides example
metformin HOLD FOR CT SCAN WITH CONTRAST
112
when do you give biguanides
with meals
113
side effects of biguanides
Mini chance og hypoglycemia Massive wt. gain Major liver/kidney toxic
114
meglitinide analogs example
prandin starlix RAPID ONSET SHORT DURATION NO IF NPO OR FLUID RESTRICTION
115
when do you give meglitinide analogs
just before meals
116
side effects of meglitinide analogs
hypoglycemia

NSG 121 (6 decks)

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