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NURS232 > Liver > Flashcards

Liver Flashcards

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1
Q

Hepitis A

A

Non chronic inflammation of the liver

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2
Q

Hep B is spread

A

By blood, therefore high risk places need vaccination

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3
Q

Hep C

A

Similar

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4
Q

Physcial manifestiatiojn of hepitis

A

Many patients have no symptoms and are unaware of their infection

anorexia, n/v, malaise, fatigue, headache, low-grade fever, arthralgias, skin rashes, jaundice (icteric) and RUQ discomfort. Food., ETOH, or cigarettes may be distasteful.

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5
Q

Physical exam would reveal

A

Physical exam: hepatomegaly, splenomegaly, lymphadenopathy.

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6
Q

Hep A tx

A

PREVENTION IS KEY! No specific treatment. Immunization if going to places where hygiene is poor

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7
Q

Hep B tx

A

Immunization in high-risk areas.
The goal of therapy is to reduce viral road, normalize liver enzymes and slow rate of disease progress through medication therapy.

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8
Q

Hep C tx

A

Sometimes spontaneously resolves (50% of infections)
In others, progresses to chronic Hep C infection. Can be cured with medication.

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9
Q

Liver Cancer

A

80-90% of HCC patients have cirrhosis
Similar to cirrhosis; minimal in early stages
Treatment: surgical removal or palliation
Focus of care: symptom management

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10
Q

Liver transplant

A

Living donors can donate segment of liver and will regrow the lost part

Living-donor liver transplant is possible because the human liver regenerates and returns to its normal size shortly after surgical removal of part of the organ

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11
Q

KNOW Clinical manifestations: Hem problems, how Cirhosisis impact the hem system

A
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12
Q

Esophogeal varicies

A

Enlarged veins in esophagus that can rupture and cause severe bleedings
- Usually caused by cirrhosis. Unmanaged portal hypertension

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13
Q

Intoxicated vs Alcohol W/d

A

SS:
Intox - CNS Depression, slurred speech, altered gait, decreased LOC

Lab: BAC

Tx. Not drinking (no aclohol)
_________________________________________________

SS of W/d: N/V, tremors, agitations, hallucinations, sweats

Lab: No test.
- Hx is important (WHEN THEY STOPPED drinking last)

Tx. Thiamine, lorazepam (Benzos)

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14
Q

Wernickes Encephalopathy

Yee

A

SS:

Ataxia, abnormal eye movement (Nystagmus), blurred vision, altered LOC
- Thymine deficiency (cant be tested)

tx basd on history and SS

No Labs

Tx. Thiamine admin

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15
Q

Liver is

A

Largest interal organ in the body organ

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16
Q

Functual units of the liver

A

Lobules

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17
Q

What does a lobule consist of

A

a plate of specialized hepatocytes around a central vein

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18
Q

kupffer cells

A

Macrophages found in liver sinusoids
Break down RBCs, and phagocytize as well

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19
Q

The liver recieves which blood

A

1/3 of from hepatic artery - oxygenated

2/3 from portal vein (Blood flow from the spleen, intestines, stomach, and pancreas) - partially oxygenated
- Carries substances absrobed from spleen and intestines, stomach and pancreas

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20
Q

Blood leaves the liver via

A

Hepatic vein, emtpyting into inferior vena cava

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21
Q

Metabolic functions of the liver

A

carbohydrate, protein and fat metabolism; detoxification of the blood; steroid metabolism

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22
Q

Bile synthesis function include

A

bile production, excretion

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23
Q

Storage funciton of liver

A

: glucose (in the form of glycogen); fat-soluble vitamins (ADEK), and water-soluble vitamins (B1, B12, folic acid); fatty acids; minerals (ie iron); amino acids in the form of ALBUMIN and beta-globulins

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24
Q

Monuclear phagocyte sytem functions of liver

A

breakdown of old RBC’s, WBC’s, bacteria, etc. Breakdown of Hgb to bilirubin and biliverdin

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25
Functions of liver (Don't need to know)
Bile production - For breakdown of fats, cholestor and some vits Absorbs and metabs bilirrubin (Used to make next generation of RBCs Assists in creating blood clotting factors (Coagulants) - i.e. Vit K Fat metabolism (Breaks them down to make easier to digest Carb metabolism - stored and then broken into glucose, stored as glycogen, released whenever requried VItamin storage - iron for hemoglobin Protein metabolism - to make them more digestable Filters the blood - hormones, drugs, alcohol - Drug metabolism Immunological - destroys pathoegens Production of albumin - helps maintain oncotic pressure Synthesis of angiotension
26
How often is alcoholism related to cirhossis
90%
27
Cirhossis
Liver cells attempt to regenerate. Regenerative process is disorganized. Abnormal blood vessel and bile duct formation Overgrowth of new fibrous connective tissue distorts liver’s normal structure, impeding blood flow. Irregular regeneration and disorganized regeneration, poor cellular nutrition and hypoxia d/t inadequate blood flow and scar tissue result in decreased liver functioning. Cirrhosis is the final stage of chronic liver disease.
28
Cirrhosis
10th leading cause of death in Canada - insidious, prolonged course
29
Serious consequences of cirhossi example
Bleeding from portal hypertension
30
Factors leading to crihossi
Chronic alcoholism Nonalcol fatty liver disease (NAFLD) Nutrtion related (malnutrtion or obesity Pts with Hep B and C Environmental and genetic predisp
31
COmpensated cirhossis ss
Anorexia, NVD, dyspepsia, weakness, constipation
32
Decompensated Cirrhosis SS
GI issues - (pale stool) - anorexia, NVD - jaundice - Dark urine - Perotis - Energy def (Carb and protein metab probs) - Anemia from bleeding - Petichaie, bruising - Periphe or pulm edema - Ascites - Change in LOC - Fluid overload - Protrutding abdom
33
Skin lesions
Spider angioma occuring in nose, cheeks, upper trunk, neck and shoulder Palmar erythema - a red area that blances From low estrogen
34
Hematologica problesm with cirrohis
Thrombocytopenia (regulating produciton of platelts - low) - Biggest indicator Leukopenia Anemia Coagulopathies Can be production issues OR destruction issues (of RBC with anemia)
35
What causes caoagulopathies
Livers inability to produce prothrombin - essential for clotting Evidinced by petichaei (non blanch), gum bleed, clotting abnorm, easy bruishing Prothrombin time will be increased
36
Endocrine disorders of cirhossis in men
Gynecomastia Loss of axillary and pubic hair Testicular atrophy Impotence +/- loss of libido
37
Endocrine disorders of cirhossis in women
Loss of menstural bleeding in younger women Vaginal bleeding in older women
38
Hyperaldosteronism
Na and water retention secondary to liver cirhosiss
39
Peripheral neuropathy from cirhossis
Deficiency in thymine, folic acid, and Vit B12 Causing weakness numbness or pain (stabbing buring or tingling)
40
Complications of liver dx
Portal HTN
41
Portal HTN
42
Esophageal varices
Forming bc of increased blood pressure on portal veins, collateral circulation forms to offset pressure, but these veins are not strong, and are a high risk of bleeding Varices can also be found near umbilicus, groin or stomach
43
How do we assess for risk of bleeding
Bleeding gums Bruising Petichae Ascities CBC (Platlet count) If they have been vomiting - what does it look like (coffee grinds) Stool (Black) VS (Drop in BP or rise in HR)
44
How do we diagnose esophageal varices
Gastronomy thin tube going all the way to jejunum
45
Greatest risk with esophageal varices
Bleeding to death Tx with IV fluids and platelet transfusion Lagation (elastic band to stop/prevent bleeding on varices)
46
Edema cause in cirrhosis
Caused by decreased colloial osmotic pressure in vasculature due to decreased production of albumin And increased hydrostatic pressure from portal HTN
47
Ascities
Accumulation of serous fluid in peritoneal/abdom cavity due to elevation of portal pressure May cause proteins to shift OUT of blood vessels into lymph due to larger pores of sinusides in liver lobules
48
Ascites looks like
Abdom distension - Firm hollow sounding Unbilical eversion Decreased urin output Signs of dehydration Abdom striae HypoK (diuretics)
49
Hepatic encephalopathy
Ammonia is normally ocnveted to urea by the liver and then is excreted in urine When liver is not funcitoning properly, ammonia is not broken down and levels increase. It crosses BBB and can be neurotoxic - Changes in LOC - Impaired thinking - Stupor - Confusion - NM change (Asterixixs "flapping), hyperflexia (exagerated reflexes) Tx. Protein reduction (Ammonia is byproduct) - Eliminating ammonia quicker from intestines to avoid absorptiond
50
Wernickes encphalopathy
Primary cause: Malnutriton or starvation associated with chornic drinkning SS: ALtered mental Status, ataxia, diplopia, nystagmus (horizontal) Not abrupt, happening over time Tx is Thymine (reversible)
51
Liver lab tests
Blood test Increased liver enzymes: ALT and AST
52
What is ALT
To the liver what troponin is to the heart A protein only made by liver when liver cells are damaged
53
AST
Found in parts of body other the liver (Brain, heart, liver) Trends can be helpful for liver test diagnosis
54
Alk phos and liver
Less specific than other test, high conc can indicate blocked ducts or liver damage
55
GGT
Elevated with liver damage or blocked ducts The only elevated value in young people post binge drinking episode Non specific
56
serum albumin in liver test
Lower levels indicate liver damage or disease periph edema maube ascities
57
Prothrombin time in liver disease
Increase pro thrombin time Decreased synth of prothormbin in liver damage
58
Unconjugated billlrubin vs conjucated bilirubin
Unconjugated - prehepatic issue causing too much bilirubin in blood Intrahepatic and posthepatic result in increased levels in both conj and unconj Conjugated: Hepatic issue resulting in
59
Collab care of liver dx
Rest Avoidance of alcohol, aspirin, acetaminaohpen and NSAIDS Prevention and management of esophageal variceal bleeding - screening Management of ascities Management of encephalpathy - if non bleeding varices pressnt take non selective beta blockers
60
What to do if acute esophageal varices begin
Fresh-frozen plasma Packed RBCs Vitamin K Proton pump inhibitors (reduce acid in stomach) Octreotide Octaplex (in severe cases) Endoscopic evaluation of the bleed: Sclerotherapy (Injecting agent that hardens veins) Ligation
61
TIPS
Transjugual intrahepatic portosystemic shunts Stent forms channel or shunt bypassing liver and reduces BP in portal vein by diverting blood flow away from ONly done if med and endoscopy tx dont work Very uncommon
62
Ascites tx
Na restriction Diuretics Paracentisis - Removes fluids from abdom cavity Temporary mesure Not first line therapy Can cause Massive fluid/electrolyte shifts
63
Heaptic eneph tx
Reduce ammonia formtion Tx Lactulose - prevents hep enceph by decreasing amount of ammonia in the blood and speeding ups it's excretion into the stool Tx of precipating cause (ie controlling GI hemmorhage) Liver transplant
64
Wernickes enceph tx
Thiamine administration IV and then PO Can result in permanent damage if not administered
65
Nursing implications for cirrohis
Acute Interventions: Energy conservation Symptom control Intake and output monitoring STRONG ASSESSMENT and advocacy when complications occur Patent IV access on patients with varices
66
Drugs and Liver function
Avoid hepatotoxic drugs like Acetaminophen, ASA First Pass effect This affects PO meds and they should be given in Smaller doses. Use caution in administering medications in patients with advanced liver disease.
67
Octreotide use in liver dx
Managment of portal HTN
68

NURS232 (27 decks)

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