Liver Disease Flashcards
(96 cards)
1
Q
metabolic liver functions
A
- fat, carb, and protein metabolism
- vitamin absorption and iron storage
2
Q
homeostatic liver functions
A
alter circulating blood volume
3
Q
filtering liver functions
A
purifies blood of bacteria
4
Q
clotting liver functions
A
produces clotting factors
5
Q
drug and chemical liver functions
A
drug and chemical detoxification and metabolization
6
Q
what do we look at when assessing liver function
A
- liver enzymes
- bilirubin
- clotting measures
- ammonia and proteins
7
Q
enzymes are the
A
clear portion of the blood
8
Q
you will see enzymes rise when an
A
organ is damaged
9
Q
____ is specific to liver damage
A
ALT
10
Q
_____ could be from cardiac more than liver
A
AST
11
Q
_____ shows biliary tract obstruction
A
ALK phospahte
12
Q
when the liver is not working well you will see ______ and increase in _______
A
proteins and increase in albumin
13
Q
ALT
A
alanine aminotransferase
14
Q
normal ALT
A
5-35 units / L
15
Q
AST
A
aspartate aminotransferase
16
Q
normal AST
A
0-35 units / L
17
Q
ALK phosphate
A
alkaline phosphate
18
Q
ALK phospate normal
A
20-90 units / L
19
Q
LDH5 and its normal
A
lactate dehydrogenase isoenzyme5 6-16%
20
Q
ALP1
A
alkaline phosphate isoenzyme1 42-136
21
Q
5’N
A
5’Nucleotidase less than 17 U/L
22
Q
GGT
A
gamma glutamyl transferase
23
Q
normal GGT
A
males 9-69 U/L
females 4-33 U/L
24
Q
bilirubin
A
end product of hemoglobin degradation
25
fat soluble bilirubin is also known as
unconjugated
26
unconjugated means
it has not gone to the liver yet to get conjugated and become water soluble
27
water soluble bilirubin is also known as
conjugated
28
conjugated means
it reaches the liver and combines glucoronic acid and becomes conjugated
29
jaundice is
problem with body breaking down rbc
30
total bilirubin normal
0.1 - 1.2 mg/dL
31
indirect (unconjugated) normal
0.1-1.0 mg/dL
32
direct (conjugated) normal
0.1-0.3 mg/dL
33
urobilinogen normal
negative in freshly voided urine
34
liver produces which clotting factors
prothrombin, vitamin K, and other clotting factors that help us clot
35
if any of the clotting factors are elevated it means
that clotting factors are not being produced
36
normal prothrombin time (PT)
11.0-12.5 seconds
37
INR
internationalized normalized ratio 0.81-1.2
38
partial thromboplastin time (PTT)
60-90 seconds
39
aPTT
activated partial prothromboplastin time
40
normal aPTT
23-32 seconds
41
serum ammonia causes
mental status changes
42
serum albumin is important
protein in the body
43
stigma to liver disease is often related to
alcoholism
44
hepatic failure
the inability of the liver to perform its normal functions
45
causes of hepatic failure
- acute viral hepatitis
- autoimmune liver disease
- drug induced liver disease
- chronic liver disease (cirrhosis)
- multiple organ failure (sepsis)
46
stages of hepatic failure
fatty liver -> liver fibrosis -> liver cirrhosis
47
fatty liver
deposits of fat causes liver enlargement
48
liver fibrosis
scar tissue forms
49
liver cirrhosis
growth of connective tissue destroys liver cells
50
acute hepatic failure
includes evidence of abnormal coagulation and INR >1.5, altered mental state, encephalopathy, and illness <26 weeks
51
acute hepatic failure results from
- a primary disease process in the absence of pre-existing disease
- as a complication of chronic liver disease, cirrhosis
- multiple organ failure in critically ill
52
fulminant hepatic failure
acute hepatic failure in a patient with no pre-existing history that develops rapidly (<8 weeks) with encephalopathy
53
fulminant hepatic failure is a severe form of
acute hepatic failure
54
fulminant hepatic failure results from
- viral infections (hep A and hep B)
- hepatotoxins (acetaminophen)
55
Hep A is transmitted by
fecal - oral route
56
Hep B is transmitted by
blood or body fluids
57
Hep C is transmitted by
blood
58
Hep D is transmitted by
blood
59
Hep E is transmitted by
fecal - oral route
60
cirrhosis of the liver
chronic disease is which liver tissue is replaced with fibrous tissue and functional liver cells are lost
61
cirrhosis of the liver is the ____th leading cause of death in Canada
13th
62
during cirrhosis of the liver
- cell necrosis occurs
- inability to conjugate bilirubin
- inability to detoxify bilirubin
- inability to produce clotting factors and albumin
- inability to convert ammonia to urea
- inability to regulate glucose
- inability to purify blood
- inability to regulate blood volume
63
complications of cirrhosis
- portal htn
- esophageal varices
- ascites and albumin
- hepatorenal syndrome
- infections
- hepatic encephalopathy
64
portal hypertension
results from increased resistance within the portal venous system
65
portal htn is caused by
cirrhosis disrupting normal structure of liver creating resistance to blood flow through the liver
66
overtime a system of collateral circulation develops to relieve the pressure =
varices
67
esophageal varices
an increase in pressure (coughing, vomiting, straining) can cause the varices to rupture
68
damage to liver tissues increases _______ resistance
vascular
69
venous flow becomes blocked in the liver, causing portal vein tension to ________
increase
70
blood backs up through the splenic vein into the spleen and ________ circulation
collateral
71
ascites
accumulation of serous fluid in the peritoneal or abdominal cavity
72
ascites is usually seen in
advanced liver failure
73
ascites is caused by
decrease colloid osmotic and portal hypertension
74
hepatorenal syndrome (HRS)
renal failure in absence of underlying kidney pathology
75
hepatorenal syndrome occurs in _____ stage of liver disease
end stage
76
clinical manifestations of hepatorenal syndrome
- oliguria
- low urinary sodium
- hyponatremia
77
bacterial peritonitis
ascites fluid becomes infected
78
hepatic encephalopathy is considered a _______ complication of liver disease
terminal
79
hepatic encephalopathy is caused by
toxic levels of circulating ammonia which cross the blood-brain barrier
80
usually the liver converts ammonia to ____ for excretion in urine
urea
81
when the liver is unable to convert ammonia to urea
toxicity develops
82
precipitating factors of hepatic encephalopathy
- infection
- elevated protein intake
- worsening hepatic function
- constipation
- increased BUN and creatinine
- GI bleeding
- hypovolemia
83
goal of hepatic encephalopathy is to
reduce ammonia formation
84
number of stages in hepatic encephalopathy
4
85
neurologic effects of hepatic failure
grade I to IV encephalopathy
86
cardiovascular effects of hepatic failure
pulmonary edema, hypotension
87
GI effects of hepatic failure
n+v, constipation or diarrhea, anorexia, ascites, abdominal pain, hypoalbumnemia, hypoglycemia
88
pulmonary effects of hepatic failure
tacypnea, crackles
89
integumentary effects of hepatic failure
spider angioma, jaundice, edema
90
laboratory evaluation for liver diseases
- liver enzymes
- bilirubin
- albumin
- ammonia
- coagulation studies
- CBC
- glucose
91
management of hepatic encephalopathy
- limit protein intake
- administer enema or laxatives
- administer anti-infective
92
management of ascites
- administer diuretics
- paracentesis
- sodium restriction
93
management of metabolic abnormalities
- monitor electrolytes
- correct electrolyte imbalances
94
management of spontaneous bacterial peritonitis
- administer antibiotic therapy
95
management of all liver diseases
high carb, low fat diet
no alcohol
96
management of esophageal varices
control bleeding
- vasopressin
constrict bleeding varices
- shunts
preventive therapy
- beta blockers
- elective shunts
- endoscopic sclerotherapy
