Liver (Exam 2)

Question 1

Major Functions of the LIver

Answer 1

Metabolism and storage of fat-CHO-vitamins-minerals

Blood volume reservoir - Distended/compresses to alter circulation blood volume

-Filters blood

-Blood clotting factors

-Drug metabolism and detoxification

Question 2

Portal Circulation

Answer 2

The portal circulatory system brings blood to the liver from the stomach, intestines, spleen, and pancreas

Blood enters through the portal vein

the absorbed products of digestion come directly to the liver and are sent to the lobules

This is the first pass effects

Question 3

Major Liver Enzymes

Answer 3

ALT
AST
Alk Phos

Question 4

Does ALT, AST, and ALK Phos increase or decrease with liver problems

Answer 4

Increase

Question 5

Does serum Ammonia increase or decrease with liver failure

Answer 5

Increase because the liver breaks ammonia down

Question 6

Does serum protein and albumin increase or decrease with liver failure

Answer 6

Decrease because the liver helps produce these

Question 7

Does prothrombin time increase or decrease with liver problems

Answer 7

Increases

Question 8

Jaundice (icterus): Caused by

Answer 8

Increased levels of bilirubin in the bloodstream

usually causes problems and is noticeable with total bilirubin is greater than 2-2.5mg/dl

Question 9

How to determine cause of jaundice

Answer 9

Look at conjugated versus unconjugated to determine possible cause

Question 10

3 classifications of Jaundice

Answer 10

Hemolytic
Hepatocellular
Obstructive

Question 11

Hemolytic Jaundice

Answer 11

Increased breakdown of RBC’s

Question 12

Hepatocellular Jaundice

Answer 12

Liver unable to take up bilirubin from blood or unable to conjugate it

Question 13

Obstructive Jaundice

Answer 13

Decrease or obstructed flow of bile

Question 14

Bilirubin

Answer 14

By product of heme breakdown –> mainly hemoglobin

Question 15

Conjugated Bilirubin

Answer 15

Direct

Question 16

Unconjugated Bilirubin

Answer 16

Indirect

Question 17

Elevations of INDIRECT bilirubin

Answer 17

bilirubin overproduction or impaired liver functioning

Question 18

Elevations of DIRECT bilirubin

Answer 18

Liver working, but cant get the bilirubin out. Obstruction / gall stone

Question 19

Jaundice Clinical Manifestations

Answer 19

Dark amber urine

Elevated liver enzymes

Normal / clay stools

Pruritus

Question 20

Viral Hepatitis

Answer 20

Systemic virus that mainly affects the liver. Inflammation

Question 21

Various strains of hepatits

Answer 21

A B C

other virus that can cause hepatitis –> epstein-barr and cytomegalovirus

Question 22

Hepatitis (not viral) can also come from

Answer 22

Alc abuse - Drugs - Chemicals - Bacteria

Question 23

What viral hepatitis is most dangerous in pregnancy

Answer 23

Hepatits E

Question 24

Viral Hepatitis: Pathogenesis

Answer 24

Viral Infection

Immune response: Inflammatory mediators

Lysis of infected cells

Edema swelling of tissue

Tissue hypoxia

Hepatocyte death

Question 25

Stages of Viral Hepatitis

Answer 25

Prodromal Icteric Recovery

Question 26

Viral Hepatitis: Prodromal stage

Answer 26

2 weeks after exposure Fatigue, anorexia, malaysia, nausea, vomiting, HA, hyperalgesia, cough, low grade fever High transmissible

Question 27

Viral Hepatitis: Icteric stage

Answer 27

Beings with jaundice Jaundice - Dark urine - Clay stools Liver enlarged and may be painful to palpate Abdominal pain persists or increases in severity

Question 28

Viral Hepatitis: Recovery

Answer 28

Resolution of jaundice 6-8 weeks after exposure, symptoms diminish Liver remains enlarged / tender

Question 29

Do symptoms always occur with hepatitis?

Answer 29

No

Question 30

Viral Hepatits: Complications

Answer 30

Most patients recover completely with no complications -Chronic hepatits -Liver cirrhosis -Liver cancer -Fulminant viral hepatitis - acute liver failure

Question 31

HEP A

Answer 31

-Food borne illness related to unsafe food handling

Question 32

HEP A transmission

Answer 32

Fecal oral, parental, sexual

Question 33

HEP A: S/S

Answer 33

Acute onset with fever. Usually mild severity

Question 34

Does HEP A cause chronic hepatitis?

Answer 34

NO

Question 35

HEP A prevention

Answer 35

Hand hygiene and Hep A vaccine

Question 36

HEP B

Answer 36

IV drug use or sexual contact common within substance use community

Question 37

HEP B: Presentation

Answer 37

Insidious with long incubation period

Question 38

Can HEP B cause chronic hepatitis?

Answer 38

Yes my be prolonged

Question 39

HEP B: prevention

Answer 39

Vaccine, safe sex, and hygiene All children and health care have to get HEP B vaccine

Question 40

HEP C common causes

Answer 40

IV drug use and unsafe sex Mother to fetal and medical mishapes

Question 41

HEP C: presentation

Answer 41

Insidious onset with mild to severe symptoms

Question 42

can HEP C lead to chronic hepatits

Answer 42

Yes, 80% do

Question 43

HEP C prevention

Answer 43

Screening for blood - Hygiene - NO vaccine

Question 44

HEP C can lead to

Answer 44

Hepatocellular carcinoma Now there are new drugs that prevent that

Question 45

HEP A vaccines

Answer 45

-2 doses 6 months apart All children beginning at 12 months Special high risk populations: Travel -Health care - Handle food

Question 46

HEP B vaccines

Answer 46

3 doses at least 4 months apart All infants beginning as newborns

Question 47

HEP C vaccines

Answer 47

none

Question 48

Two classes of drugs that are use for chronic HBV

Answer 48

Interferons Nucleoside analogs

Question 49

Treatment for HBV is only for

Answer 49

High risk patients: Increase AST levels Hepatic inflammation Advanced fibrosis

Question 50

Disadvantages of HBV treatment

Answer 50

Prolonged therapy Costs and Adverse effects High relapse

Question 51

HCV treatment thoughts

Answer 51

Treatment is only recommended for patients with chronic disease However, this through is changing with the introduction of newer, very effective drugs

Question 52

HCV treatment

Answer 52

Direct-acting antiviral therapy and interferon-based regimen some require treatment along with nucleoside analogue medication as well

Question 53

Any patient with hepatitis can or cant take tylenol?

Answer 53

Can but it has to be less than 2 grams per day