Liver Lecture

Question 1

4 meds decr metabolism in geriatric

Answer 1

Anticonvulsant
Psychotropic
Anticoagulants
Narcotics

Question 2

Cirrhosis

Answer 2

Small and hard

Question 3

Acute hep

Answer 3

Soft mobile tender

Question 4

Alcoholic hepatitis

Answer 4

Non tender (wouldn’t hurt yet)

Question 5

Alt drugs

Answer 5

Hep cirrhosis liver tumor cholestatis

Question 6

Serum pneumonia

3 diseases

Answer 6

Renal failure Reyes hepatic encephalopathy

Question 7

Bilirubin

Answer 7

Hemolytic anemia
Bile obstruction
Transfusion reaction

Question 8

Prothrombin

Answer 8

Vitamin k deficiency
Salicylate I toxicity
Warfarin

Question 9

4 cardinal signs of jaundice

Answer 9

incr bilirubin
Clay stool
Frothy urine
Itchy skin

Question 10

5 signs portal htn ascites

Answer 10

Increase abd girth
Sob
Straie
Fluid electrolyte imbalance

Question 11

Hepatic encephalopathy

8 s/s

Answer 11

Loc/ mood changes 
Unkempt
Change in sleep 
Asterixis 
Constructional apraxia
Dtr hyperactive then absent 
Fetor hepaticas 
Seizure

Question 12

First pass Med effect

Answer 12

Med absorb from GI metabolized to liver reaching systemic circulation

Question 13

Bioavailability

Answer 13

Percentage of administered drug that is reaching systemic circulation.

Question 14

What gives feces and urine its color

Answer 14

Bilirubin

Question 15

Which LFT decreases

Answer 15

Serum albumin

Question 16

Ast
Cause
Result

Answer 16

Scotch drinking

MI , hep, cirrhosis pancreatitis, skeletal trauma, muscle disease

Question 17

Jaundice s/s 6

Answer 17

Icteric 
Pruitis 
Frothy urine 
Clay still 
Incr bilirubin 
Jaundice

Question 18

7 causes hepatic dysfunction

Illnesses, body functions, ingestion of what

Answer 18

Liver disease /metabolic diseases 
Obstruction of bile 
Alt hep circulation 
Malnutrition etoh
Infection 
Anoxia
Toxins and meds

Question 19

Portal htn ascites 5 s/s

Answer 19

Increase abd girth 
Sob 
Fluid and lyte imbalance 
Weight gain 
Striae-stretch marks

Question 20

Assessment for htn 4

Answer 20

Abdomen for bruis
Bulging flanks
Fluid waves
abd girth

Question 21

7 to for p. Htn/ascites

Diet,meds, procedure, at home

Answer 21

Reduce fluid- less 200 mg na 
Spiralactone then lacis 
Daily weight 
Paracentesis 
Iv salt poor albumin 
Tips 
Home- skin low na dly wt, cognitive emotional

Question 22

Lasix

3

Answer 22

Decrease na/k
Bad if cardiac issues
Can give if k is ok

Question 23

Paracentesis def and used for what?

Answer 23

Removal of fluid from abd wall

portal htn/ascites

Question 24

4 causes of hepatic encephalopathy

Answer 24

Gi bleed
High protein diet
Bacterial infection
uremia

Question 25

Hep encephalopathy 3 meds to D.C.

Answer 25

Sedatives Tranquilizer analgesics

Question 26

Management hepatic encephalopathy | 5 things

Answer 26

``` Neruo checks freq Monitor vs q 4, I&O, dly wt Asses lungs /peritoneum Serum ammonia q day Restrict protein 20-60g day (add gradually) ```

Question 27

Home care hepatic encephalopathy | 5

Answer 27

Protein 20-60g day Vegetable protein (no animal)- crisco lard fat to cook Home health if alone Someone check daily

Question 28

Percutaneous needle bx Def PC

Answer 28

Small amount of liver tissue Most definitive liver test Pc- bile peritonitis and hemorrhage

Question 29

Bile peritonitis Def Ss-

Answer 29

Bile leaks from gallbladder Increase in temp incr bp board like ridgid

Question 30

What is edema secondary to

Answer 30

Hypo albumin

Question 31

Bleeding secondary to

Answer 31

Decrease in clotting factors and absb Vit K

Question 32

hepatic dysfunction s/s | Abnormal 8

Answer 32

``` Hyper/hypo glycemic Gynecomastia -breast in men irregular periods, sexual fucnt dysfn-metabolism of estrogen Splenomegaly- portal htn Pruitis- retain bile salts Spider angioma above waste Palmar erythema ```

Question 33

Hepatic cirrhosis Type Def

Answer 33

Chronic disease normal tissue replaces by scarred tissue so attempt for new bile ducts Alcoholic Post necrotic Biliary

Question 34

Hepatic cirrhosis | 7 s/s

Answer 34

``` Liver enlargement Portal obstruction Infection/ peritonitis Gi varicose Edema Vit def anemia Mental deterioration ```

Question 35

Hepatic cirrhosis management | 7 - meds diet

Answer 35

``` Antacid- gi Multi vitamin - damage cells spiralactone and iv salt poor albumin - ascites Diet - no alcohol Colchinine- anti gout and survival incr Neomycin- decr bact ```

Question 36

Nursing management Hepatic cirrhosis Airway, diet, reducing injury

Answer 36

Resp therapy - o2 Mild exercise Increase Vit, small frequent meals, low protein TPN Skin care- immobile jaundice thick lotion tepid bath Side rails up, explain, pressure after injection, soft toothbrush, no razor (has to be electric) Melena and hematemisis

Question 37

3 Potential complications | hepatic cirrhosis

Answer 37

Hepatic encephalopathy CHF Fluid volume excess

Question 38

Hepatic cirrhosis

Answer 38

No alcohol /aa Restrict na, Balance diet c vit Rest Hh- long recovery, mental evaluation, coping

Question 39

Bleeding esophageal varicose | 4 things it results in?

Answer 39

Shock, decrease perfusion- incr HR, | Decr BP

Question 40

Bleeding esophagus car. Factors that contr to hemorrhage 5 food, med, disease, activity

Answer 40

``` Heavy lifting Valsalva- sneak cough vomit Poorly chewed food and irritating fluid Gerd Alcohol and asa ```

Question 41

Bleeding esophageal var | 4

Answer 41

Hematemesis, Melana Mental /physical deterioration Shock- cold clammy skin , decr BP, incr HR Hemorrhoid

Question 42

Portal htn s/s | 3

Answer 42

Dilated abdomen veins Rectal hemorrhoids Splenomegaly- how high pressure is

Question 43

Splenoportography xray does what?

Answer 43

Detect collateral circulation in esophageal varices

Question 44

Hepatic cirrhosis | Meds reduce petal pressure 3 and a se for each

Answer 44

Vasopressin- angina Propranolol- decrease bp and pulse Somastatin-none

Question 45

Hepatic cirrhosis | 5 medical management.

Answer 45

``` Meds3 Endoscopic injection sclerotherapy Variceal band ligation Transjugular intrahepatic ( tips) Balloon tamponade ```