Liver Problems Flashcards
(104 cards)
1
Q
major functions of the liver
A
–metabolism and/or storage of fat, CHO, proteins, vitamins, and minerals
–blood volume reservoir
–blood filter
–blood clotting factors
–drug metabolism and detox
2
Q
blood volume reservoir
A
distends/compresses to alter circulating blood volume
3
Q
blood clotting factors
A
prothrombin and fibrinogen
4
Q
where is the liver located?
A
right epigastric region
5
Q
liver cells
A
hepatocytes
6
Q
portal circulatory system
A
brings blood to the liver from the stomach, intestines, spleen, and pancreas
7
Q
how does portal circulation work?
A
–deoxygenated blood enters the liver through the portal vein
–absorbed products of digestion come directly to the liver and are sent to the lobules
–“first pass effect”
8
Q
Liver Function Tests (LFTs)
A
–liver enymes (AST, ALT, Alk Phos)
–Bilirubin
–Serum Ammonia
–Serum protein
–Serum albumin
–Prothrombin Time
9
Q
Liver enzymes with liver failure
A
> 150; not great indicator of severity
10
Q
serum ammonia level with liver failure
A
increased
11
Q
serum protein level with liver failure
A
decreased
12
Q
serum albumin level with liver failure
A
decreased
13
Q
prothrombin time with liver failure
A
increased
14
Q
jaundice
A
–caused by increased levels of bilirubin in the bloodstream
–yellowish discoloration of skin and deep tissues
15
Q
when is jaundice noticeable?
A
when bilirubin > 2-2.5 mg/dl
16
Q
hemolytic jaundice
A
increased breakdown of RBCs
17
Q
hepatocellular jaundice
A
liver unable to take up bilirubin from blood or unable to conjugate it
18
Q
obstructive jaundice
A
decreased or obstructed flow of bile
19
Q
example of cause of obstructive jaundice
A
gallstones
20
Q
examples of hemolytic jaundice
A
bleeding, polycythemia, pathologic
21
Q
direct jaundice
A
conjugated (30%)
22
Q
indirect jaundice
A
unconjugated (70%)
23
Q
elevations of indirect bilirubin
A
bilirubin overproduction OR impaired liver functioning
24
Q
elevations of direct bilirubin
A
liver working, but can’t get the bilirubin out
25
examples of direct bilirubin
--bile duct obstruction
--gallstones
26
what is bilirubin?
byproduct of heme breakdown --> mainly hemoglobin
27
symptoms of jaundice
--darker urine
--elevated LFTs
--normal or clay colored stools
--pruritis
28
viral hepatitis
--inflammation of the liver
--hepatitis (not the infection) can occur from other causes (alcohol abuse, drugs, chemicals, and bacteria)
29
other viruses that cause hepatitis
--Epstein-Barr
--cytomegalovirus
30
pathogenesis of viral hepatitis
viral infection --> immune response from inflammatory mediators --> lysis of infected cells --> edema and swelling of tissue --> tissue hypoxia --> hepatocyte death
31
symptoms of viral hepatitis
--similar between all types
--asymptomatic
--abnormal elevated LFTs
32
when does the prodromal phase of viral hepatitis occur?
2 weeks after exposure
33
symptoms of prodromal phase of viral hepatitis
--fatigue
--anorexia
--malaise
--N/V
--HA
--hyperalgesia
--cough
--low-grade fever
34
hyperalgesia
increased pain response
35
when is viral hepatitis highly transmissible?
prodromal phase
36
what does the icteric phase of viral hepatitis begin with?
jaundice
37
symptoms of icteric phase of hepatitis
--jaundice
--dark urine
--clay colored stools
--enlarged liver potentially painful to palpation
--fatigue and abdominal pain
38
length of icteric phase of hepatitis
2-6 weeks
39
recovery phase of hepatitis
--resolution of jaundice
--6-8 weeks after exposure, symptoms diminish
--liver remains enlarged/tender
40
complications with viral hepatitis
--mostly recover completely with no complications
--low mortality rate
--chronic hepatitis
--liver cirrhosis
--liver cancer
--fulminant viral hepatitis
41
transmission of Hep A
fecal-oral, parental, sexual
42
specifics of Hep A
--acute onset with fever
--usually mild severity
--does NOT lead to chronic hepatitis
--usually affects children and adult
--food-borne illness
43
prevention of Hep A
--hand hygiene
--vaccine
44
routes of transmission of Hep B
--dirty needles (parental)
--unsafe sex (sexual)
45
Hep B specifics
--severe disease
--may be prolonged course or develop into chronic
--any age group affected
46
prevention of Hep B
--HBV vaccine
--safe sex
--hand hygiene
47
routes of transmission of Hep C
--IV drugs (parental)
--unsafe sex (sexual)
48
Hep C specifics
--insidious onset
--mild to severe symptoms
--can develop into chronic hepatitis (80%)
--any age is affected
49
prevention of Hep C
--screening blood
--hygiene
--NO vaccine
50
what can Hep C cause?
--hepatocellular carcinoma
--liver transplant
51
Hep A vaccine series
--2 doses, 6 months apart
--all children beginning at 12 months
--special "high risk" populations (traveling, HC, food handlers)
52
Hep B vaccine series
--3 doses at least 4 months apart
--all infants beginning as newborns
53
two classes of drugs used for chronic HBV
--interferons
--nucleoside analogs
54
treatment indications for HBV pharm
--increased AST levels
--hepatic inflammation
--advanced fibrosis
55
disadvantages of HBV pharm
--prolonged therapy
--costs and adverse effects
--high relapse
56
who is HCV treatment recommended for?
patients with chronic disease
57
HCV treatment regimen
direct-acting antiviral therapy and interferon-based
58
Tylenol and hepatitis
active hepatitis can only take <2g of Tylenol per day
59
examples of hepatitis meds
--entecavir
--tenofovir
60
cirrhosis
--irreversible
--inflammatory
--fibrotic
61
effect of fibrosis in liver
--leads to obstructive biliary channels and blood flow
62
what do obstructive biliary channels and blood flow lead to?
--jaundice
--portal HTN
63
effect of removal of toxin with cirrhosis
removal can slow progression, but won't stop it
64
what is liver regeneration interrupted by with cirrhosis?
hypoxia, necrosis, atrophy, and liver failure
65
common cause of cirrhosis
--Hep B and C
--excessive alcohol intake
--idiopathic
--non-alcoholic fatty liver disease
66
alcoholic fatty liver
--mildest
--asymptomatic
--increased lipogenesis
--reversible if stop drinking
67
alcoholic steatohepatitis
--precursor to cirrhosis
--inflammation
--degeneration of hepatocytes
--becomes irreversible
68
alcoholic cirrhosis
--fibrosis and scarring alter liver structure
--irreversible
69
symptoms of alcoholic steatohepatitis
--jaundice
--anorexia
--edema
--nausea
70
how does alcoholism cause cirrhosis?
increased acetylhyde = altered hepatocyte function --> hepatic stellate cells
71
hepatic stellate cells
primary cell in liver fibrosis
72
patho of cirrhosis
liver cells destroyed --> cells try to regenerate --> disorganized process --> abnormal growth --> poor blood flow and scar tissue --> hypoxia --> liver failure
73
early manifestations of cirrhosis
--N/V
--anorexia
--flatulence
--change in bowel habits
--fever
--weight loss
--palpable liver
74
late manifestations of cirrhosis
--jaundice
--peripheral edema
--decreased albumin and PT
--ascites
--skin lesions
--hematologic problems
--endocrine problems
--esophageal and anorectal varices
--encephalopathy
75
portal hypertension
--resistant portal blood flow = varices and ascites
76
causes of portal hypertension
--systemic hypotension
--vascular underfilling
--stimulation of vasoactive systems
--plasma volume expansion
--increased CO
77
complications of portal HTN
--variceal hemorrhage
--ascites
--peritonitis
--hepatorenal syndrome
--cardiomyopathy
78
treatment of portal HTN
--prevent/treat complications
--no treatment except liver transplant
79
hepatic encephalopathy
--liver isn't filtering out toxins
--increased toxins in brain
80
diagnosis of hepatic encephalopathy
LOC = primary driver of diagnosis
81
minimal severity hepatic encephalopathy
abnormal results on psychometric or neurophysiological testing without clinical manifestations
82
Grade I hepatic encephalopathy
changes in behavior, mild confusion, slurred speech, disordered sleep
83
Grade II hepatic encephalopathy
lethargy, moderate confusion
84
Grade III hepatic encephalopathy
marked confusion, incoherent speech, sleeping but arousable
85
Grade IV hepatic encephalopathy
coma, unresponsive to pain
86
labs and hepatic encephalopathy
--correlate with liver labs
--mainly ammonia = LOC changes
--ammonia crosses BBB
87
acute liver failure
separate liver failure not caused by cirrhosis or other types of liver disease
88
most common cause of acute liver failure
acetaminophen overdose
--treated with acetylcysteine
89
patho of acute liver failure
edematous hepatocytes and patchy areas of necrosis and inflammatory cell infiltrates and disrupts the liver tissue
90
timing of acute liver failure
can occur 6-8 weeks after a viral hepatitis or metabolic liver disease
91
symptoms of acute liver failure
similar to cirrhosis symptoms
92
treatment of acute liver failure
liver transplant
93
class of lactulose
hyperosmotic laxative
94
indication of lactulose
reduction of ammonia absorption in hepatic encephalopathy
95
where does lactulose work?
colon and large intestines
96
MOA of lactulose
reduces blood ammonia levels by converting ammonia to ammonium
97
route for lactulose
PO or enema/rectal
98
when is lactulose given?
--titrated by number of stools or by ammonia levels
--not just high ammonia levels...must have s/s of encephalopathy
99
nursing consideration for giving lactulose
make sure patient is not hypokalemic
100
when is rifaximin given?
second line of defense if lactulose isn't working
101
MOA of rifaximin
inhibits bacterial RNA synthesis by binding to bacterial DNA
102
route of rifaximin
PO
103
side effects of rifaximin
--peripheral edema
--nausea
--ascites
--dizziness
--fatigue
--pruritis
--skin rash
--abdominal pain
--anemia
104
specifics of rifaximin
--can sometimes be given preventatively
--has been associated with increased risk of c. diff
