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NUR 326-Pathopharm > Liver Problems > Flashcards

Liver Problems Flashcards

(44 cards)

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1
Q

Major Functions of Liver

A

Metabolism &/or storage of:
* Fat, CHO, PRO, vitamins and minerals

Blood volume reservoir
* Distends/compresses to alter circulating blood volume

Blood filter
* Helps purify blood

Blood clotting factors
* Including prothrombin & fibrinogen

Drug metabolism and detoxification

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2
Q

Portal Circulation

A
  • The portal circulatory system brings blood to the liver from the stomach, intestines, spleen, and pancreas
  • The blood enters the liver 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 effect”
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3
Q

Components of the Liver funtion tests (LFT)

A

Liver enzymes
-ALT, AST, Alk Phos

Bilirubin
-conjugated (direct), unconjugated (indirect)

Serum Ammonia
Serum Protein
Serum Albumin
Prothrombin time (PT)

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4
Q

Jaundice (Icterus) caused by:

A
  • Caused by increased level of bilirubin in the bloodstream
  • Usually causes problems and is noticeable with total bilirubin is greater than 2-2.5mg/dl
  • Look at conjugated versus unconjugated to determine possible cause
  • Yellowish discoloration of skin and deep tissues
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5
Q

3 classifications of Jaundice

A
  • Hemolytic: increased breakdown of RBCs
  • Hepatocellular: liver unable to take up bilirubin from blood or unable to conjugate it
  • Obstructive: decreased or obstructed flow of bile
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6
Q

What is Bilirubin?

A

By product of heme breakdown (mainly hemoglobin)

DIRECT: Conjugated INDIRECT:unconjugated

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7
Q

Elevations of INDIRECT bilirubin:

A

Bilirubin overproduction OR impaired liver functioning

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8
Q

Elevations of DIRECT bilirubin:

A

Liver working, but can’t get the bilirubin out
* Bile duct obstruction, gall stones

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9
Q

Jaundice: Clinical Manifestations

A
  • Urine is darker
  • Liver enzymes = elevated
  • Stools = Normal or clay colored
  • Pruritis
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10
Q

What is Viral Hepatitis?

A

Systemic virus that mainly affects the livers
* Inflammation of the liver
Various strains cause the different types of hepatitis
* HAV, HBV, HCV
* Other viruses that can cause hepatitis (Epstein-Barr, cytomegalovirus)

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11
Q

T/F: Hepatitis is always from a viral infection

A

FALSE: can occur from other causes
* Alcohol abuse, drugs, chemicals, and bacteria

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12
Q

Viral Hepatitis: Pathogenesis

A
  1. Viral infection
  2. Immune response: imflammatory mediators
  3. Lysis of infected cells
  4. Edema and swelling of tissue
  5. Tissue hypoxia
  6. Hepatocyte death
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13
Q

Clinical Manifestations of Viral Hepatitis

A
  • Similar between all types
  • Many cases of ALL types of hepatitis are asymptomatic
  • But can range from none, mild, to liver failure
  • Causes abnormal elevated LFTs– but NOT consistent with cellular damage within the liver
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14
Q

Hepatitis: Prodromal

A
  • 2 weeks after exposure
  • Fatigue, anorexia, malaise, nausea, vomiting, HA hyperalgesia, cough, low- grade fever
  • HIGHLY transmissible
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15
Q

Hepatitis: Icteric

A
  • Begins with jaundice
  • Jaundice, dark urine, clay-colored stools
  • Liver enlarged and may be painful to palpation
  • Fatigue abdominal pain persists or increases in severity
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16
Q

Hepatitis: Recovery

A
  • Resolution of jaundice
  • 6-8 weeks after exposure, symptoms diminish
  • Liver remains enlarged/tender
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17
Q

Viral Hepatitis: Complications

A
  • Chronic hepatitis
  • Liver cirrhosis
  • Liver cancer
  • Fulminant viral hepatitis – acute liver failure

Most patients with acute viral hepatitis recover completely with no complications

Overall mortality rate is less than 1%
* Higher mortality in elderly and comorbidities

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18
Q

Hepatitis A
-transmission, progression, population, prevention

Study These Flashcards
A
  • Transmission: fecal-oral, parental, sexual
  • Acute onset with fever
  • Usually mild severity
  • Does NOT lead to chronic hepatitis
  • Usually affects children and adult
  • Hand hygiene, Hep A vaccine
19
Q

Hepatitis B
-transmission, progression, population, prevention

Study These Flashcards
A
  • Transmission: parental, sexual
  • Insidious onset
  • Severe disease, may be prolonged course or develop into chronic
  • Any age group affected
  • HBV vaccine and safe sex and hygiene
20
Q

Hepatitis C
-transmission, progression, population, prevention

Study These Flashcards
A
  • Transmission: parental, sexual
  • Insidious onset
  • Mild to severe symptoms
  • Can develop into chronic hepatitis (80%)
  • Any age is affected
  • Screening blood, hygiene; NO vaccine
  • Leads to hepatocellular carcinoma, liver transplant
  • New treatment is developing and becoming more widely available
21
Q

Prevention of Hepatitis: Vaccines
Hep A Series

Study These Flashcards
A
  • 2 doses 6 months apart
    Recommendations
  • All children beginning at age 12 months
  • Special “high risk” populations
22
Q

Prevention of Hepatitis: Vaccines
Hep B Series

Study These Flashcards
A
  • 3 doses at least 4 months apart
  • Recommendation: All infants beginning as newborns
23
Q

Prevention of Hepatitis: Vaccines
Hep C

24
Q

Two classes of drugs are used for chronic HBV:

Study These Flashcards
A
  • Interferons
  • Nucleoside analogs
25
HBV treatment is only for high-risk patients who have:
* ↑ AST levels * Hepatic inflammation * Advanced fibrosis
26
Disadvantages of HBV treatment:
* Prolonged therapy * Costs and adverse effects * High relapse
27
How is HCV treated
* Treated with direct-acting antiviral therapy and interferon-based regiments * Some require treatment along with a nucleoside analogue medication as well * Now easily treatable and eliminated in most all patients | Can take tylenol although must be <2,000 mg
28
What is Cirrhosis?
* Irreversible, inflammatory, fibrotic liver disease * Structural changes from injury (alcohol/viruses) and fibrosis * Regeneration is disrupted by hypoxia, necrosis, atrophy, and liver failure
29
Chaotic fibrosis leads to:
Obstructive biliary channels and blood flow which lead to jaundice and portal hypertension
30
Cirrhosis Common Causes
-Hepatitis B&C -Excessive alcohol intake -Idiopathic -Non-alcoholic fatty liver disease [NASH, NAFLD]
31
Stages of alcoholic liver disease
1. Alcoholic fatty liver -Mildest, asymptomatic 2. Alcohol steatohepatitis -precusor to cirrhosis -Inflammation, degeneration of hepatocytes 3. Alcohol cirrhosis -Fibrosis and scarring alter liver structure
32
Cirrhosis: Pathogenesis
-Liver cells destroyed -Cells try to regenerate -Disorganized process -Abnormal growth -Poor blood flow and scar tissue -Hypoxia -Liver failure
33
Cirrhosis: Early Manifestations
GI disturbances * N/V * Anorexia * Flatulence * Change in bowel habits Fever, weight loss Palpable liver
34
Cirrhosis: Late Manifestations
Jaundice Peripheral edema Decreased albumin & PT Ascites Skin lesions Hematologic problems (anemia, bleeding) Endocrine problems Esophageal & anorectal varices Encephalopathy
35
What is Portal Hypertension?
Resistant portal blood flow  leads to varices & ascites
36
Portal hypertension causes
Causes: systemic hypotension, vascular underfilling, stimulation of vasoactive (RAAS system) systems, plasma volume expansion, increased cardiac output leads to ascites
37
Portal hypertension symptoms
Asymptomatic until complications * Variceal hemorrhage, ascites, peritonitis, hepatorenal syndrome, cardiomyopathy
38
Portal hypertension prevention/treatment
Can’t do anything for the portal hypertension except liver transplant
39
How is hepatic encephalopathy diagnosed?
LOC is the primary driver of diagnosis * Graded by severity * Correlate with liver labs, mainly ammonia which is primary chemical driver of LOC changes
40
What are the grades of hepatic encephalopathy?
* Minimal: Abnormal results on psychometric or neurophysiological testing without clinical manifestations (see 'Psychometric tests' below) * Grade I: Changes in behavior, mild confusion, slurred speech, disordered sleep * Grade II: Lethargy, moderate confusion * Grade III: Marked confusion (stupor), incoherent speech, sleeping but arousable * Grade IV: Coma, unresponsive to pain
41
Acute liver failure (fulminant liver failure) -Common cause
Most common cause: acetaminophen overdose * Can be treated with acetylcysteine
42
T/F Acute liver failure caused by cirrhosis
False, acute liver failure is a separate liver failure NOT caused by cirrhosis or other type of liver disease
43
Acute liver failure: Patho
Patho: edematous hepatocytes and patchy areas of necrosis and inflammatory cell infiltrates and disrupts the liver tissue Can occur 6-8 weeks after a viral hepatitis or metabolic liver disease * 5 days to 8 weeks after an acetaminophen overdose
44
Acute liver failure -S/S and treatment
* Signs are similar to cirrhosis symptoms * Treatment: not much, liver transplant

NUR 326-Pathopharm (24 decks)

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