Liver Test Questions

Question 1

The majority of perfusion to the liver is delivered via the?

Answer 1

Hepatic Portal vein

Question 2

The Hepatic portal Vein is the venous drainage for which four organs?

Answer 2

Stomach, esophagus, sm and lg intestines

Question 3

What would happen if there was enough pressure in the hepatic portal vein?

Answer 3

Portal hypertension and could lead to an upper GI bleed

Question 4

Where does the liver receive products of RBC breakdown from?

Answer 4

The spleen

Question 5

The liver eliminates ammonia by converting it into?

Answer 5

BUN

Question 6

Ammonia is the waste product of the break down in?

Answer 6

Protein

Question 7

If there was a build up of ammonia, what medications would be normally see given to help the balance the lab value?

Answer 7

Lactalose
AND
antibiotics

Question 8

Why would we see an antibiotic when ammonia gets too high?

Answer 8

An antibiotic will kill the gut flora, to control how much is being produced

Question 9

What is Oncotic pressure?

Answer 9

Oncotic pressure, or colloid osmotic pressure, is a form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel’s plasma (blood/liquid) that usually tends to pull water into the circulatory system.

Question 10

What protein produced by the liver maintains oncotic pressure of our capillaries?

Answer 10

Albumin

Question 11

What happens to oncotic pressure when a pt is in liver failure?

Answer 11

Liver produces albumin > LIVER FAILURE OCCURS > less albumin is being produced > decrease in oncotic pressure > ASCITES/ EDEMA

Question 12

What does the spleen do?

Answer 12

Creates and releases platelets

Question 13

Where is bile stored?

Answer 13

Gallbladder

Question 14

What is iron used for?

Answer 14

to make Hgb or RBCS

Question 15

Bile is needed for?

Answer 15

Fat absorption

Question 16

Hepatic vein

Answer 16

nutrient and oxygen poor, takes blood back to right side of heart

Question 17

portal vein

Answer 17

nutrient rich, takes from the spleen, stomach and sm and lg intestines. delivers the nutrients to the liver

Question 18

proper hepatic

Answer 18

oxygen rich

Question 19

What the fuck is a hepatic lobule?

Answer 19

Blood enters the lobules through branches of the portal vein and hepatic artery proper, then flows through sinusoids. YOU HAVE SO MANY OF THESE IN YOUR LIVER

Question 20

Portal Triad is made up of?

Answer 20

Hepatic artery, portal vein, bile duct

Question 21

Largest gland in your body?

Answer 21

Liver bitch

Question 22

What does the liver do?

Answer 22

Storage, protection, metabolism

Question 23

This is used to make RBCs and HgB in bone marrow?

Answer 23

Iron

Question 24

The is used to make blood clot

Answer 24

Vitamin K

Question 25

This is needed for calcium absorption

Answer 25

Vit D

Question 26

What are Kupffler cells?

Answer 26

Destroy intestinal bacteria

Question 27

How does the liver protect us?

Answer 27

It detoxifies blood! Foreign bodies are attacked!

Question 28

Two ways for us to get cholesterol

Answer 28

Diet and liver production

Question 29

Liver is supposed to convert Bilirubin into

Answer 29

Bile

Question 30

Build of bilirubin leads to?

Answer 30

Jaundice

Question 31

#1 reason for liver failure?

Answer 31

ALCOHOL

Question 32

#2 reason for liver failure

Answer 32

HEP C

Question 33

#3 reason for liver failure?

Answer 33

NASH

Question 34

What is NASH?

Answer 34

Non-alcoholic steatohepatisis

Question 35

Who is more at risk for NASH?

Answer 35

Pt with DM or chronically obese

Question 36

What's another name for NASH?

Answer 36

"fatty liver"

Question 37

Early signs and symptoms

Answer 37

fatigue, may or may not have weight loss (caused by malnutrition), anorexia, vomiting/nausea, RUQ tenderness

Question 38

Late signs and symptoms

Answer 38

GI B, Jaundice, Ascites (third spacing), spontaneous brushing

Question 39

Complications with liver failure:

Answer 39

``` portal hypertension splenomegaly esophageal varices coagulation defects ascites GIB spontaneous bacterial peritonitis Hepatorenal syndrome Hepatic enchephalopathy ```

Question 40

Is cirrhosis reversible?

Answer 40

fucking no it's not.

Question 41

Is acute liver failure reversible?

Answer 41

yes boy it is

Question 42

How many stages of liver failure are there?

Answer 42

4 stages

Question 43

What is liver cirrhosis?

Answer 43

SCARRING | when the liver is unable to carry out excretory function, metabolic function are inadequate to meet demands

Question 44

What labs are we looking at for Liver Cirrhosis?

Answer 44

AST, ALT, LDH, ALK PHOS, Bilirubin, direct and total, urine urobilinogen, albumin, ammonia, PT/INR, platelets, HCT, Hgb

Question 45

Serum Enzymes: AST, ALT, LDH, ALK Phos

Answer 45

elevated

Question 46

Bilirubin: direct, total, urine urobilinogen

Answer 46

elevated

Question 47

Serum Proteins: Albumin

Answer 47

decreased

Question 48

PT/INR:

Answer 48

Prolonged (more time, increase)

Question 49

Ammonia:

Answer 49

Elevated

Question 50

CBC:

Answer 50

decreased

Question 51

What is Ascites?

Answer 51

Collection of fluid in the peritoneal cavity (3rd spacing) due to portal vein hypertension

Question 52

Ascites signs and symptoms

Answer 52

rigid, guarding behavior, abd. pain, warm, edema, yellow (amber) colored urine, hyperkalemia

Question 53

Treatment of Ascites

Answer 53

``` Lasix Aldactone IV albumin low sodium diet stricts I&Os ```

Question 54

What diuretic is potassium sparing?

Answer 54

Aldactone

Question 55

What is Jaundice?

Answer 55

A build up of bilirubin, the livers inability to convert bilirubin to bile

Question 56

What are some different reasons that Jaundice can happen?

Answer 56

Hemolytic, hepatocellular, obstructive

Question 57

Signs and symptoms of Jaundice

Answer 57

yellow eyes, ITCHY, amber urine, pale stools, fatigue, abdominal pain, vomiting

Question 58

Portal Hypertension

Answer 58

Splenomegaly > caput medusae > hemorrhoids > espophageal varices > gastropathy

Question 59

A pt says, "what the hell are these snake like things on my belly" what is it?

Answer 59

Caput Medusae

Question 60

Signs and symptoms or portal hypertension

Answer 60

``` veins that pop out prone to bleeding coffee ground emesis maroon stool iron smelling stool ```

Question 61

Coagulation defects

Answer 61

Liver makes clotting factors, if liver is impaired the clotting factors are impaired. injury > vessel contracts > platelet plug > fibrin clot

Question 62

Hepatic Encephalopathy is?

Answer 62

Increase ammonia | Shunting of portal venous blood back to central circulation, the substances from the intestines are not detoxified

Question 63

Treatment for Hepatic encephalopathy

Answer 63

lactalose | antibiotic

Question 64

Signs and symptoms of Hepatic Encephalopathy

Answer 64

shortened attention lethargy and disorientation somnolence with gross orientation coma

Question 65

Those who have hepatic encephalopathy at at risk for

Answer 65

FALLS

Question 66

Hepatorenal syndrome

Answer 66

decreased renal perfusion

Question 67

Signs and symptoms of hepatorenal syndrome

Answer 67

``` decreased UO, chronic ascites reoccurring GIB coffee ground emesis hypovolemic shock ```

Question 68

At risk: Hemorrhage (congestion)

Answer 68

INTERVENTIONS: Screen for esophageal varices, IV fluids, Drug therapy, endoscopic therapy, Labs TX: Fresh frozen plasma

Question 69

At risk: Fluids (fluid volume excess r/t third spacing/ ascites and peripheral edema

Answer 69

INTERVENTIONS: nutrition therapy, drug therapy, paracentesis, respiratory, position

Question 70

At risk: Hepatic Encephalopathy

Answer 70

INTERVENTIONS: Assessment (confusion, hand tremors), Nutrition therapy, Drug Therapy

Question 71

Transplant

Answer 71

refer if bilirubin increased, clotting increased, creatinine increase

Question 72

Hepatoxic Drugs

Answer 72

Acetaminophen, anti-platelet meds: aspirin, codeine, cyclosporine, valium, oral contraceptives, anti-seizure meds, anti psychotic meds amiodarone

Question 73

IV albumin

Answer 73

Thicker, short/vented tubing