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Hepatic Disorders
NU122 Hepatic Disorders
| Question | Answer |
|---|---|
| What is Special about the Liver | - it is the largest gland in the body |
| Where is the liver located | - Upper right abdomen |
| Is the liver a very vascular organ | - Yes is it |
| Where does the liver receive its blood supply from | - Portal Vein - Hepatic Artery |
| What percentage of blood is from the portal vein | - 80% |
| What percentage of blood is from the hepatic artery | - 20% |
| What is the characteristics of the blood from the portal vein | - rich in nutrients because it comes from the GI tract |
| What is the characteristics of the blood from the hepatic artery | - rich in oxygen |
| What are the two main types of cells found in the liver | - Hepatocytes - Kupffer cells |
| What do the Hepatocytes do | - Form bile - Store glycogen |
| What do the Kupffer cells do | - Phagocytic action engulfs bacteria and particulate matter entering the liver from the portal vein |
| What are the functions of the liver | - Glucose Metabolism - Ammonia Conversion - Protein Metabolism - Fat Metabolism - Vitamin Storage - Bile Formation - Bilirubin Excretion - Drug Metabolism |
| How does the Liver Metabolize Glucose | - After a meal glucose enters the liver via the portal vein and stored in hepatocytes as gylcogen |
| What are the two mechanisms the liver performs with the metabolism of glucose | - Glycogenolysis - Gluconeogenesis |
| What is Glycogenolysis | - Liver releases stored glycogen into the bloodstream to keep blood glucose levels normal |
| What is Gluconeogenesis | - Liver converts amino acids to lactate into glucose in response to hypoglycemia |
| What is Ammonia a by product of | - Protein digestion in the intestines - gluconeogenesis |
| What does the liver convert ammonia to | - Urea |
| Where is urea excreted | - in the urine |
| How does the liver aid in the metabolism of protein | - It uses amino acids to synthesize all plasma protein - albumin - blood clotting factors |
| What role does albumin play in fluid balance | - it produces oncotic pressure in the blood vessels because they are too large to pass through the pores. This oncotic pressure draws fluid back into the blood vessels keeping the tissues around them free from edema |
| How does the liver play a role in fat metabolism | - Fatty acids are broken down by the liver into ketone bodies for energy production |
| When does the liver break down fatty acids for energy | - When glucose levels are low - Usually in uncontrolled diabetes and starvation |
| What do fatty acids produce | - Cholesterol |
| How does the liver aid in vitamin storage | - The liver stores Vitamins A,B,D - Many B-complex vitamins - Iron and Copper |
| How does the liver aid in Bile formation | - bile is formed by the hepatocytes |
| Where is the bile collected | - in the bile ducts |
| Where is bile stored | - the gall bladder |
| What is bile formed from | - Water, Electrolytes, cholesterol, bilirubin and bile salts |
| What is the function of bile | - Emulsifies fat as part of digestion |
| Where are the bile salts reabsorbed | - in the distal ileum - entero-hepatic circulation |
| Where does Bilirubin come from | - It is a pigment from the breakdown of red blood cells |
| How does the liver aid in the excretion of bilirubin | - It is released by the kupffer cells to the hepatocytes where it is conjugated and added into the bile |
| Where is the bilirubin converted | - Released into the small intestines and converted into urobilinogen |
| Where is urobilinogen excreted | - Filtered through the kidneys and excreted through the urine |
| How does the liver aid in drug metabolism | - By changing the bioavailability |
| What is bioavailability | - The amount of drug that actually reaches systemic circulation |
| What is the first pass effect | - If a drug is metabolized to a great extent by the liver is reduces the bioavailability |
| What are some liver function studies | - Serum Protein studies - Biliburin Studies - Prothrombin time - Serum alkaline phosphatase - Serum ammonia - Cholesterol |
| What are the tests for serum aminotransferases | - AST - ALT - GGT - LDH |
| What do increases in serum aminotransferases or AST,ALT, GGT or LDH indicate | - Injury to the liver |
| What are some liver diagnostic studies | - Ultrasound, CT, MRI - Nuclear medicine - Liver biopsy |
| What are ultrasounds, CTs, and MRIs used to identify | - Normal and abnormal structures of the liver |
| What does nuclear medicine identify in the liver | - Liver scans assess the size of the liver and flow of blood through the liver |
| What does a liver biopsy identify in the liver | - Examines cells - Identifies lesions |
| What are the two types of Dysfunction of the liver | - it can be - Chronic or Acute |
| What is the most common cause of Liver dysfunction | - ETOH |
| How is liver dysfunction compounded with the use of Alcohol | - Malnutrition |
| What can ETOH use lead to | - Cirrhosis |
| What are some of the other causes of liver dysfunction | - Infection - Anorexia - Metabolic Disorders - Nutritional deficiencies - hypersensitivity states |
| What are some of the manifestations of liver dysfunction | - Jaundice - Portal Hypertension - Ascities - Varices - Heptatic encephalopathy or coma - Nutritional deficiencies |
| What is jaundice | - Yellow or green tinged body tissue, sclera and skin |
| What is the yellowing related to | - Total bilirubin levels > 2.5 mg/dL |
| What are the normal bilirubin levels | - 0 - 0.9 mg/dL |
| What Causes Jaundice | - Hepato-cellular damage - obstruction |
| How does hepato-cellular damage cause jaundice | - the damaged liver cells cannot clear bilirubin from the blood |
| How does an obstruction cause jaundice | - Bile blocked from flowing into intestine - bilirubin reabsorbed into blood thus staining tissue |
| What are the signs and symptoms of juandice caused by hepato-cellular damage | - Loss of appetite, nausea - Malaise, fatigue, weakness - Headache, fever if due to infection, chills - Mildly or severely ill |
| What are the signs and symptoms of jaundice caused by an obstruction | - Dark, orange-brown urine - light clay colored stool - Dyspepsia, intolerance of fats, impaired digestion - Pruritis |
| What is Portal Hypertension | - Obstructed blood flow through the liver due to fibrosis of liver tissue - leads to increased pressure throughout the portal venous system |
| What can portal hypertension lead to | - Ascites - Esophageal varices |
| What is Ascites | - Fluid in peritoneal cavity |
| What are the causes of Ascites | - Portal Hypertension - Vasodilation of splanic circulation - Aldosterone - decreased albumin levels - movement of albumin |
| How does Portal hypertension cause Ascites | - Results in increased capillary pressure and obstruction of venous blood flow |
| How does Vasodilation cause Ascites | - The vasodilation of splahnic circulation increases the blood flow to the major abdominal organs |
| How does aldosterone lead to Ascites | - The changes in the ability to metabolize aldosterone leads to an increase in fluid retention |
| How does Albumin lead to Ascites | - Decreased synthesis of albumin leads to the decreased serum osmotic pressure which leads to fluids into the cells - Albumin moves into the peritoneal cavity which further pulls fluid into the cavity |
| Pathogenesis of Ascites | - Cirrhosis with Portal Hypertension - Splanchnic Arterial Vasodilation - Decrease in Circulating Arterial Blood Volume - Activation of renin-angiotensin and sympathetic nervous system and antidiuretic hormone - Kidney retains sodium and water |
| Pathogenesis of Ascites Continued | - Hypervolemia - Persistent activation of systems for retention of sodium and water; ascites and edema formation - Contiued arterial underfilling; cycle repeats |
| What sound you record in the assessment of ascites | - Abdominal girth and weights daily |
| What should you monitor for in the assessment of ascites | - Potential fluid and electrolyte imbalances |
| What physical attributes may a person have with ascites | - Striae - Distended veins - Umbilical hernia |
| How should you assess for fluid in the abdominal cavity | - by percussion for shifting dullness - or by fluid wave |
| What should be restricted in the diet in a person with ascites | - Sodium |
| What type of diuretic should a person be on | - Spironalactone - aldosterone blocking |
| What does bedrest do for a person with ascites | - improves diuresis |
| What is a paracentesis | - Use to drain fluid from the abdomen by the insertion of a tube |
| What can be given to increase the hydrostatic pressure | - Albumin |
| What is a TIPS Shunt | - Transjugular Intrahepatic Portosystemic Shunt - allows blood return to inferior vena cava - may lead to increased ammonia levels or right sided heart failure |
| What is Hepatic Encephalopathy | - Life-threatening complication of liver disease |
| What does Hepatic Encephalopathy result in | - Accumulation of ammonia in blood |
| What are the normal ammonia levels in the blood | - 15 - 45 mcg/dL |
| What should you assess for in a patient with Hepatic Encephalopathy | - EEG - Neurological status often for changes in LOC - Potential Seizures - Fector Hepaticus - Monitor Fluid, Electolytes and Ammonia Levels |
| What is Fector Hepaticus | - Earthy smelling breath |
| What is Asterixis | - When a person cannot keep their hands in an upright position |
| What are the effects of constructional Apraxia | - When a person cannot make simple shapes through drawing - They cannon write clear legible sentences |
| How can you decrease the ammonia Levels | - By eliminating the underlying causes |
| What can you give to a patient to reduce the ammonia levels | - Lactulose |
| Why would you give a person with high ammonia levels IV Glucose | - to minimize protein catabolism |
| What dietary restrictions would be in place with a patient with high ammonia levels | - Reduce protein intake |
| What medications should be discontinued in a person with increased ammonia levels | - Sedatives - Analgesics - Tranquilizers |
| Why should you provide a person a safe environment with increased ammonia levels | - To prevent injury due to confusion |
| What happens in about 1/3 of the patients with cirrhosis and varices | - The bleed into the esophagus |
| What is the mortality rate of bleeding esophageal varices | - 30 - 50% in the first bleeding episode |
| What are the manifestations of bleeding esophageal varices | - Hematemesis - melena - deterioration - shock |
| How often should a person with cirrhosis patients be screened for esophageal varices | - every 2 years |
| What is the pathogeneis pf bleeding esophageal varices | - Portal hypertension(caused by resistance to portal flow and increased portal venous inflow) - Development of pressure gradient of 12 mm Hg or greater between portal vein and inferior vena cava(Portal Pressure Gradient) |
| What is the pathogeneis of bleeding esophageal varices continued | - Venous collaterals develop from high portal system pressure to systemic veins in esophageal plexus, hemorrhoidal plexus and retroperitoneal veins - Abnormal varicoid vessels form in any of above locations - vessels may rupture life-threatening |
| What is should you treat for when a person has a bleeding varices | - Shock |
| What if given to a patient in the treatment of bleeding varices | - Oxygen - IV Fluids, Electrolytes and volume expanders - Blood and blood products |
| What medication is given to decrease bleeding | - Vasopressin - Octreotide |
| What medication is given to reduce coronary vasoconstriction | - Nitroglycerin in combination with vasopressin |
| What medication is given to decrease portal pressure | - Propranolol and nadolol in combination |
| What surgical interventions an be used with bleeding varices | - balloon Tamponade:Sengstaken-Blakemore Tube - Endoscopic Sclerotherapy - Esophageal Banding |
| Why should a nurse monitor a patients condition frequently with Bleeding varices | - Because of Alcohol withdrawl |
| What should a nurse monitor for in a person with bleeding varices | - For hepatic encephalopathy(blood breakdown in GI) - Monitor Treatments - GI Suction and Tube care - Oral Care - Quiet environment(Keep Calm) - Reduce anxiety, agitation, Family needs support |
| What should be done for a person with hepatic disorders and is vitamin deficient | - Prescribed a multi-vitamin - Thiamine - Folic Acid - Vitamin K |
| What happens to a person after eating meals with hepatic disorders | - They become hyperglycemic |
| Why does a person become hypoglycemic during fasting states | - Decreased hepatic Glycogen reserves - Decreased gluconeogenesis |
| What does a decreased albumin production by liver cause | - Systemic edema |
| What does a decrease in the production of clotting factors by the liver result in | - Increased bruising - GI Bleeding - bleeding from wounds |
| What does a Decrease in sex hormone metabolism by the liver result in | - Testicular atrophy - Loss of pubic hair - Menstrual irregularities |
| How long does it take for hepatic Cirrhosis take to develop | - Approximately 30 years |
| What first develops in Hepatic Cirrhosis | - A fatty liver |
| What develops after the fatty liver in Hepatic Cirrhosis | - Fibrotic Tissue replaces the normal tissue |
| What are the Signs and symptoms of Compensated Hepatic Cirrhosis | - Vascular Spiders - Reddened Palms - Unexplained epitaxis - Ankle Edema - Abdominal pain - Firm Enlarge liver - Vague indigestion in AM - Faltulent dyspepsia |
| What are the Signs and Symptoms of Decompensated hepatic Cirrhosis | - Ascites - jaundice - Weakness - Purpura - Spontaneous Bruising - Epitaxis - Hypotension - Muscle Wasting |
| What are the nursing diagnosis for a Cirrhosis patient | - Activity intolerance - Imbalanced Nutrition - Impaired Skin Integrity - Risk for Injury and Bleedin |
| What are the 2 types of Hepatitis | - Viral - Non-viral |
| What is Viral Hepatitis | - A systemic viral infection taht causes necrosis and inflammation of liver cells with characteristic symptoms and cellular and biochemical changes |
| What are the types of Viral Hepatitis | - A, B, C, D, E |
| What is non Viral Hepatitis | - Caused by toxins or drugs |
| How is Haptitis A Transmitted | - Fecal-Oral Transmission - Spread by poor hygiene - Hand to mouth - Through food and fluids |
| What is the incubation period for Hepatitis A | - 15 - 50 Days |
| How long will the illness last | - 4 - 8 Weeks |
| What is the mortality rate with Hepatitis A | - Very Low |
| What are the signs and Symptoms of Hepatitis A | - Mild flu like symptoms - Low-grade fever - anorexia - Indigestion - Jaundice - Dark urine later - Enlargement of liver and spleen |
| When does the Anti-HAV antibody appear | - After symptoms appear |
| How can you prevent Hepatitis A | - Good Handwashing - Clean Water - Proper Sewage Disposal - Vaccine - Immunoglobulin for for contacts for passive immunity |
| What is the treatment for Hepatitis A | - Bed Rest during acute phase - Nutritional Support |
| How is Hepatitis B and C Transmitted | - Through Body Fluids - Blood - Sexual contact - Needles |
| What does Hepatitis B and C Lead to | - major Cause of liver cancer and Cirrhosis |
| Is there a vaccine for Hepatitis B | - Yes |
| What Can hepatitis B and C be treated with | - interferon and anti-viral drugs |
| What does alcohol encourage in persons with Hepatitis B and C | - the progression of the disease |
| When can Hepatitis D be Present | - only in persons infected with Hepatitis B |
| How can you Prevent Hepatitis B and C | - vaccine for hepatitis B - Passive Immunization for those exposed - Standard Precautions - Screening for blood and blood products |
| Does cancer originate in the liver | - Usually not only a few does |
| What usually precedes Live cancer | - Hepatitis B or C |
| What is the growth called with liver cancer | - Hepatocellular carcinoma |
| What is the frequent site for metastatic cancer | - The liver |
| What are some of the manifestations of liver cancer | - Pain - dull continuous ache in RUQ, apigastrium or back - Weight loss - loss of strength - anorexia - anemia |
| How does jaundice occur with liver cancer | - if bile ducts are blocked |
| How does ascites occur with liver cancer | - if portal vein is obstructed |
| What is done in the pre-porcedure with a liver biopsy | - Consent form - Coagulation tests - blood for transfusion available |
| What is done in the procedure in a liver biopsy | - Expose right lateral chest wall - Instruct to inhale and exhale several times, then exhale and hold breath - physician will introduce biopsy needle between ribs into liver, aspirate tissue, and withdrawl needle |
| What should be done immediately after a liver biopsy is done | - turn patient onto right side - place a pillow or sand bag under costal margin - instruct patient to remain in this position for several hours |
| How often should vital signs be taken in a patient with a liver biopsy | - every 15 minutes for the first hour - every 30 minutes for the next 2 hours |
| What should you teach a patient that has just had a liver biopsy | - avoid heavy lifting or any strenuous activity for one week |
| What are major complications in a liver biopsy | - Bleeding - bile peritonitis |
| What makes surgery dangerous in patients with liver cancer | - Cirrhosis |
| What are some palliative and sometimes curative treatment in patients with liver cancer | - Radiation therapy - Chemotherapy - Percutaneous biliary drainage |
| When would a surgery be performed on a patient with liver cancer | - if it is confined to one lobe - if function is adequate |
| What does the liver have the capability of doing | - regenerating its cells |
| What are some of the surgeries that can be done for liver cancer | - Lobectomy - Cryosurgery - Liver transplant |
| What are some of the anti-rejection medications that a person must take | - Prograf - cellcept - cyclosporine - azathioprine - corticosteriods |
Created by:
saraken2007
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