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Stack #199526
Liver
| Question | Answer |
|---|---|
| Liver | located RUQ, sheltered by ribcage, Dullness on percussion, difficult to palpate, non-tender unless inflammed. |
| Liver function | carbohydrate, protein, fat, and bilirubin matabolism, bile production, detoxification, and vitamin and mineral storage. |
| Carbohydrate metabolism | Glucose formation and storage as glygogen |
| Protein metabolism | Albumin: 1 of 2 proteins in the blood. It maintains oncotic pressure in the blood, transports Bilirubin, fatty acids, drugs and hormones; Clotting factors: P.T and P.T.T; Globulins: a plasma protein formed by the liver. |
| Fat metabolism | If not metabolized builds up in the arteries |
| Bile production | assist with fat digestion and fat soluble vitamen absorption (A,D,E,K) |
| Bilirubin Metabolism | Bi-product of RBC breakdown |
| Detoxification | Ammonia- a bi-product of protein metabolism converts to urea; hormones-estrogens and androgens; drugs and alcohol |
| Which vitamens and minerals are stored by the liver? | A,D,E,K,B12, Iron, Ferritin, Copper |
| Altered liver function | Altered CHO, protein, fat, metabolism, and altered detoxification |
| Altered CHO metabolism | Decreased glyconeogenesis- the making of glucose from a non-carbohydrate source, decreased glycogenesis- making of glycgen from glucose, and decreased glycogenolysis- glucose changing back to glycogen. |
| Alterd protein Metabolism | Decreased clotting factors, decreased albumin- results in edemas, decreased protein synthesis- muscle wasting |
| Altered fat metabolism | Increased Triglycerides and decreased fatty acid synthesis |
| Altered Detoxification | Increased hormone levels, ammonia, drug level (can't detoxify) and bilirubin |
| Major symptom of altered liver function | Jaundice |
| Jaundice | yellowish dicoloration of body tissue resulting from alteration in norml bilirubin or flow of bile onto the hepatic or biliary duct system |
| icteric | eyes are yellow or jaundiced |
| aicteric | eyes are not jaundiced |
| Types of Bilirubin (breakdown of RBCs) | conjugated (direct, after it gets to the liver, water soluble, secreted into bile) and Uncongugated (indirect before it gets to the liver, not water soluble) Liver does the conjugating. |
| What are the Types of Jaundice? | Hemolytic: Heptatocellular: Obstructive: |
| Obstructive Jaundice | obstructed bile flow thru liver or biliary duct system. |
| Heptatocellular Jaundice | livers altered ability to take bilirubin from blood and excrete it. |
| Hemolytic Jaundice | not livers fault, increased breakdon of RBC's; |
| Hepatitis | any inflammation of the livercaused by viral or bacterial5 types- A,B,C,D,E,G |
| Hepatitis A (HAV) | food born, fecal-oral route.GI symtomsincubation 15-50 daysAnti-HAV IgM= acute infectionAnti-HAV IgG= antibody |
| Hepatitis B (HBV) | Blood and fluidsincubation 45-180 daysIV drug use, needle stick, semen, vaginal secretion, saliva, birthing |
| Hepatitis B- 3 antigens | complex molecule: Surface antigen HBsAg, Core antigen HBcAg, e antigen (each antigen has a corresponding antibody) |
| Hepatitis B- LABS: HBsAg | in the blood for 6-12 months. Indicates carrier, elevated in current infection. This is bad, the body should have made antibodies by now. |
| Hepatitis B- LABS: Anti-HBs | immunity, previous infection or vaccine |
| Hepatitis B- LABS: HBeAg | degree of infection |
| Hepatitis B- LABS: Anti-HBe | previous infection |
| Hepatitis B- LABS: Anti-HBc IgM | acute infection |
| Hepatitis profile Lab | checks all 3: A,B,and C |
| Hepatitis C (HCV) | contracted through Blood and body fluids, tatoos, snorting coccaine, incubation 14-180 days, Anti-HCV can indicate acute or chronic, Signs are similar to Hep B |
| Hepatitis D (HDV) | can only Live together with HBV, can be eraticated with HBV vaccination, incubation 14-180 days, converts HBV from mild to severe, Lab- Anti-HDV may show current or carrier |
| Hepatitis E (HEV) | fecal-oral route of transmission, incubation 15-64 days, found in India, Asia, Mexico, and Africa, no serologic test |
| Hepatitis G (HGV) | only with needle sticks and transfusions, recently discovered, persists for 12 months either recover or become chronic, co-infection with HCV |
| Pathophysiology of Hepatitis | Inflammation of liversome regeneration of cells can occur, immune system is activated leading to S/S |
| Hepatitis complications | greater mortality with HBV and HCV, chronic persistant Hepatitis, chronic active hepatitis, fulminant hepatitis-necrosis of liver cells |
| hepatitis clinical manifestations: Preicteric | 1-21 days: N&V, anorexia, decreased smell and taste, RUQ pain. wgt loss. diarrhea, malaise, HA, dark yellow urine, Arthralgias, uticaria (itching), hepatospeenomegaly, lymphadenopathy, increased liver enzymes. |
| hepatitis clinical manifestations: Icteric | 2-3 weeks S&S include, jaundice, dark urine, clay colored stools, pruritis, hepatomegaly, increased liver enzymes, fatigue |
| hepatitis clinical manifestations: posticteric | convalescant 2-4 months, S&S: jaundice disappears, fatigue, malaise, hepatomegaly continue, decreased splenomegaly, lab values to normal. normal urine, normal stool. |
| management of hepatitis | no meds to treat, supportive care, diet high protein and carb, low fat, need adequate calories, vits. B complex (cell growth), K (clotting),fluid intake ( 2500-3000 ml/day), Rest-BR while symptomatic, antiemetics to relieve nausea |
| management of hepatitis A and B | supportive care |
| management of chronic hepatitis B | use of Interferon, Lamivudine is long term |
| management of chronic hepatitis C | use of Interferon and Ribavirin |
| Hepatitis health promotion | hand washing, safe sex, IgG to those exposed, HBV vaccine to at risk population, no alcohol if liver problem exist |
| Most important labs for liver function | Albumin and INR |
Created by:
gemjema
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