BC3 - Liver
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| Functions of the liver | Bile production & excretion; excretion of bilirubin, cholesterol, hormones & drugs; metabolism of fats, proteins, CHO. Enzyme activation
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| Functions of the liver | Storage of glycogen, vitamins, and minerals; Synthesis of plasma proteins - albumin and clotting factor; Blood detoxification and purification
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| Portal circulatory system - 75% of the blood comes from | Stomach, intestines, spleen, pancreas - to the liver through the portal vein
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| Hepatocytes | secrete bile
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| Bile Flow | Formed in hepatocytes - Through canaliculi - to bile duct - combined to form larger ducts - empty into common bile duct
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| Sinusoids | Surrounded by hepatocytes; Distensible vascular channels - spongy epithelial cells
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| Portal Circulation | Blood flows through sinusoids - Central veins - Hepatic vein - Inferior Vena Cava
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| Kupffer Cells | Phagocytic cells - Remove bacteria & blood toxins
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| Portal Hypertension | r/t anything that causes an increase in pressure
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| Obstruction of the portal circulation | thrombosis, inflammation, fibrosis of the sinusoids
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| Most common cause of portal hypertension | cirrhosis
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| Obstruction of the portal circulation leads to | development of collateral circulation (blood makes its own route)
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| Long term problems of portal hypertension | Varices (increased pressure leads to weakening of vessel walls)
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| Where do varices occur | esophageal, stomach, rectum
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| Why do varices rupture | d/t gastric acid & elevated pressure
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| S/S of varices | vomiting blood, anemia if slow chronic bleed, they will have low Hgb
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| Dx of varices | endoscopy identifes portal HTN
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| Tx of varices | Beta Blockers; Nitrates;
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| Tx of varices (Vassopressors) | Used cocomitantly with NTG to reduce vasopressive action on other organs especially cardiac
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| Sclerotherapy r/t acute bleed of varices | endoscopically delivered medications (injected at site),
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| TIPPS | shunt between hepatic/portal veins; metal stent used to maintain patency; decompresses portal system (used for varices)
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| Splenomegaly | increased pressure in the splenic vein
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| Ascites | fluid accumulates n the peritoneal cavity
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| S/S of ascites | enlarged abd.; visible venous mapping showing collateral circulation; dyspnes because organs displaced; bacterial peritonitis can develoop
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| Tx of ascites | Paracentesis, may spontaneously resolve if functional restoration possible
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| Paracentesis helps to | evaluate fluid, relieve discomfort
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| Hepatic Encephalopathy | CNS disturbance, alterations in consciousness - toxins, ammonia, hormones accumulate in circulation and lead to damage in the brain
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| Hepatic encephalopathy was previously called | hepatic coma
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| What causes hepatic encephalopathy | ammonia freely circulating in the blood: competes with oxygen on Hgb causing hypoxia; it crosses the blood-brain barrier leading to toxic buildup of ammonia/urea in the brain
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| Early stage s/s of hepatic encephalopathy | lethargy, personality changes, irritability, sleep disturbances
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| Late stages s/s of hepatic encephalopathy | confusion, liver flap, stupor, convulsions, coma (liver failure), death
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| Liver flap | hands/arms up and they "flap" when held up
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| Jaundice (other name) | Icterus
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| Three types of jaundice | Hemolytic, Hepatocellular, Obstructive
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| Hemolytic jaundice | excessive breakdown of RBC's; metabolism of the heme component
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| Hepatocellular jaundice | Hepatocytes are damaged; can't conjugate bili; total bilirubin elevated
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| Obstructive jaundice | Extrahepatic - bile duct into duodenum obstructed (gallstones); Intrahepatic - obstruction of bile canaliculi
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| Hyperbilirubinemia | r/t water soluble; excreted by kidneys; transformed/metabolized by liver; cirrhosis; biliary obstruction; infectious hep; pancreatic CA; meds
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| Hepatitis | Inflammation of the liver
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| Hepatorenal syndrome | advanced liver disease with functional renal failure
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| S/S of hepatorenal syndrome | Oliguria, Na & water retention; hypotension; peripheral vasodilation
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| Hepatorenal syndrome is usually associated with | alcoholic cirrhosis & fulminant hepatitis
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| Acute Hepatitis | Viral, most common
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| If you have chronic hepatitis you are a | life long carrier
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| Hepatitis A rout of transmission | Fecal Oral route of transmission;
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| Hep A comes from | crowded living, food handlers, contaminated food/water, sexual contact
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| Hepatitis B routes of transmission | Blood/blood products, sexual contact, perinatal transmission, can produce lifelong carrier
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| Hepatitis C | Same as B, Significant number develop chronic
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| Hepatitis D | Causes infection only in conjunction with B (Very fragile); Superinfection; Same as B - unable to survive independently; infectious during all stages
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| Hepatitis E route of transmission | Fecal-oral
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| Hepatitis E is found in | contaminated water, prevalent in third world countries, unknown period of infectious transmission
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| Prodromal phase (preicteric) | Approximately 2 weeks after exposure; ends with jaundice
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| S/S of hepatitis during the preicteric phase | fatigue, N/V, flu like symptoms
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| Icteric phase | starts when they turn yellow (jaundice); 1-2 weeks after prodromal phase; lasts approx 2-6 wks; enlarged liver (palpable below the ribs and painful); Actual disease phase of hepatitis
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| Recovery phase of hepatitis is called | posticteric
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| Posticteric phase begins | when jaundice resolves; averages 6-8 wks after exposure; symptoms diminish -liver still tender & enlarged; Fnct returns to normal 2-12 wks after onset of jaundice
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| Chronic active hepatitis | Persists after Hep B; Abnl LFT's for more than 6 months; persistent surface antigen; Predisposed to Cirrhosis & primary hepatocellular CA
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| Fulminant Hepatitis | Complication of Hep B/C; Severe impairment or necrosis of liver cells
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| Dx of Cirrhosis | Abd Xrays; Liver US; Nuclear scan of liver & spleen, CT, Percutaneous Liver Bx; Hepatic Angiography
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| Cirrhosis | severe ascites results from cirrhosis as the most common cause
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| Causes of Cirrhosis (diseases) | Alcoholic; Chronic Hep C; Chronic Hep B & D; Autoimmune hepatitis; Inherited disease
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| Causes of Cirrhosis | blocked bile ducts; drugs, toxin & infections; Severe reactions to Rx; Prolonged exposure to environmental toxins; Repeat bouts of heart failure with liver congestion
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| Tx of Cirrhosis | Corticosteroids; Rest; Nutrition management - controlling Na, Diuretics, Paracentesis (for ascites)
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| Cholelithiasis | Gallstones
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| Gallstones are caused by | cholesterol stones & pigmented stones
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| Cholecystitis | Inflamation of the gallbladder; acute or chronic; almost always caused by stone in the cystic duct
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| S/S of cholecystitis | Rebound tenderness, abd muscle guarding, fever, leukocytosis
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| What labs are elevated with cholecystitis | Serum bilirubin & alk phos
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| Dx of Cholecystitis | Cholangiography & ERCP
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| Endoscopic Retrograde Cholangiopancreatography (ERCP) | Used to dx problems in liveer, gallbladder, bile ducts, pancreas
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| Tx of cholecystitis | narcotics to control pain, antibiotics, & cholecystectomy
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| What narcotics are used for cholecystitis | Morphine, Demerol, Dilaudid
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| Pancreatitis | inflammation of the pancreas; generally rare but potentially serious disorder; occurs equally in both sexesw
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| Pancreatitis is associated with | Alcohol, Obstructive biliary tract disease, peptic ulcers, trauma, hyperlipidemia, certain drugs
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| Complications of pancreatitis | Hypovolemia, Hypotension, Myocardial insufficiency
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| Some pts with pancreatitis develop | tachypnea, hypoxemia (secondary to pulm edema), Atelectasis, Pleural effusions from circulating pancreatic enzymes
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| Acute Hemorrhagic Pancreatitis | Usually mild disease; leaking enzymes into the pancreatic tissue from obstruction
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| Tx of Pancreatitis | Pain med, NGT to low intermittent suction, NPO, IVF, Hyperailmentation
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| Chronic pancreatitis | Structural or functional impairment; chronic alcoholic, characterized by intermittent pain (may intensify after eating); Steatorrhea; Malabsorption syndrome
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| Tx of Chronic pancreatitis | Oral enzymes replacement tx; potential loss of islet cells (lead to IDDM); No More Booze; Surgical intervention; at risk for developing pancreatic CA
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| Surgical intervention of chronic pancreatitis | Cyst development, drainage or removal, fibrosis, strictures
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