Adult Health- Management of patients with problems of the liver, pancreas, and gallbladder Flashcards
What are some things the liver does?
Glucose, protein and fat metabolism
Ammonia(found in urea and is the breakdown of protein) conversion
Vitamin (fat soluble vitamins A, D, E, K,) and iron storage
Metabolism of steroid hormones..
sex hormones, glucocorticoids,
aldosterone
Metabolism of drugs
Synthesis of clotting factors: fibrinogen, prothrombin, factors V, VII, IX, X Bile formation and bilirubin excretion Filtration of blood and removal of bacteria and particulate matter via Kupffer cells Metabolic Activities of the Liver Carbohydrate metabolism Lipid metabolism Amino acid metabolism Waste product removal Vitamin storage Mineral storage Drug inactivation
What are the metabolic activities of the liver?
Carbohydrate metabolism Lipid metabolism Amino acid metabolism Waste product removal Vitamin storage Mineral storage Drug inactivation
What is cirrhosis?
Cirrhosis is extensive scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis.
Complications depend on the amount of damage sustained by the liver
what is compensated cirrhosis?
, the liver has significant scarring but performs essential functions without causing significant symptoms
Describe the etiology of cirrhosis.
Known causes of liver disease include: see table 58-1
Alcohol (long term alcohol use)
Viral hepatitis (Hep A, B, C, D, E)- inflammation of the liver from some toxin
Autoimmune hepatitis
Steatohepatitis (fatty liver)
Drugs and toxins (NSAIDs as well- primarily Tylenol)
Biliary disease
Metabolic/genetic causes
Cardiovascular disease (chronic right-heart failure)
Describe clinical manifestations of early liver disease
In early stages, signs of liver disease include: Fatigue Significant change in weight GI symptoms Abdominal pain and liver tenderness Pruritus- itching
Describe clinical manifestations of late stages of liver disease
In late stages, the signs vary: Jaundice and icterus Dry skin Petechiae, or ecchymoses (lesions) Warm, bright red palms of the hands Spider angiomas Peripheral dependent edema of the extremities, sacrum and abdomen (ascites) If portal vein becomes so scarred that it cannot work well, it will begin to block the fluid that will then cause severe edema and ascites
What happens if the portal vein becomes so scarred that it cannot work well?
it will begin to block the fluid that will then cause severe edema and ascites
What is fetor hepaticus?
breath odor that is kinda musty
What is asterixis?
flappy hands
what is melena?
old blood in the stool- dark purplish or dark tarry stool
what are some physical assessments with liver disease?
Assess for presence of bleeding
Fetor hepaticus (breath odor)- musty odor
Amenorrhea
Gynecomastia, testicular atrophy, impotence
Bruising, petechiae, enlarged spleen
Neurologic changes (due to increase of ammonia which will cross the blood brain barrier)
Asterixis (flappy hands)
Melena- old blood in the stool – dark purplish- dark tarry stool
spider angiomas!
What are some complications of cirrhosis?
Portal hypertension
Ascites
Bleeding esophageal varices
Coagulation defects
Jaundice
Portal-systemic encephalopathy with hepatic coma
Hepatorenal syndrome
Spontaneous bacterial peritonitis (distention, hard abdomen, a bunch of rebound painful tenderness, and signs of infection.) possible paracentesis to get a sample
Describe an abdominal assessment of liver disease/cirrhosis
Massive ascites
Umbilicus protrusion
Caput medusae (dilated abdominal veins)
Hepatomegaly (liver enlargement)
Describe a laboratory assessment for liver disease and cirrhosis.
Aminotransferase serum levels and lactate dehydrogenase may be elevated
Alkaline phosphatase levels may increase
Total serum bilirubin and urine urobilinogen levels may increase (fecal urobilinogen may fall)
Total serum protein and albumin levels decrease
