Biliary & Hepatic Flashcards
Pancreas exocrine excretions
Amylase, trypsin, lipase, secretin
Pancreas endocrine excretions
Insulin, glucagon, somatostatin
Pancreatitis
MOA acute
Pancreatic duct becomes obstructed and enzymes back up, causing auto-digestion and inflammation of the pancreas
Pancreatitis
MOA chronic
Progressive inflammatory D/O w/ destruction of the pancreas; cells are replaced by fibrous tissue; pressure w/in pancreas increases, obstructing the pancreatic and common bile ducts
Pancreatitis
Complications
- F&E disturbances
- Necrosis of pancreas
- Shock
- MODS
- DIC
Metabolic function of liver
- Glucose metabolism
- Ammonia conversion
- Protein metabolism
- Fat metabolism
- Vitamin and iron storage
- Bile formation
- Bilirubin excretion
- Drug metabolism
LFTs
- Serum aminotransferase: AST, ALT, GGT, GGTP, LDH
- Serum protein studies
- Direct & indirect serum bilirubin, urine bilirubin, urine urobilinogen
- Clotting factors
- Serum alk phos
- Lipids
Serum aminotransferases
Indicators of injury to liver cells
Helpful in detecting hepatitis
Alanine aminotransferase (ALT)
Levels increase primarily in liver D/O
Used to monitor course of hepatitis, cirrhosis, effects of TX that may be toxic to liver
Aspirate aminotransferase (AST)
Not specific to liver disease
May be increased in cirrhosis, hepatitis, liver cancer
Gamma-glutamyl transferase (GGT)
Levels associated w/cholestasis, alcoholic liver disease
Additional DX studies for liver disease
Liver biopsy, US, CT, MRI
Manifestations of hepatic dysfunction
Jaundice, portal HTN, ascites, varices, hepatic encephalopathy, coma, nutritional deficiencies
Bilirubin level to cause jaundice
> 2
S/S associated w/hepatocellular jaundice
- Lack of appetite, N/V, weight loss
- Malaise, fatigue, weakness
- HA, chills, fever, infection
S/S associated w/obstructive jaundice
- Dark orange-brown urine, clay-colored stools
- Dyspepsia & intolerance of fats, impaired digestion
- Pruritus
Consequences of portal HTN
Ascites
Varices
Ascites
Causes
- Portal HTN —> increased capillary pressure —> obstruction of venous blood flow
- Vasodilation of splanchnic circulation
- Changes in ability to metabolize aldosterone, increasing fluid retention
- Decreased synthesis of albumin, decreasing serum osmotic pressure
- Movement of albumin into peritoneal cavity
Ascites
Assessment
- Abdominal girth, daily weights
- May have striae, distended veins, umbilical hernia
- Percussion shows shifting dullness or fluid wave
- Monitor for F&E imbalances
Ascites
Treatment
- Low Na diet
- Diuretics
- Bed rest
- Paracentesis
- Admin of salt-poor albumin
- Transjugular intrahepatic portosystem shunt (TIPS)
Hepatic encephalopathy
Management
- Lactulose
- IV glucose to minimize protein catabolism
- Protein restriction
- Reduction of ammonia from GI tract by gastric suction, enemas, PO ABX
- D/C sedatives, analgesics, tranquilizers
- Monitor/Tx complications and infections
Esophageal varices
Management/Tx
- Treat for shock, admin O2
- IVF, lytes, volume expanders, blood/blood products
- Vasopressin, somatostatin, octreotide to decrease bleeding
- Nitroglycerin in combo w/ vasopressin to decrease coronary vasoconstriction
- Propranolol, nadolol to decrease portal pressure (combo Tx)
- Balloon tamponade, endoscopic sclerotherapy, endoscopic variceal ligation, TIPS, surgical bypass, devascularization/transaction
Hepatitis A & E spread
Fecal-oral
Hepatitis B & C spread
Bloodborne
Hepatitis D spread
Only people w/B can get D
Hep A incubation
2-6 wks, may last 4-8 wks
Hep A S/S
Mild flu-like S/S, low-grade fever, anorexia, jaundice/dark urine, indigestion, epigastric distress, enlargement of liver/spleen
Hep A management
- Prevention: hand hygiene, safe water, proper sewage disposal, vaccine
- Bed rest during acute stage, nutritional support
Hep B incubation
1-6 months
Hep B S/S
Insidious and variable - similar to HAV, loss of appetite, dyspepsia, abdominal pain, generalized aching, malaise, weakness
Jaundice may/may not be evident
Hep B management
- Meds: alpha interferon, antiviral agents (entevavir, tenofovir)
- Best rest, nutritional support
- Vaccine for high risk
Hep C incubation
15-160 days
Hep C management
- Antiviral meds
- Alcohol worsens disease - AVOID
Cirrhosis
S/S
Liver enlargement, portal obstruction, ascites, infection/peritonitis, varices, edema, vitamin deficiency, anemia, mental deterioration
Cirrhosis
Nutrition
- Small, frequent meals
- I&O
- High-calorie diet, Na restriction
- Protein modified or restricted if patient is @ risk of encephalopathy
- Supplemental vitamins
Liver cancer
S/S
- Dull, persistent pain - RUQ, back, epigastrium
- Weight loss, anemia, anorexia, weakness
- Jaundice, bile ducts occluded, ascites, obstructed portal veins
