chapter 19 book notes Flashcards
1
Q
What is the most metabolically active organ in the body? & why
A
-liver
-plays central role in processing & storing the nutrients provided by the foods we eat.
2
Q
What proteins does the liver produce?
A
-most of the proteins that circulate in plasma,
including albumin, blood-clotting proteins, and transport proteins
3
Q
What else does the liver produce?
A
-bile
4
Q
the liver ??? drugs and alcohol and processes excess ?? so that it can be safely excreted as urea.
A
-detoxifies
-nitrogen
5
Q
primary symptom of liver disease:
A
-fatigue, which often goes unnoticed
6
Q
two most common disorders of the liver:
A
-fatty liver
-hepatitis
7
Q
fatty liver:
A
-an accumulation of fat in liver tissue;
-an imbalance between the amount of fat produced in the liver and the amount the liver uses or exports to the blood via very-low-density lipoproteins
8
Q
what causes a fatty liver?
A
-defects in metabolism
-excessive alcohol ingestion
-exposure to various drugs and toxins
9
Q
nonalcoholic fatty liver disease
A
-unrelated to alcohol
-insulin resistance is the primary risk factor
10
Q
what can accompany in a nonalcoholic fatty liver?
A
-type 2 diabetes mellitus, metabolic syndrome, and obesity
11
Q
Additional causes of a fatty liver:
A
-protein-energy malnutrition
-long-term total parenteral nutrition
12
Q
Fatty liver is estimated to affect as many as ??? of adults in Westernized countries
and nearly ?? percent of heavy drinkers.
A
-1/3
-90%
13
Q
In many individuals, fatty liver is ??? and
causes no harm.
A
-asymptomatic `
14
Q
In other cases, it may be associated with ???? , AND ?? and ?? (SYMPTOMS)
A
-inflammation (steatohepatitis)
-liver enlargement (hepatomegaly)
-fatigue
15
Q
If inflammation and scarring develop, fatty liver may progress to…
A
-cirrhosis
-liver failure
-liver cancer
16
Q
What is the most common cause of abnormal liver enzymes levels in the blood?
A
-fatty liver
17
Q
Laboratory findings typically include elevated concentrations of what liver enzymes ?
A
-alanine aminotransferase (ALT) and aspartate aminotransferase (AST),
as well as triglycerides, cholesterol and glucose
18
Q
What is the usual treatment for a fatty liver?
A
-eliminate the factors that cause it
-For example, if fatty liver is due to excessive alcohol use or a drug treatment, it may improve after the patient discontinues use of the substance
19
Q
An appropriate treatment for patients with obesity or diabetes with a fatty liver is:
A
-weight reduction
-increased physical activity
-medications that improve insulin sensitivity
20
Q
Dietary suggestions for a fatty liver:
A
-reduction in added sugars (especially fructose) and replacement of saturated with unsaturated fats.
-Mediterranean dietary pattern
21
Q
hepatitis:
A
-infection of liver tissue with specific viruses that causes inflammation and damage
-A, B, C, D, and E
22
Q
other causes of hepatitis:
A
- excessive alcohol intake,
- exposure to some drugs
- fatty liver disease,
-autoimmune disease.
23
Q
long term hepatitis can lead to:
A
-cirrhosis and liver cancer
24
Q
acute hepatitis is most often caused by infection
with what hepatitis viruses
A
- A, B, or C
25
Hepatitis A virus (HAV):
-primarily spread via fecal–oral transmission,
- involves the ingestion of foods or beverages that have been contaminated
with fecal material
26
Outbreaks of HAV infection are often associated with :
-floods and other natural disasters,
-when sewage contaminates water supplies.
27
Vaccinations against HAV are recommended for high-risk individuals, such
as (5)
-international travelers,
-children living in communities with high disease rates,
-people experiencing homelessness,
-people who inject illicit drugs,
-persons with unsafe sexual behaviors
28
, routine vaccination is recommended for all
children at ?? year of age.
-1
29
HAV infection usually resolves within a few ?? and
does not cause chronic infection or permanent liver damage.
-months
30
Hepatitis B virus (HBV) is transmitted by infected
-blood or needles,
- by sexual contact with an infected person,
-from mother to infant during childbirth.
31
A major global health concern, HBV has infected as much as ?? of the world
population
chronic illness develops
in fewer than ?? percent of cases.
-half
-10%
32
Hepatitis C virus (HCV) is spread via infected ?? or ?? but is not readily
spread by ?? or ??
-blood or needles
-sexual contact or childbirth
33
HCV infection is currently the most
common bloodborne infection in the United States and is a leading cause of ???
-chronic liver disease
34
is there a vaccine for HVC?
-no
35
symptoms and signs of hepatitis:
-jaundice
-enlarged liver
-fatigue
-anorexia
-muscle weakness
36
Treatment of hepatitis:
-bed rest
-appropriate diet
-avoid substances that irritate the liver such as alcohol, drugs, and certain dietary substnaces
37
Does hepatitis A need medication to be resolved? what about B and C?
-NO
-YES
38
antiviral agents that can treat HBV AND HBC
-lamivudine and ribavirin,
-block viral replication, and interferon alfa, which both inhibits viral replication
and enhances immune responses
39
Nonviral forms of hepatitis may be treated with
??? and ??
-anti-inflammatory and immunosuppressant drugs
40
is hospitalization required for hepatitis?
-NO
-unless other medical conditions or complications hamper recovery
41
cirrhosis:
-an advanced stage of liver disease
-extensive scarring replaces healthy liver tissue
42
physical description of a cirrhotic liver
-shrunken, irregular, nodular appearance
43
Together, chronic liver disease and cirrhosis rank as the ?? leading
cause of death in the United States.
-11th
44
The chief causes of cirrhosis in the United States are
-HBC
-alcoholic liver disease,
-nonalcoholic fatty liver
-HBV
45
Many patients with liver disease remain ?? for years.
-asymptomatic
46
Initial symptoms are usually nonspecific and may include
-fatigue,
-malaise,
-anorexia,
-weight loss
47
the decline in liver function can lead to metabolic disturbances: patients
may develop ?? , ?? easily, and be more susceptible to ??.
-anemia
-bruise
-infection
48
If bile obstruction occurs, ?? , ?? , and ??
(itchy skin) are likely
-jaundice
-fat malabsorption
-pruritus
49
The physical changes in liver tissue may interfere
with ?? flow, causing fluid to accumulate in blood vessels and body
tissues.
-blood
50
Advanced cirrhosis can disrupt function of which organs?
-kidney, liver and brain
51
?? liver enzyme levels are elevated in liver disease
because the injured liver tissue releases the ?? into the bloodstream
-serum
-enzymes
52
Serum levels of ?? may be elevated if the liver is too damaged to
process the ?? or if bile ducts are blocked and prevent its excretion.
-bilirubin
53
The impaired synthesis of plasma proteins in the liver reduces ??
levels and ??
blood-clotting time
-albumin-
-extends
54
Liver damage also impairs the connversion of
-ammonia to urea, causing ammonia levels in the blood to rise
55
A large volume of ? normally flows through the liver.
-blood
56
The hepatic portal vein and hepatic artery together supply approximately ?? milliliters
-1500
-1.5 quarts each minute
57
The scarred tissue of a cirrhotic liver ?? the flow of blood, ?? of which
is supplied by the portal vein
-impairs
-3/4
58
The restricted blood flow within the liver stimulates
the release of ?? (and therefore, increased blood flow) in nearby arterioles leading to a greater volume of blood
-vasodilators
59
portal hypertension:
-elevated blood pressure in the hepatic portal vein
-due to obstructed blood flow through the liver and a greater inflow of portal blood
60
collateral vessels:
-blood vessels that enlarge or newly form to allow an alternative pathway for diverted blood, usually in GI tract and abdominal wall
-happens when blood is forced backward into the veins that normally supply the portal vein
61
varices:
-abnormally dilated blood vessels
62
what varices vulnerable to rupture because they have thin walls
and often bulge into the lumen
-esophageal varices
-gastric varices
63
Within 10 years of disease onset, about ?? percent of patients with cirrhosis
develop ??
-50%
-ascites
64
ascites:
-an abnormal accumulation of fluid in the abdominal cavity
65
The development of ascites indicates that liver damage has reached
a ?? stage, as up to half of patients with ascites die within ?? years.
-critical
-5
66
Ascites happens due to…..
-portal hypertension and sodium retention in the kidneys
67
The elevated pressure within the liver’s small blood vessels (?? )
causes fluid to leak into ?? vessels and, ultimately, the abdominal cavity.
-sinusoids
-lymphatic
68
The movement of water into the abdomen may be exacerbated by low levels of
serum ??
-albumin
-this protein helps retain fluid in blood vessels
69
hepatic encephalopathy:
- a neurological complication of advanced liver disease
changes in personality, mood, behavior, mental ability, and motor functions.
70
At worst what can also develop due to hepatic encephalopathy:
-amnesia,
-unresponsiveness
-hepatic coma
71
Although hepatic encephalopathy is ??? with medical treatment, its presence suggests a ?? prognosis for the patient with liver disease, especially when the
neurological changes are more pronounced.
-reversible
-poor
72
What is the exact cause of hepatic encephalopthay?
-unknown
73
what elevated blood level is believed to contribute to some impairment of haptic encephalopathy?
-ammonia
74
Normally, the liver extracts this ammonia from portal ?? and converts it to ?? , which is then excreted by the ?? . In advanced liver disease, the liver is unable to process the ammonia sufficiently.
-blood
-urea
-kidneys
75
Most patients with advanced cirrhosis develop ?? and experience some degree of ??
-PEM
-wasting
76
A liver transplant may be necessary for patients with advanced ??
-cirrhosis
77
THE FOLOWING MEDICATIONS HELP TREAT CIRRHOSIS
78
Individuals with portal hypertension and varices may be given ?? such as
--betablockers
-propranolol (Inderal) and nadolol (Corgard)
-REDUCES PORTAL BLOOD PRESSURE AND BLEEDING RISK
79
Diuretics help to control portal hypertension and ascites; common examples
include
-spironolactone (Aldactone) and furosemide (Lasix).
80
what treats hepatic encephalopathy by reducing ammonia production and
absorption in the colon?
-lactulose, a nonabsorbable disaccharide
81
To stimulate the appetite and promote
weight gain, what can be prescribed?
-megestrol acetate (Megace) or dronabinol (Marinol)
82
nutrition diet for cirrhosis
-high protein, high kcaloric
83
Estimates of energy needs generally range from ?? to ?? kcalories per kilogram
of body weight per day
-30 to 40
84
protein needs range from ?? to ?? grams of protein per kilogram
of body weight per day based on dry weight or an appropriate weight for height
-1.2 to 1.5
85
In patients with hepatic encephalopathy, the
protein intake should be ?? ?? the day so that only modest amounts are consumed at each meal.
-soread throughout
86
Protein restriction is rarely recommended because an
inadequate protein intake can worsen ?? and ??.
-malnutrition
-wasting
87
what oral supplementation may improve neurological functioning in patients with hepatic encephalopathy?
-branched chain amino acids
88
The muscle tissue in these patients typically sacrifices its own BCAAs
to assist with ?? detoxification; hence, BCAA supplementation may help to
prevent this damaging ?? breakdown and also reduce tissue ammonia levels.
-ammonia
-muscle
89
In patients with fat malabsorption, fat intake may be restricted to less than
?? percent of total kcalories or as necessary to control steatorrhea
-30%
90
Patients with ascites are generally advised to restrict
their ?? intake
-sodium
91
treatment for ascities
-sodium restriction (no more than 2000mg per day)
-diuretic therapy to promote fluid loss
92
Note that fluid restrictions are occasionally implemented
when ascites is accompanied by severe
-hyponatremia
-abnormally low sodium levels in the blood, a possible result of fluid overload
93
Many patients find low-sodium diets??? , so some health practitioners may
allow a more liberal sodium intake and depend on diuretics to remove excess fluid.
-unpalatable
94
If patients do not respond to sodium restriction and diuretic therapy, excess fluid may be removed from the abdomen by surgical puncture called ??
-paracentesis
95
To prevent recurrent ascites what can be performed?
-transjugular intrahepatic portosystemic shunt:
-a passage within the liver that connects a portion of the portal vein to the
hepatic vein using a stent; access to the liver is gained via the jugular vein in the neck.
96
If steatorrhea is present, fat-soluble nutrients can
be provided in
- water-soluble forms.
97
Patients with esophageal varices may find it easier
to ingest supplements in ?? form
-liquid
98
In hospitalized patients who are unable
to consume enough food, ?? feedings may be infused overnight as a supplement
to oral intakes or may replace oral feedings entirely
-tube
99
In patients with esophageal
varices, the feeding tube should be as ?? and ?? as possible to prevent
rupture and bleeding.
-narrow and flexible
100
To avoid excessive fluid delivery, patients with ascites
typically require concentrated ?? solutions, which are infused into ??
veins
-parenteral
-central
101
The most common illness that precedes liver
transplants is ?? liver disease, which accounts for about ?? percent of liver
transplant cases
-alcoholic
-23%
102
Five-year survival rates among transplant recipients may be as high as
?? percent, depending on the cause of illness.
-80%
103
Complications such as ?? and ???? worsen the prognosis for liver transplants
-ascites and haptic encephalopathy
104
Correcting malnutrition ?? transplant surgery can
help to speed recovery after the surgery
-before
105
The main concerns immediately following a transplant are
-organ rejection and infection
106
what drugs reduce the immune responses that cause rejection of liver transplant but also raise risk for infection:
-immunosuppressive drugs
-prednisone, cyclosporine, tacrolimus
107
Infections are a potential cause of
Death following a liver transplant; therefore, ?? and ?? medications are
prescribed to reduce infection risk.
-antiviral and antibiotics
108
Immunosuppressive drugs can affect nutrition status in numerous ways by causing side effects that..
-affect the gastrointestinal
-nausea, vomiting, diarrhea, mouth sores
109
The stress associated with transplant surgery increases ?? and ??
requirements.
-protein and energy
-so a high calorie, high protein diet will help meet the postsurgical needs of a transplant patient.
