Chapter 43: Hepatic Disorders Flashcards
Basic functions of the liver
* Glucose ______________
* Ammonia Conversion
* Fat ___________
* Protein __________
* Vitamin and Iron __________
* Bile formation
* Bilirubin Excretion
* Drug metabolism
* Creation of clotting factors
metabolism
metabolism
metabolism
storage
Protein and bacteria breakdown and creates ___________ as a by-product
ammonia
Liver converts ammonia into ______ and we pee it away
urea
What happens if the liver does not convert ammonia into urea so we can pee it away?
Too much ammonia goes to the brain causing swelling that can lead to bleeding
ASR and ALT __________ when there is liver damage, but __________ when scarring occurs
increases
decreases
The liver makes _______ which is crucial to digestion and fat absorption
bile
Bilirubin is the __________ created form the breakdown of hemoglobin
pigment
Conjugated bilirubin is secreted in bile and is carried to the ___________
duodenum
Many dugs are bound in the __________ and excreted in the feces or urine
liver
If the liver is not working at full capacity what could happen if certain medications are administered?
The medications will hang around in the liver longer because the metabolism has decreased, causing liver damage
ALT: increase in liver disorders and can be used to monitor the course of __________ or cirrhosis
**4-36
hepatitis
AST reflects cell ______ or death
** 0-35
damage
Bilirubin: jaundice becomes clinically evident when level is >____
2.0
Albumin: decreased due to the lack of ________ synthesis
protein
What vitamins are known to quickly cause damage to the liver?
Vitamin D and A
Before a patient has a liver biopsy, they should have their _____ checked
INR
After a liver biopsy, there is a high risk of bleeding. Keep patients on their _______ side for ___ hours after their procedure
right
2
Hemolytic jaundice is the increased destruction of _______ which flood plasma with bilirubin that can’t be excreted quickly enough even though the liver is functioning fine
Hemolytic transfusion reactions
RBCs
Heptocellular jaundice is when liver cells are too damaged to clear normal amounts of ________
Cirrhosis
bilirubin
Obstructive jaundice is the ________ of the small bile duct from gallstone, inflammation, or tumor backs up bile in the liver and gets reabsorbed into circulation. this stains skin and mucous membranes and it eventually excreted through _______ turning it orange
occlusion
urine
Heredity Hyperbilirubinemia effects __-__% of the population
3-8
Liver cirrhosis has a cure — a long list of medications are used for this cure (TRUE OR FALSE)
FALSE— there is no cure for cirrhosis, but it can be managed. Treatments exist which can often times slow the progression of the disease
Cirrhosis occurs when the ______ cells are damaged. They come together and form regenerative nodules
liver
Cirrhosis is considered end stage ______ damage
liver
Fibrosis = scar tissue, the cells are thickened with ________
protein
Men who ingest greater than ____ - ____ grams of alcohol per day for 10 years usually develop cirrhosis
60-80
Women who ingest ___-___ grams of alcohol per day for 10 years usually develop cirrhosis
20-40
Cirrhosis decreases the functioning ability of the liver to make ____________ factors
clotting
When there is a decrease in clotting factors, there is an increased risk for:
* B_________
*Epistaxis
* ___________ from wounds
* GI____________
* Petechia
* Bleeding can be spontaneous
Bruising
Bleeding
Bleeding
Clotting times requires multiple enzymes made within the liver. If these enzymes are not made correctly by the liver, it effects clotting times (___/____)
PT/INR
PT/INR are the first things to go bad as the liver fails because these factors are dependent on __________ that are ALL synthesized in the liver
enzymes
_________ hypertension is a complication of cirrhosis. The portal vein drains the whole GI system.
Portal
Liver cirrhosis increased ________ vein blood pressure
portal
The blood in the portal venous system contains al the nutrients absorbed from the GI tract and toxins that will be ______________ by the liver. Once the liver metabolizes toxins or waste products, they are then excreted by the ________
metabolized
kidneys
What is one of the most common complications of portal hypertension?
Ascites — Self-perpetuating problem as kidneys hold on to fluid due to overall volume loss. The peritoneal space continues to grow as the body hold on to fluid. This is protein rich fluid that draws even more fluid due to the osmotic pressure gradient
Can be up to 20 liters
Treatment for ascites
* Diuretic medication, usually spironolactone which is a ___________ _________ _______
* Low _________ diet
potassium sparing diuretic
Sodium
** We do not fluid restrict these patients because they are already dehydrated in their vascular space**
A paracentesis is the removal of ________ from the ____________ cavity using a needle. What is a post op risk? What is a major benefit?
fluid, peritoneal
Flour? toxicity
Immediate relief
Esophageal Varices occurs due to the increasing pressure of the venous system causing pressure to increase the size and pressure inside the vessels of the esophagus. These vessels become prone to ________, along with clotting abnormalities, patients can have significant _______ loss in a short amount of time. An upper GI bleed can be deadly
rupture
blood
Splenomegaly results in:
Anemia
Leukopenia
Thrombocytopenia
Lactulose reduces ________ levels by trapping it and excreting it through feces
ammonia
When a patient is taking lactulose, the nurse should monitor the patient’s __________ level and assess them for ____________
potassium
dehydration
Hepatitis is the _______________ of the liver
inflammation
There are 5 definitive types of viral hepatitis that cause liver damage:
Hep A
Hep B
Hep C
Hep D
Hep E
treatments of Hepatitis vary, but include anti________ and gamma globulins
virals
Hepatitis A is transmitted by the _______ _______ route. Patients usually recover at home. There (is/is not) a vaccination for this virus
Common s/s include:
fecal oral
is
Flu-like sx
jaundice
hepatomegaly
dark urine
pale stool
Hep C is a virus that targets hepatocytes and _____________. Acute HCV infection is usually mild and chronic _________ results in at least 75% of patients. The mode of transmission is _________ as in IV drug use. HCV can live ________ in the patient for years before the symptoms develop
lymphocytes
hepatitis
blood
dormant
When viral hepatitis lasts longer than ___ months, it can become a chronic long-term _____________ condition. Chronic hepatic inflammation increased the risk of hepatocellular _________
6
inflammatory
cancer
A client has undergone. liver biopsy after the procedure, the nurse should place the client in which position?
A. on the left side
B. on the right side
C. trendelenburg
D. High fowler
B. On the right side
A nurse is caring for a client with cholelithiasis. Which sign indicated obstructive jaundice?
A. straw-colored urine
B. Reduced hematocrit
C. Clay-colored stool
D. elevated urobilinogen in the urine
C. clay colored stools
if a patient has alcoholic induced cirrhosis, the will develop a ______ _____ deficiency
folic acid
