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Nursing Semester 3 > Cyndi - Week 3 - Exam 2 > Flashcards

Cyndi - Week 3 - Exam 2 Flashcards

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1
Q

what are the 7 functions of the liver?

A
  • bilirubin metabolism
  • fat + protein metabolism
  • carbohydrate metabolism
  • hematological role
  • endocrine role
  • detoxification
  • other functions
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2
Q

what are the characteristics of bilirubin metabolism?

A
  • bile synthesis and secretion
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3
Q

in regards to bilirubin metabolism, what occurs when the liver isn’t functioning?

A

bilirubin can’t be secreted, so it goes into the blood → jaundice

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4
Q

what are the characteristics of fat and protein metabolism?

A
  • albumin (provides oncotic pressure)
  • deamination (ammonia conversion - breaks down protein → a nitrogen → coverts to ammonia → urea → kidneys. can’t do? brain → encephalopathy
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5
Q

what are the characteristics of the carbohydrate role?

A

glycogenesis (creates sugar)

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6
Q

what are the characteristics of hematological role?

A

clotting factors 1, 2, 6, 9, 10; prothrombin

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7
Q

what are the characteristics of detoxification? what disrupts this?

A
  • Biotransformation, first pass, and drug metabolism

* Hepatocyte injury disrupts detoxification, which results in accumulation of drugs

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8
Q

what are the other functions of the liver?

A
  • Stores A, D, B‐12, iron ferritin, copper, angiotensinogen, - immunological role, and more
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9
Q

what are the risk factors for liver disease? (11)

A
  • Alcohol abuse
  • Some medications
  • Gastric bypass surgery
  • HBV or HCV, chronic
  • Elevated cholesterol, triglycerides (↑ fat gets stuck → inflammation)
  • Iron overload (stuck in cells and destroy them)
  • Malnutrition
  • Obesity, metabolic syndrome
  • Toxin or chemical exposure
  • Rapid weight loss
  • Wilson disease (inherited disease → excessive copper + can’t get rid of
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10
Q

TEST: what is a potent toxin of hepatocytes?

A

ALCOHOL

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11
Q

what are the classic signs of liver disease?

A
  • Anorexia
  • Ascities
  • Dark urine (bili)
  • Hepatomegaly
  • Hyperbilirubinemia (itchy)
  • Jaundice
  • RUQ tenderness
  • Splenomegaly (giant spleen)
  • Steatorrhea (fatty stool)
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12
Q

what is the general tx for liver disease?

A
  • Control of symptoms
  • Supportive care
  • Rest
  • Small, high calorie, high protein meals; low fat
  • Avoid alcohol
  • Medication specific to cause (hepatitis)
  • Surveillance for infection, bleeding, metabolic parameters and nutrition (plt labs)
  • Consider liver transplantation
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13
Q

what are the 7 diagnostics tests related to liver disorder?

A
  • UGI endoscopy (beware of varices - could cauterize)
  • Ultrasound
  • CT scan abdomen (show ascities)
  • Angiographic studies
  • Radioisotope liver scan (isotope in vein to see what liver looks like)
  • Liver biopsy – gold standard
  • Labs
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14
Q

TEST: what is the main concern of someone who is having a liver biopsy?

A

hemorrhage

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15
Q

why should a patient position themselves on the right side after a biopsy?

A

to put pressure to stop bleeding

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16
Q

what are the labs that should be ordered?

A
  • Clotting studies
  • CBC, CMP
  • Liver function tests – ALT, AST, bilirubin levels, ammonia, albumin, ALP, GGT
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17
Q

what is hepatitis?

A

Inflammation of liver ‐ caused by virus, drugs, alcohol, or toxin

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18
Q

what are the 3 different categories of hepatitis?

A
  • Acute
  • Chronic
  • Fulminate (explosive)
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19
Q

what are the changes that occur during hepatitis?

A

Changes that occur in hepatitis include:

infiltration of WBCs and ↑ permeability of hepatocyte cell membranes (not functional d/t invasion)

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20
Q

what other diseases can cause hepatitis?

A

Epstein Barr and cytomegalovirus

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21
Q

what are the types of hepatitis?

A

A B C D E G

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22
Q

what are the diagnostic tests for hepatitis?

A

hepatitis panel lab, liver function tests, biopsy

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23
Q

what are the complications of hepatitis?

A

cirrhosis, hepatocellular carinoma

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24
Q

TEST: how does cirrhosis occur?

A

cirrhosis occurs because of a toxin (alcohol) inflames the tissue → scarring → fibrotic/tough → remodel/fix → doesn’t work as well → fibrosis → malfunction

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25
Q

what are the other causes of hepatitis?

A

toxin, or alcohol induced, autoimmune, genetic,

metabolic, nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatosis (NASH)

26
Q

what are the characteristics of the clinical manifestations of viral hepatitis?

A

Asymptomatic in many people
• Subclinical or unaware carriers can still transmit disease
• Maximum infectibility in acute phase

27
Q

when is the acute phase and what are the sxs of viral hepatitis?

A 
Acute: 1‐4 months
• Anorexia, n/v, RUQ pain, fever,
malaise, wt loss, fatigue, dark urine,
arthralgia, hepatomegaly,
splenomegaly, jaundice, pruritus, etc.
28
Q

when is the chronic phase and what are the sxs of viral hepatitis?

A

Chronic: > 6 months:
• Malaise, fatigue, myalgia, arthralgia,
hepatomegaly

29
Q

TEST: in early cirrhosis, the patient may complain of… ?

A

loss of appetite, weight loss, jaundice, itching, nausea, and easily bruising.

30
Q

how is hepatitis A transmitted?

A

Contamination of food, water or milk (oral-fecal)

31
Q

how is hep B transmitted?

A

• Sexual transmission , other body fluids, stool
• Parentally ‐ needle stick with contaminated blood
• Perinatal
- 40% of cases; lifetime infection ↑ risk of hepatoceullular carcinoma → cancer
- percutaneous/permucosal

32
Q

how is hep C transmitted?

A 
• Sexual transmission
• Parentally  ‐ shared needles, tattoos
• Perinatal
• Hemodialysis
- percutaneous/permucosal
33
Q

how is hep D transmitted?

A

• Acquired at the same time or after HBV – does not infect on own
• Virulent – leads quickly to liver failure
- percutaneous/permucosal

34
Q

how is hep E transmitted?

A
  • Fecal‐oral transmission

* Contaminated drinking water

35
Q

how is hep G transmitted?

A
  • Parenterally and sexually transmitted
  • Co‐exists with other viral infections, esp. other hepatitis
  • If exists alone – does not cause liver failure
36
Q

what viral hepatitis’ cause chronic infections?

A

B, C, D

37
Q

what is the prevention measures for viral hepatitis?

A 
A: pre/post exposure, immunization
B: pre/post exposure, immunization, blood donor screening
C: blood donor screening
D: pre/post exposure, immunization
E: ensure safe drinking water
38
Q

what viral hepatitis are there immunizations for?

A

only hep A and B

39
Q

what is the drug tx for hepatitis?

A
  • Interferon

* Nucleoside/nucleotides

40
Q

what are the treatment goals for hepatitis?

A
  • Decreasing viral load

* Decrease liver damage

41
Q

what is important for hepatitis patient education?

A
  • Vaccinations
  • Handwashing
  • Blood and body fluid precautions
  • No sharing IV needles or donating blood
  • Diet, no alcohol
42
Q

what is cirrhosis?

A

Chronic, progressive disease of the liver characterized by the degeneration and destruction of hepatocytes.

43
Q

what are the diagnostic tests ordered for cirrhosis?

A

U/S, labs, CT, biopsy (histopathological changes,

such as Mallory body)

44
Q

what are the sxs of the early stages of cirrhosis?

A
  • Loss of appetite
  • Generalized malaise
  • Weight Loss (↓ bile)
  • Steatorrhea
  • Jaundice (aka icterus)
  • Itching
  • Nausea
  • Easy bruising (↓ plt)
  • Nosebleeds
45
Q

what are the sxs of later stages of cirrhosis?

A
  • Ascites
  • Peripheral edema
  • Vomiting of blood
  • Black stools (blood varicies)
  • Muscle wasting
  • Spider angiomas
  • Dilated blood vessels
  • Fever and chills
  • Hepatic encephalopathy
  • Hepatorenal syndrome
46
Q

what is the treatment for cirrhosis? (10)

A
  • REST
  • Management of ascites (paracentesis, TIPS procedures)
  • Management of ammonia level
  • May have ↓ detoxification capability, and albumin binding!
  • Upper respiratory infections treated promptly
  • Monitoring of bleeding status
  • May have NGT – but caution!
  • Correct electrolyte and acid‐base imbalances
  • Diet, nutritional status support – NO ALCOHOL!!!
  • Stringent safety precautions!
47
Q

what meds are used for the management of ammonia level?

A

lactulose, neomycin

48
Q

read how portal HTN leads to esophageal varices

A

READ IT

49
Q

what is a paracentesis?

A

Removal of fluid from abdomen (ascites)
• Decreases intra‐abdominal pressure
• Improves diaphragmatic function
• Comfort

50
Q

what are the risks of a paracentesis?

A
  • Massive hemorrhage
  • Hypotension
  • Infection
  • Pain at site
51
Q

what is a transjugular intrahepatic portosystemic shunt (TIPS)?

A

Treatment for portal hypertension and gastric varices.
• Interventional radiology procedure that puts a stent between the portal vein and the hepatic vein, relieving
pressure in the portal system.

52
Q

what are the characteristics of liver cancer (hepatocellular carcinoma)?

A

Patients at risk
Metastatic cancer vs. primary
• Symptoms similar to liver failure

53
Q

what are the diagnostic tests for liver cancer?

A
  • Alpha‐fetoprotein (AFP) – 60% accuracy

* CT, MRI, liver biopsy (may be CT guided)

54
Q

what is the tx for liver cancer?

A
  • Chemoembolization procedure

* Liver transplant may be possible

55
Q

what is a MELD score and what are the qualifications?

A

• Screening for hepatic transplant qualification
• Age + bili level + sodium + INR + creatinine
Alcohol abstention for 6 months or more if alcohol the cause of liver disease

56
Q

what is the post op care for a patient with a liver transplant?

A
  • Monitor neurologic status
  • Signs of hemorrhage
  • Prevent pulmonary complications
  • Signs of rejection, infection – slight fever may be only sign
  • Monitor for renal failure
  • Drains include Jackson‐Pratt drain, N/G, and T‐Tube
57
Q

what are the other characteristics of liver transplant?

A

complications

- emotional support and teaching essential

58
Q

TEST: T/F: depending on whether it metastatic or primary cancer, the goal for treatment is different

A

TRUE

If metastatic, the tx goes from eliminating the cancer to preventing pain–comfort measures

59
Q

TEST: If someone has a liver transplant and they have a slight fever, what should you do?

A

call the MD; they have immunosuppression → slight fever in them is like a higher fever in normal people.

60
Q

TEST: If you have patient who has a liver transplant what should you education them on regarding medications?

A

they are going to be on meds for life

- antirejection meds

61
Q

what are the characteristics of the endocrine role?

A

glucagon to stimulate glycogenolysis, gluconeogenesis, and lipolysis; GF1

Nursing Semester 3 (29 decks)

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