Cyndi - Week 3 - Exam 2 Flashcards
what are the 7 functions of the liver?
- bilirubin metabolism
- fat + protein metabolism
- carbohydrate metabolism
- hematological role
- endocrine role
- detoxification
- other functions
what are the characteristics of bilirubin metabolism?
- bile synthesis and secretion
in regards to bilirubin metabolism, what occurs when the liver isn’t functioning?
bilirubin can’t be secreted, so it goes into the blood → jaundice
what are the characteristics of fat and protein metabolism?
- albumin (provides oncotic pressure)
- deamination (ammonia conversion - breaks down protein → a nitrogen → coverts to ammonia → urea → kidneys. can’t do? brain → encephalopathy
what are the characteristics of the carbohydrate role?
glycogenesis (creates sugar)
what are the characteristics of hematological role?
clotting factors 1, 2, 6, 9, 10; prothrombin
what are the characteristics of detoxification? what disrupts this?
- Biotransformation, first pass, and drug metabolism
* Hepatocyte injury disrupts detoxification, which results in accumulation of drugs
what are the other functions of the liver?
- Stores A, D, B‐12, iron ferritin, copper, angiotensinogen, - immunological role, and more
what are the risk factors for liver disease? (11)
- 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
TEST: what is a potent toxin of hepatocytes?
ALCOHOL
what are the classic signs of liver disease?
- Anorexia
- Ascities
- Dark urine (bili)
- Hepatomegaly
- Hyperbilirubinemia (itchy)
- Jaundice
- RUQ tenderness
- Splenomegaly (giant spleen)
- Steatorrhea (fatty stool)
what is the general tx for liver disease?
- 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
what are the 7 diagnostics tests related to liver disorder?
- 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
TEST: what is the main concern of someone who is having a liver biopsy?
hemorrhage
why should a patient position themselves on the right side after a biopsy?
to put pressure to stop bleeding
what are the labs that should be ordered?
- Clotting studies
- CBC, CMP
- Liver function tests – ALT, AST, bilirubin levels, ammonia, albumin, ALP, GGT
what is hepatitis?
Inflammation of liver ‐ caused by virus, drugs, alcohol, or toxin
what are the 3 different categories of hepatitis?
- Acute
- Chronic
- Fulminate (explosive)
what are the changes that occur during hepatitis?
Changes that occur in hepatitis include:
infiltration of WBCs and ↑ permeability of hepatocyte cell membranes (not functional d/t invasion)
what other diseases can cause hepatitis?
Epstein Barr and cytomegalovirus
what are the types of hepatitis?
A B C D E G
what are the diagnostic tests for hepatitis?
hepatitis panel lab, liver function tests, biopsy
what are the complications of hepatitis?
cirrhosis, hepatocellular carinoma
TEST: how does cirrhosis occur?
cirrhosis occurs because of a toxin (alcohol) inflames the tissue → scarring → fibrotic/tough → remodel/fix → doesn’t work as well → fibrosis → malfunction
what are the other causes of hepatitis?
toxin, or alcohol induced, autoimmune, genetic,
metabolic, nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatosis (NASH)
what are the characteristics of the clinical manifestations of viral hepatitis?
Asymptomatic in many people
• Subclinical or unaware carriers can still transmit disease
• Maximum infectibility in acute phase
when is the acute phase and what are the sxs of viral hepatitis?
Acute: 1‐4 months • Anorexia, n/v, RUQ pain, fever, malaise, wt loss, fatigue, dark urine, arthralgia, hepatomegaly, splenomegaly, jaundice, pruritus, etc.
when is the chronic phase and what are the sxs of viral hepatitis?
Chronic: > 6 months:
• Malaise, fatigue, myalgia, arthralgia,
hepatomegaly
TEST: in early cirrhosis, the patient may complain of… ?
loss of appetite, weight loss, jaundice, itching, nausea, and easily bruising.
how is hepatitis A transmitted?
Contamination of food, water or milk (oral-fecal)
how is hep B transmitted?
• 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
how is hep C transmitted?
• Sexual transmission • Parentally ‐ shared needles, tattoos • Perinatal • Hemodialysis - percutaneous/permucosal
how is hep D transmitted?
• Acquired at the same time or after HBV – does not infect on own
• Virulent – leads quickly to liver failure
- percutaneous/permucosal
how is hep E transmitted?
- Fecal‐oral transmission
* Contaminated drinking water
how is hep G transmitted?
- Parenterally and sexually transmitted
- Co‐exists with other viral infections, esp. other hepatitis
- If exists alone – does not cause liver failure
what viral hepatitis’ cause chronic infections?
B, C, D
what is the prevention measures for viral hepatitis?
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
what viral hepatitis are there immunizations for?
only hep A and B
what is the drug tx for hepatitis?
- Interferon
* Nucleoside/nucleotides
what are the treatment goals for hepatitis?
- Decreasing viral load
* Decrease liver damage
what is important for hepatitis patient education?
- Vaccinations
- Handwashing
- Blood and body fluid precautions
- No sharing IV needles or donating blood
- Diet, no alcohol
what is cirrhosis?
Chronic, progressive disease of the liver characterized by the degeneration and destruction of hepatocytes.
what are the diagnostic tests ordered for cirrhosis?
U/S, labs, CT, biopsy (histopathological changes,
such as Mallory body)
what are the sxs of the early stages of cirrhosis?
- Loss of appetite
- Generalized malaise
- Weight Loss (↓ bile)
- Steatorrhea
- Jaundice (aka icterus)
- Itching
- Nausea
- Easy bruising (↓ plt)
- Nosebleeds
what are the sxs of later stages of cirrhosis?
- Ascites
- Peripheral edema
- Vomiting of blood
- Black stools (blood varicies)
- Muscle wasting
- Spider angiomas
- Dilated blood vessels
- Fever and chills
- Hepatic encephalopathy
- Hepatorenal syndrome
what is the treatment for cirrhosis? (10)
- 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!
what meds are used for the management of ammonia level?
lactulose, neomycin
read how portal HTN leads to esophageal varices
READ IT
what is a paracentesis?
Removal of fluid from abdomen (ascites)
• Decreases intra‐abdominal pressure
• Improves diaphragmatic function
• Comfort
what are the risks of a paracentesis?
- Massive hemorrhage
- Hypotension
- Infection
- Pain at site
what is a transjugular intrahepatic portosystemic shunt (TIPS)?
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.
what are the characteristics of liver cancer (hepatocellular carcinoma)?
Patients at risk
Metastatic cancer vs. primary
• Symptoms similar to liver failure
what are the diagnostic tests for liver cancer?
- Alpha‐fetoprotein (AFP) – 60% accuracy
* CT, MRI, liver biopsy (may be CT guided)
what is the tx for liver cancer?
- Chemoembolization procedure
* Liver transplant may be possible
what is a MELD score and what are the qualifications?
• 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
what is the post op care for a patient with a liver transplant?
- 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
what are the other characteristics of liver transplant?
complications
- emotional support and teaching essential
TEST: T/F: depending on whether it metastatic or primary cancer, the goal for treatment is different
TRUE
If metastatic, the tx goes from eliminating the cancer to preventing pain–comfort measures
TEST: If someone has a liver transplant and they have a slight fever, what should you do?
call the MD; they have immunosuppression → slight fever in them is like a higher fever in normal people.
TEST: If you have patient who has a liver transplant what should you education them on regarding medications?
they are going to be on meds for life
- antirejection meds
what are the characteristics of the endocrine role?
glucagon to stimulate glycogenolysis, gluconeogenesis, and lipolysis; GF1
