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NURS 320 > Exam 2: The GI System And Disorders Of The Liver > Flashcards

Exam 2: The GI System And Disorders Of The Liver Flashcards

1
Q

Function of the liver

A
  1. Secrete substances necessary for digestion of chyme.

2. Produces bile: contains salts necessary for fat digestion and absorption.

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2
Q

Bile

A

alkaline, bitter-tasting yellowish green fluid that contains bile salts, cholesterol, bilirubin, electrolytes, and water

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3
Q

Bile is formed by

A

hepatocytes and secreted into the canaliculi

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4
Q

Enterohepatic Circulation

A

Recycles bile salts

Primary and secondary bile acids

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5
Q

Bilirubin

A

A by-product of the destruction of aged red blood cells.

Gives bile a greenish black color and produces the yellow tinge in jaundice.

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6
Q

Metabolism of Bilirubin

A

Unconjugated bilirubin (free bilirubin which is lipid soluble)→ in the liver moves from plasma to hepatocytes → conjugated bilirubin (water soluble)→ reaches distal ileum and colon → urobilinogen → excreted in urine and small amount eliminated in feces.

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7
Q

Liver: Vascular and Hematologic Functions

A
  1. Store large volume of blood.
  2. Can release blood to maintain systemic circulatory volume in event of hemorrhage.
  3. Kupffer cells play important role in destroying intestinal bacteria and preventing infections.
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8
Q

The Liver is responsible for synthesizing

A

Prothrombin fibrinogen and factors I, II, VII, IX and X necessary for effective clotting.

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9
Q

Vitamin K

A

Essential for synthesis of other clotting factors -> absorption of K depends on adequate bile production.

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10
Q

Liver: Metabolism of Nutrients

A
  1. Fat is synthesized from carbohydrates and protein.
  2. Synthesizes phospholipids and cholesterol.
  3. Synthesizes plasma proteins, including albumins and globulins → maintains blood volume and pressure by maintaining plasma oncotic pressure
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11
Q

The liver synthesizes serum enzymes including

A 
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Lactate dehydrogenase (LDH)
Alkaline phosphatase
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12
Q

How does the liver contribute to the stability of blood glucose levels?

A

Glyconeogenesis (glycogen storage)

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13
Q

Liver Metabolic Detoxification

A

diminishes intestinal or renal tubular reabsorption of potentially toxic substances and facilitates intestinal and renal excretion

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14
Q

Examples of substances that the liver metabolizes include

A

Alcohol, barbiturates, amphetamines, steroids, and hormones (estrogens, aldosterone, antidiuretic hormone, and testosterone) metabolized or detoxified → prevention of excessive accumulation and adverse effects.

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15
Q

The liver is responsible for the storage of the following vitamins and minerals in times of excessive intake and releases them when needed:

A 
Vitamin B12
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Iron (stored as ferritin) → released as needed for RBC production
Copper
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16
Q

Acute or chronic liver disease can lead to systemic, life-threatening complications including:

A 
Portal hypertension
Ascites
Hepatic encephalopathy
Jaundice
Hepatorenal syndrome
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17
Q

Portal Hypertension

A

Abnormally high blood pressure in the portal venous System.

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18
Q

Portal Hypertension is d/t

A

Obstruction or impediment of blood flow through the vena cava: intrahepatic causes and posthepatic causes.

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19
Q

Portal Hypertension: Most Common Cause

A

Obstruction caused by cirrhosis of liver

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20
Q

Intrahepatic causes of Portal Hypertension

A

Results form thrombosis, inflammation or fibrosis of sinusoids, as occurs in cirrhosis of liver, viral hepatitis, schistosomiasis (parasitic infection)

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21
Q

Posthepatic causes of Portal Hypertension

A

Result from hepatic vein thrombosis or cardiac disorders that impair pumping ability of right heart → blood to back up and increase pressure in portal system

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22
Q

Long-term portal hypertension causes several problems that are difficult to treat and can be fatal including:

A
  • Varices
  • Splenomegaly
  • Ascites
  • Hepatic encephalopathy
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23
Q

Varices

A

Dissented, tortuous collateral veins
Occurs mostly in lower esophagus, stomach and rectum.
Rupture can cause life-threatening hemorrhage

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24
Q

Splenomegaly

A

Enlargement of spleen.

Caused by increased pressure in splenic vein.

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25
Q

Ascites

A

Accumulation of fluid in peritoneal cavity.

Caused by increased pressure in mesenteric tributaries of portal vein.

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26
Q

Hepatic Encephalopathy

A

Characterized by CNS disturbances

Results from presence of substances (ammonia) in blood that reaches the brain

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27
Q

Most common clinical manifestation of Portal Hypertension

A

Vomiting of blood from bleeding esophageal varices

28
Q

Slow, chronic bleeding from varices can lead to

A

Anemia and blood in stools.

Usually bleeding from varices is developed slowly over a period of years.

29
Q

Clinical Manifestations of Ascites

A

Weight gain
Abdominal distention
Increased abdominal girth
Dyspnea (decreased lung capacity d/t large volume of fluid displacing diaphragm) -> Increased RR
Can develop bacterial peritonitis -> fever/chills, abdominal pain and decreased bowel sounds.

30
Q

Other causes of Ascites include

A 
Cirrhosis *most common
CHF
Constrictive pericarditis
Abdominal malignancies
Nephrotic syndrome
Malnutrition
31
Q

Initial Clinical Manifestations of Hepatic Encephalopathy

A 
Change in personality
Memory loss
Irritability
Lethargy 
Sleep disturbances
32
Q

Later manifestations of hepatic encephalopathy

A 
Confusion
Flapping tremor of hands (asterixis)
Stupor
Convulsions
Coma
33
Q

Hepatic Encephalopathy results from

A

Biochemical alterations that affect neurotransmission -> permit toxins from GI tract to circulate to brain -> most hazardous end product of intestinal protein digestion (ammonia)

34
Q

Jaundice

A

Yellow or green pigmentation of skin cased by hyperbilirubinemia.

35
Q

Hemolytic jaundice

A 
(Prehepatic jaundice) 
Excessive hemolysis (breakdown) of RBC
36
Q

Obstructive jaundice

A

Develops from common bile duct occlusion

37
Q

Intrahepatic Obstructive jaundice

A

Disturbances in hepatocyte function and obstruction of bile canaliculi

38
Q

Hepatorenal syndrome

A

Complication of advanced liver disease with portal hypertension.

39
Q

Hepatorenal Syndrome Clinical Manifestations

A

Renal failure demonsrating oliguiria, sodium and water retention, hypotension and peripheral vasodilation -> caused by circulatory Alterations -> decreased GFR

40
Q

Hepatorenal syndrome is usually associated with

A

Usually associated with alcoholic cirrhosis and fulminant hepatitis

41
Q

Cirrhosis

A

Normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C.
Irreversible inflammatory disease that disrupts liver function and even structure.
Decreased hepatic function caused by modular and fibrotic tissue synthesis (fibrosis).

42
Q

Cirrhosis can lead to

A

Biliary channels become obstructed and cause portal hypertension. Because of the hypertension, blood can be shunted away from the liver, and a hypoxic necrosis develops.

43
Q

Hypoxic necrosis can lead to

A

Leads to liver’s ability to handle toxins and blood flow → internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.

44
Q

Cirrhosis begins in the

A

Bile canaliculi and ducts

45
Q

Primary biliary cirrhosis

A

Autoimmune

46
Q

Secondary biliary cirrhosis

A

Obstruction

47
Q

Cirrhosis Treatment: Varices

A

Beta blocker - Propranolol
Nitrate Isosorbide dinitrate
Upper endoscopy with band ligation

48
Q

How can beta blockers (Propranolol) treat varices?

A

Effective in lower pressure in portal vein and prevents initial bleeding and rebleeding

49
Q

How does nitrate isosorbide dinitrate treat varices?

A

Lowers portal pressure

50
Q

Cirrhosis Treatment: Ascites

A

Diuretics
Restriction fluid and salt
Remove fluid (paracentesis)

51
Q

Cirrhosis Treatment: Coagulation Disturbances

A

Fresh Frozen Plasma

Vitamin K

52
Q

Vitamin K Treatment

A

IM injection which helps to treat and prevent unusual bleeding by increasing the body’s production of blood clotting factors.

53
Q

Adverse Effects of Vitamin K Treatment

A

Pain, swelling, or soreness at injection site.

Flushing, taste changes, dizziness, rapid heatbeat, sweating, shortness of breath

54
Q

Cirrhosis Treatment: Hepatic Encephalopathy

A

Lactulose

Antibiotics (Neomycin or Metronidazole)

55
Q

How does Lactulose treat hepatic encephalopathy?

A

is a laxative → traps toxic compounds in the colon → adequacy of treatment judged by loosening or increasing frequency of stools

56
Q

How do antibiotics (neomycin or metronidazole) treat hepatic encephalopathy?

A

Block the production of the toxic compounds by the bacteria in the colon.

57
Q

Lactulose uses

A

Given PO or rectally to treat or prevent complications of liver disease (hepatic encephalopathy).

58
Q

Lactulose MOA

A

Colonic acidifier that works by decreasing the amount of ammonia in the blood → improve mental status.

59
Q

Side Effects: Lactulose

A

Side Effects: gas, bloating, burping, stomach pain, nausea, cramps.

Serious side effects: excessive diarrhea, vomiting, muscle cramps/weakness, irregular heartbeat, seizures.

May effect blood glucose levels
Can lead to dehydration

60
Q

Liver failure

A

Occurs when large parts of liver become damaged beyond repair → liver is no longer able to function.

Most often occurs gradually and over many years.

61
Q

Acute liver failure

A 
Rare
Occurs rapidly (in as little as 48 hours)
62
Q

Most common causes of chronic liver failure

A 
Hepatitis B
Hepatitis C
Long term alcohol consumption
Cirrhosis
Hemochromatosis (inherited disorder that causes body to absorb and store too much iron)
Malnutrition
63
Q

Most common causes of acute liver failure

A

Acetaminophen overdose
Viruses including Hepatitis A, B, and C (especially in children)
Reactions to certain prescription and herbal medications
Ingestion of poisonous wild mushrooms

64
Q

Early symptoms of liver failure

A 
are often ones that can be due to any number of conditions → initially difficult to diagnose
Nausea
Loss of appetite
Fatigue
Diarrhea
65
Q

As liver failure progresses, symptoms become more serious including

A 
Jaundice
Bleeding easily
Swollen abdomen
Mental disorientation or confusion
Sleepiness 
Coma
66
Q

Drug related hepatotoxicity an be caused by

A

Acetaminophen
Antibiotics (ampicillin-clavulanate, ciprofloxacin, doxycycline, erythromycin, isoniazid, nitrofurantoin, tetracycline)
Antidepressants (amitriptyline, nortriptyline)
Antiepileptics (phenytoin, valproate)
Anesthetic agents (halothane)
Lipid-lowering medications (atorvastatin, lovastatin, simvastatin)
Immunosuppressive agents (cyclophosphamide, methotrexate)
NSAIDS
Salicylates

NURS 320 (28 decks)

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