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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
Ascites
Accumulation of fluid in peritoneal cavity. | Caused by increased pressure in mesenteric tributaries of portal vein.
26
Hepatic Encephalopathy
Characterized by CNS disturbances | Results from presence of substances (ammonia) in blood that reaches the brain
27
Most common clinical manifestation of Portal Hypertension
Vomiting of blood from bleeding esophageal varices
28
Slow, chronic bleeding from varices can lead to
Anemia and blood in stools. | Usually bleeding from varices is developed slowly over a period of years.
29
Clinical Manifestations of Ascites
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
Other causes of Ascites include
``` Cirrhosis *most common CHF Constrictive pericarditis Abdominal malignancies Nephrotic syndrome Malnutrition ```
31
Initial Clinical Manifestations of Hepatic Encephalopathy
``` Change in personality Memory loss Irritability Lethargy Sleep disturbances ```
32
Later manifestations of hepatic encephalopathy
``` Confusion Flapping tremor of hands (asterixis) Stupor Convulsions Coma ```
33
Hepatic Encephalopathy results from
Biochemical alterations that affect neurotransmission -> permit toxins from GI tract to circulate to brain -> most hazardous end product of intestinal protein digestion (ammonia)
34
Jaundice
Yellow or green pigmentation of skin cased by hyperbilirubinemia.
35
Hemolytic jaundice
``` (Prehepatic jaundice) Excessive hemolysis (breakdown) of RBC ```
36
Obstructive jaundice
Develops from common bile duct occlusion
37
Intrahepatic Obstructive jaundice
Disturbances in hepatocyte function and obstruction of bile canaliculi
38
Hepatorenal syndrome
Complication of advanced liver disease with portal hypertension.
39
Hepatorenal Syndrome Clinical Manifestations
Renal failure demonsrating oliguiria, sodium and water retention, hypotension and peripheral vasodilation -> caused by circulatory Alterations -> decreased GFR
40
Hepatorenal syndrome is usually associated with
Usually associated with alcoholic cirrhosis and fulminant hepatitis
41
Cirrhosis
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
Cirrhosis can lead to
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
Hypoxic necrosis can lead to
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
Cirrhosis begins in the
Bile canaliculi and ducts
45
Primary biliary cirrhosis
Autoimmune
46
Secondary biliary cirrhosis
Obstruction
47
Cirrhosis Treatment: Varices
Beta blocker - Propranolol Nitrate Isosorbide dinitrate Upper endoscopy with band ligation
48
How can beta blockers (Propranolol) treat varices?
Effective in lower pressure in portal vein and prevents initial bleeding and rebleeding
49
How does nitrate isosorbide dinitrate treat varices?
Lowers portal pressure
50
Cirrhosis Treatment: Ascites
Diuretics Restriction fluid and salt Remove fluid (paracentesis)
51
Cirrhosis Treatment: Coagulation Disturbances
Fresh Frozen Plasma | Vitamin K
52
Vitamin K Treatment
IM injection which helps to treat and prevent unusual bleeding by increasing the body’s production of blood clotting factors.
53
Adverse Effects of Vitamin K Treatment
Pain, swelling, or soreness at injection site. | Flushing, taste changes, dizziness, rapid heatbeat, sweating, shortness of breath
54
Cirrhosis Treatment: Hepatic Encephalopathy
Lactulose | Antibiotics (Neomycin or Metronidazole)
55
How does Lactulose treat hepatic encephalopathy?
is a laxative → traps toxic compounds in the colon → adequacy of treatment judged by loosening or increasing frequency of stools
56
How do antibiotics (neomycin or metronidazole) treat hepatic encephalopathy?
Block the production of the toxic compounds by the bacteria in the colon.
57
Lactulose uses
Given PO or rectally to treat or prevent complications of liver disease (hepatic encephalopathy).
58
Lactulose MOA
Colonic acidifier that works by decreasing the amount of ammonia in the blood → improve mental status.
59
Side Effects: Lactulose
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
Liver failure
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
Acute liver failure
``` Rare Occurs rapidly (in as little as 48 hours) ```
62
Most common causes of chronic liver failure
``` Hepatitis B Hepatitis C Long term alcohol consumption Cirrhosis Hemochromatosis (inherited disorder that causes body to absorb and store too much iron) Malnutrition ```
63
Most common causes of acute liver failure
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
Early symptoms of liver failure
``` are often ones that can be due to any number of conditions → initially difficult to diagnose Nausea Loss of appetite Fatigue Diarrhea ```
65
As liver failure progresses, symptoms become more serious including
``` Jaundice Bleeding easily Swollen abdomen Mental disorientation or confusion Sleepiness Coma ```
66
Drug related hepatotoxicity an be caused by
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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