GI exam #3 Flashcards
Major functions of the liver
- carb, fat, and protein metabolism
- detoxification
- steroid metabolism
- bile synthesis
- storage
- produces coagulation factors
Jaundice
- yellow pigmentation of the sclera, skin, and deeper tissues
- results from alteration in normal bilirubin metabolism or flow of bile into hepatic or biliary duct systems
- concentration of bilirubin in blood becomes abnormally increased
Story of bilirubin
Bilirubin formed by breakdown of Hgb of old RBCs–>unconjugated bilirubin is released into blood and bound to albumin (not water soluble)–> Not filtered or excreted by kidneys so builds up and goes to the liver–>Liver attaches bilirubin to glucuronic acid to make conjugated bilirubin (not water soluble)–>Liver secretes conjugated bilirubin into bile—>In Lrg intestine bili converted to bilinogen and excreted in feces and urine
2 most common causes of Jaundice
- excessive RBC breakdown
- bile excretion obstruction
Jaundice
- bilirubin level is 3 times greater than normal for jaundice to occur
- jaundice is a symptom of an underlying disease
3 classifications of Jaundice
- Pre-hepatic (hemolytic)
- Hepatic/ within the liver (hepatocellular)
- Post-hepatic (obstructive)
Pre-hepatic Jaundice
(Hemolytic)
- Results from excessive RBC destruction
- occurs before the liver
- excess unconjugated bilirubin in blood (liver can’t handle increased load but function normal)
- pre-hepatic disappears when hemolysis decreases.
Causes of Pre-hepatic Jaundice
- hemolytic anemia
- sickle cell anemia crisis
- severe burns
- newborns
- blood transfusion
Hepatic Jaundice
(Hepatocellular)
- defective uptake, conjugation, or excretion of bilirubin within the liver
- increased unconjugated and conjugated bilirubin initially
- hepatocytes damaged, leak bilirubin increasing conjugated bilirubin levels
- as the number of unhealthy hepatocytes increased -the ability to conjugate bilirubin eventually decreases
Causes of Hepatic Jaundice
- cirrhosis, hepatitis, hepatic carcinoma
- prolonged usage of meds detoxified by liver
- **MAJOR problem is the conjugation and excretion of bilirubin
Post-hepatic Jaundice
(obstructive)
- decreased or obstructed flow of bile thru liver or biliary duct system
- swelling or fibrosis of the liver’s canaliculi and bile ducts
- damage from liver tumor, hepatitis, cirrhosis
- blocks the outward flow of bile
- obstruction of the CBD from a stone, biliary strictures, sclerosing cholangitis, CA of panc.
- *clay colored stools
S/S of Jaundice
- yellow discoloration
- pruritis of skin (bile salt deposits)
- Bruising, bleeding of skin in obstructive jaundice bc bile is necessary for Vit K absorp from GI
- brown, frothy urine
- change in stool color (gray)
- N/V, fever, weakness, loss of appetite, HA, edema
Nursing care for Jaundice
- **treat underlying cause
- pruritis: alkaline baths
- bleeding/bruising: handle gently, avoid ASA, monitor PTT
- monitor stool/urine, labs
- emotional support
Hepatitis
- any type of inflammation in the liver
- wide spread inflammation of the liver cells
- can be caused by drugs, viruses, bacteria, toxic substances, hereditary, fatty liver tissue
Most common type of hepatitis
Viral hepatitis
