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Pathophysiology > Hepatic > Flashcards

Hepatic Flashcards

1
Q

List the functions of the Hepatic System

A
  1. Conversion and excretion of bilirubin ammonia
  2. Sole source of albumin and other plasma proteins
  3. Produces bile (500 - 1500 mls/day)
  4. Synthesizes clotting factors
  5. Absorbs and processes nutrients from the gut
  6. Detoxification (drugs, ETOH and toxins)
  7. Storage (glycogen, vitamins, iron)
  8. Synthesizes cholesterol
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2
Q

List S/S of Hepatic Disease

A
  1. GI symtpoms
    • N/V, diarrhea, constipation, heartburn, abdominal pain, GI bleeding
  2. Edema/Ascites
  3. Dark urine (bilirubin)
  4. Light/clay colored stools
  5. Right upper quadrant abdominal pain
  6. Neuro involvement
    • confusion, muscle tremors, sleep disturbances
  7. Hepatic Osteodystrophy
  8. Osteoporosis
  9. Skin changes: Juandice, increased burising
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3
Q

What is juandice?

A

a symptom not a disease

  • bilirubin break down product of RBC macophages
  • yellow discoloration of the skin, sclerae, and mucous membranes
  • increased bilirubin production. Decreased processing bilirubin
  • Hepatocyte dysfunction leading to bilirubin accumulation
  • impaired bile flow
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4
Q

how is jaundice treated?

A

treat underlying disease

return to normal color suggests resolution

activity and exercise can be resumed after resolution

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5
Q

what causes neuro symptoms in hepatic disease?

A

ammonia accumulation in blood

  • ammonia converted into urea in liver
  • ammonia comes from degradation of amino acids
  • ammonia is then catabolized by liver generating urea
  • decreased urea leads to ammonia accumulation in blood
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6
Q

what is a flapping tremor?

A

tremor elicted by attempted wrist extension while forearm is fixed

most common neuro abnormality w/liver failure

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7
Q

what musculoskeletal pain is associated with liver and biliary system?

A

posterior thoracic pain (inter scapular, R shoulder, R upper trap, R subscapular)

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8
Q

what is hepatic osteodystrophy?

A

abnormal development of bone/osteoporosis in individuals with chronic liver disease

leads to osteopenia and osteoporosis

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9
Q

what is cirrhosis?

A

a late scarring (fibrosis) of the liver caused by many forms of liver disease

typically a result of alcoholism or hepatitis

Progressive, patterened loss of healthy tissue which is replaced with fibrotic tissue

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10
Q

describe the process that results in liver scarring

A
  1. liver inflammation causes tissue damage necrosis
  2. liver repairs itself
  3. liver is reinjured leading to more tissue damage and necrosis
  4. this cycle of inflammation and healing leads to the replacement of liver tissue with bands of CT
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11
Q

what are the practice implications for cirrhosis?

A
  1. Osteoporosis
  2. Impaired posture
  3. Impaired muscle performance/weakness
  4. Loss of balance
  5. Deconditioning
  6. Ascites/bilateral edema of feet and ankles
  7. Blood loss: bruising/bleeding
  8. Rest to reduce metabolic demand on the heart is recommended; rest during treatment sessions and avoid unnecessary fatigue
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12
Q

what is portal hypertension?

A

defined as an increase in hepatic sinusoidal BP > 6 mm

fibrosis, and abnormal liver architecture combine to form mechanical barriers to blood flow in the liver increasing the resistance and BP in the hepatic portal system

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13
Q

what is the effect of portal hypertension on blood flow?

A

increased portal pressure causes a retrograde flow of blood back into the stomach, spleen, large and small intestine, rectum and esophagus

result is varices back upstream

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14
Q

what is are varices?

A

an abnormally dilated vessel with a tortuous course

an ex is varicose veins in LE

these can leak blood/bleed

serious bleeding can quickly result in hypovolemia, shock, and death

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15
Q

List some consequences of portal hypertension

A
  1. ascites → from increased hydrostatic venous pressure
  2. spleenomegally → enlargement of the spleen caused by venous congestion in spleen
  3. Hemorrhoids → from venous congestion in the bowel
  4. Varices → esophagus, stomach, rectum or umbilical area
  5. May rupture and bleed
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16
Q

what is hepatic encephalopathy

A

potentially irreversible, decreased level of consciousness in people with severe liver disease

thought to be caused by elevated blood ammonia and altered NT status in the brain

Insidious onset, progressively worsening os symptoms as disease progresses

17
Q

List symptoms of hepatic encephalopathy

A
  1. depression, personality changes, impaired attention
  2. drowsines, sleep disorders, ataxia, asterixis (rapid extension-flexion motion of head and extremities), slurred speech, hyperreflexia
  3. marked confusion, incoherent speech, muscle rigidity
  4. stupor, decerebrate posturing, positive Babinskis, dialted pupils
18
Q

T/F: symptoms of hepatic encephalopathy are reversible

A

TRUE

if cause is determined

19
Q

list some PT implications for hepatic encaphalopathy

A
  1. patient safety
  2. impaired motor and sensory integrity ie. impaired mobility, balance
  3. impaired arousal
  4. risk for pressure ulcers 2º to malnutrition, immobility, edema
20
Q

what is ascities associated with?

A

mostly with cirrohosis and accompanying portal hypertension resulting in congestion and varices and loss of blood into the abdomen

21
Q

management of ascites includes what?

A
  1. Paracentesis
  2. albumin consumption
  3. diuretics
  4. sodium and fluid restriction
22
Q

list implications for ascites

A
  1. accompanying impaired cardiac and respiratory function
  2. lymphedema
  3. integumentary disorders (peripheral edema, reduced blood flow, lymphedema)
  4. malnutrition
  5. muscle degradation
23
Q

what is viral hepatitis?

A

inflammatory condition of the liver

result of an infection by one of several viruses with specific affinity for the liver (A, B, C, D, E)

24
Q

list some causes of chronic hepatitis

A
  1. viruses
  2. medications
  3. metabolic abnormalities
  4. autoimmune disorders
  5. idiopathic
25
Q

T/F: most people with chronic hepatitis are asymptomatic

A

TRUE

when symptoms appear they are nonspecific

26
Q

list diagnostic criteria for chronic hepatitis

A
  1. symptoms
  2. physical exam
  3. blood test
    • specific Ab, liver function tests
    • liver biopsy (chronic inflammation, necrosis)
27
Q

list symptoms for viral hepatitis?

A
  1. N/V
  2. poor appetite, Wt. loss
  3. weakness
  4. Jaundice, dark urine
  5. pale or clay-colored stool (defect in bilirubin homeostasis)
  6. Fatigue
  7. Most people have vague or no symptoms at all
28
Q

Describe Hepatitis A

A
  • formerly known as infectious hepatitis
  • spread by close personal contact or oral-fecal contamination of water and food, poor hand hygiene, shared use of oral utensils
  • Benign and self-limiting disease
  • most persons w/acute disease recover with no lasting liver damage; rarely fatal
  • highly contagious
  • preventable w/vaccine
29
Q

how is hepatitis B spread?

A
  1. blood transfusions
  2. needle sticks
  3. IV drug use/shared needles
  4. dialysis
  5. sexual contact
  6. exchange of bodily fluids
30
Q

T/F: Hepatitis B is considered an STD

A

TRUE

31
Q

who is at most risk for hepatitis B?

A

healthcare workers who come into contact with blood

32
Q

what is the leading cause of chronic liver disease?

A

Hepatitis C

transmitted by contact w/blood or an infected person, primarily through contaminated needles, sexual contact, needle sticks

33
Q

T/F: Hepatitis C has a vaccine

A

FALSE

treated w/interferon, ribavirin and direct acting antiviral agents

34
Q

who should be tested for Hepatitis C?

A
  1. ppl who recieved an organ transplant before 1992
  2. if you have ever injected drugs
  3. if you received blood product used to treat clotting problems that was made before 1987
  4. those born between 1945-1965
  5. on long term kidney dialysis
  6. children born to HCV+ mothers
35
Q

List some other causes of Hepatitis

A
  1. autoimmune
  2. other viral causes:
    • CMV
    • Epstein-Barr (mono)
    • Yellow fever
  3. drug and toxin induced liver disease
  4. fatty liver
  5. alcoholism
36
Q

how can a fatty liver lead to liver damage?

A

fat accumulates → inflammation → scarring (cirrhosis)

37
Q

how can alcoholism result in chronic liver damage?

A

cirrhosis can occur along with the following:

  1. mitochondrial damage
  2. excessive fat content in liver leads to inflammation with degeneration of hepatocytes
  3. degenerated hepatocytes can stimulate an autoimmune reaction that causes further damage
    • **alcoholic hepatitis**
  4. nutritional deficit → occurs b/c most alcoholics don’t eat right

Pathophysiology (18 decks)

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