Hepatic Flashcards
List the functions of the Hepatic System
- Conversion and excretion of bilirubin ammonia
- Sole source of albumin and other plasma proteins
- Produces bile (500 - 1500 mls/day)
- Synthesizes clotting factors
- Absorbs and processes nutrients from the gut
- Detoxification (drugs, ETOH and toxins)
- Storage (glycogen, vitamins, iron)
- Synthesizes cholesterol
List S/S of Hepatic Disease
- GI symtpoms
- N/V, diarrhea, constipation, heartburn, abdominal pain, GI bleeding
- Edema/Ascites
- Dark urine (bilirubin)
- Light/clay colored stools
- Right upper quadrant abdominal pain
- Neuro involvement
- confusion, muscle tremors, sleep disturbances
- Hepatic Osteodystrophy
- Osteoporosis
- Skin changes: Juandice, increased burising
What is juandice?
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
how is jaundice treated?
treat underlying disease
return to normal color suggests resolution
activity and exercise can be resumed after resolution
what causes neuro symptoms in hepatic disease?
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
what is a flapping tremor?
tremor elicted by attempted wrist extension while forearm is fixed
most common neuro abnormality w/liver failure
what musculoskeletal pain is associated with liver and biliary system?
posterior thoracic pain (inter scapular, R shoulder, R upper trap, R subscapular)
what is hepatic osteodystrophy?
abnormal development of bone/osteoporosis in individuals with chronic liver disease
leads to osteopenia and osteoporosis
what is cirrhosis?
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
describe the process that results in liver scarring
- liver inflammation causes tissue damage necrosis
- liver repairs itself
- liver is reinjured leading to more tissue damage and necrosis
- this cycle of inflammation and healing leads to the replacement of liver tissue with bands of CT
what are the practice implications for cirrhosis?
- Osteoporosis
- Impaired posture
- Impaired muscle performance/weakness
- Loss of balance
- Deconditioning
- Ascites/bilateral edema of feet and ankles
- Blood loss: bruising/bleeding
- Rest to reduce metabolic demand on the heart is recommended; rest during treatment sessions and avoid unnecessary fatigue
what is portal hypertension?
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
what is the effect of portal hypertension on blood flow?
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
what is are varices?
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
List some consequences of portal hypertension
- ascites → from increased hydrostatic venous pressure
- spleenomegally → enlargement of the spleen caused by venous congestion in spleen
- Hemorrhoids → from venous congestion in the bowel
- Varices → esophagus, stomach, rectum or umbilical area
- May rupture and bleed
what is hepatic encephalopathy
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
List symptoms of hepatic encephalopathy
- depression, personality changes, impaired attention
- drowsines, sleep disorders, ataxia, asterixis (rapid extension-flexion motion of head and extremities), slurred speech, hyperreflexia
- marked confusion, incoherent speech, muscle rigidity
- stupor, decerebrate posturing, positive Babinskis, dialted pupils
T/F: symptoms of hepatic encephalopathy are reversible
TRUE
if cause is determined
list some PT implications for hepatic encaphalopathy
- patient safety
- impaired motor and sensory integrity ie. impaired mobility, balance
- impaired arousal
- risk for pressure ulcers 2º to malnutrition, immobility, edema
what is ascities associated with?
mostly with cirrohosis and accompanying portal hypertension resulting in congestion and varices and loss of blood into the abdomen
management of ascites includes what?
- Paracentesis
- albumin consumption
- diuretics
- sodium and fluid restriction
list implications for ascites
- accompanying impaired cardiac and respiratory function
- lymphedema
- integumentary disorders (peripheral edema, reduced blood flow, lymphedema)
- malnutrition
- muscle degradation
what is viral hepatitis?
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)
list some causes of chronic hepatitis
- viruses
- medications
- metabolic abnormalities
- autoimmune disorders
- idiopathic
T/F: most people with chronic hepatitis are asymptomatic
TRUE
when symptoms appear they are nonspecific
list diagnostic criteria for chronic hepatitis
- symptoms
- physical exam
- blood test
- specific Ab, liver function tests
- liver biopsy (chronic inflammation, necrosis)
list symptoms for viral hepatitis?
- N/V
- poor appetite, Wt. loss
- weakness
- Jaundice, dark urine
- pale or clay-colored stool (defect in bilirubin homeostasis)
- Fatigue
- Most people have vague or no symptoms at all
Describe Hepatitis 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
how is hepatitis B spread?
- blood transfusions
- needle sticks
- IV drug use/shared needles
- dialysis
- sexual contact
- exchange of bodily fluids
T/F: Hepatitis B is considered an STD
TRUE
who is at most risk for hepatitis B?
healthcare workers who come into contact with blood
what is the leading cause of chronic liver disease?
Hepatitis C
transmitted by contact w/blood or an infected person, primarily through contaminated needles, sexual contact, needle sticks
T/F: Hepatitis C has a vaccine
FALSE
treated w/interferon, ribavirin and direct acting antiviral agents
who should be tested for Hepatitis C?
- ppl who recieved an organ transplant before 1992
- if you have ever injected drugs
- if you received blood product used to treat clotting problems that was made before 1987
- those born between 1945-1965
- on long term kidney dialysis
- children born to HCV+ mothers
List some other causes of Hepatitis
- autoimmune
- other viral causes:
- CMV
- Epstein-Barr (mono)
- Yellow fever
- drug and toxin induced liver disease
- fatty liver
- alcoholism
how can a fatty liver lead to liver damage?
fat accumulates → inflammation → scarring (cirrhosis)
how can alcoholism result in chronic liver damage?
cirrhosis can occur along with the following:
- mitochondrial damage
- excessive fat content in liver leads to inflammation with degeneration of hepatocytes
- degenerated hepatocytes can stimulate an autoimmune reaction that causes further damage
- **alcoholic hepatitis**
- nutritional deficit → occurs b/c most alcoholics don’t eat right
