Hepatic and Biliary Flashcards
What is the first and sometimes only symptom of liver disease?
Jaundice
Jaundice is first seen in the eye sclera when bilirubin reaches __-__ mg/dL
2-3
Jaundice seen in skin color when bilirubin reaches __-__ mg/dL
5-6
What are the risk factors for hepatitis?
• Injection drug use
• Acupuncture
• Tattoo inscription or removal
• Ear or body piercing
• Recent operative procedure
• Liver transplant
• Blood or plasma transfusion before 1991
• Hemodialysis
• Health care worker exposed to blood products or body
fluids
• Exposure to certain chemicals or medications
• Unprotected homosexual/bisexual activity
• Severe alcoholism
• Travel to high risk areas
• Consuming raw shellfish
Tell me about hepatitis A
- found in poor areas with poor sanitation
- can be vaccinated against it
- occurs most commonly in fall and early winter (can’t survive in heat)
- incubation 2-6 weeks
- risk factors; contact with contaminated things (i.e. Feces or water)
- transmission; shell fish from contaminated water, fecal oral, airborne
- severity; moderately low
- how to avoid it; hygiene
Tell me about hepatitis B
- World wide
- common in addicts, homosexuals…
- incubation; 6 weeks- 6 months
- risk factors; touching blood like at all
- transmission; parenteral, sex, fecal oral
- severe
- avoid by avoiding risk factors and being hygienic and getting vaccinated
Tell me about hepatitis C
- acquired post transfusion
- incubation; 6-7 weeks
- *health care workers or people that touch blood
- transmitted via blood
- can lead to chronic hepatitis
- avoid it by being hygienic
The liver filters blood from the GI tract making it the primary metastatic site for ________, _______, and _________ cancers
Stomach, colorectum, and pancreas
What are the clinical signs and symptoms of Hepatitis A?
Extreme fatigue
Anorexia
Fever
Arthralgias and myalgias (generalized aching) Right upper abdominal pain
Clay-colored stools
Dark urine
Icterus (jaundice)
Headache
Pharyngitis
Alterations in the senses of taste and smell Loss of desire to smoke cigarettes or drink alcohol
Low-grade fever
Indigestion (varying degrees of nausea, heart- burn, flatulence)
What are the signs and symptoms of hepatitis B?
Jaundice (changes in skin and eye color)
Arthralgias
Rash (over entire body)
Dark urine
Anorexia, nausea
Painful abdominal bloating
Fever
What are the signs and symptoms for chronic active hepatitis?
- Fatigue
• Jaundice
• Abdominal pain
• Anorexia
• Arthralgia
• Fever
• Splenomegaly and hepatomegaly - Weakness
• Ascites
• Hepatic encephalopathy
What are the signs and symptoms of toxic and drug induced hepatitis?
• Anorexia, nausea, vomiting
• Fatigue and malaise
• Jaundice
• Dark urine
• Clay-colored stools
• Headache, dizziness, drowsiness (carbon tetrachloride poisoning)
• Fever, rash, arthralgias, epigastric or right upper quadrant pain (halothane anesthetic)
What are signs and symptoms of cirrhosis?
• Mild right upper quadrant pain (progressive)
• GI symptoms
• Anorexia
• Indigestion
• Weight loss
• Nausea and vomiting
• Diarrhea or constipation
• Dull abdominal ache
• Ease of fatigue (with mild exertion)
• Weakness
• Fever
What is stage I of hepatic encephalopathy?
1) prodromal stage
Subtle symptoms may be overlooked
Slight personality changes:
Disorientation
Confusion
Euphoria or depression Forgetfulness
Slurred speech
What is stage II of hepatic encephalopathy ?
Impending stage
Tremor progresses to asterixis (liver flap)
Resistance to passive movement (increased muscle tone)
Lethargy
Aberrant behavior Apraxia*
Ataxia
Facial grimacing and
blinking
What is stage III of hepatic encephalopathy ?
Stuporous stage
Client can still be aroused
Hyperventilation
Marked confusion
Abusive and violent
Noisy, incoherent speech
Asterixis (liver flap)
Muscle rigidity
Positive Babinskit reflex
Hyperactive deep tendon reflexes
What is stage IV of hepatic encephalopathy ?
Comatose stage
Client cannot be aroused; responds only to painful stimuli
No asterixis
Positive Babinski reflex
Hepatic fetor (musty, sweet odor to the breath caused by the liver’s inability to metabolize the amino acid methionine)
What are the signs and symptoms for acute cholecystitis?
Chills, low-grade fever
Jaundice
GI symptoms
Nausea
Anorexia
Vomiting
Tenderness over the gallbladder
Tenderness on the tip of the 10th rib (right side anteriorly); called a “hot rib;” can also affect 11 th and 12th ribs (right anterior)
Severe pain in the right upper quadrant and epigastrium (increases on inspiration and movement)
Pain radiating into the right shoulder and between the scapulae
What are the signs and symptoms for chronic cholecystitis?
Biliary colic: severe, steady pain for 3 to 4 hours in the right upper quadrant
Pain: may radiate to the mid-back between the scapulae (caused by splanchnic fibers synapsing with phrenic nerve fibers)
Nausea (intolerance of fatty foods; decreased bile production results in decreased fat digestion)
Abdominal fullness
Heartburn
Excessive belching Constipation and diarrhea
What are the risk factors for gallstones?
- Age: Incidence increases with age
• Sex: Women are affected more than men before age 60
• Elevated estrogen levels
•Pregnancy
•Oral contraceptives
•Hormone therapy
•Multiparity (woman who has had two or more pregnancies resulting in viable offspring) - Obesity
• Diet: High cholesterol, low fiber - Diabetes mellitus
• Liver disease
• Rapid weight loss or fasting
• Taking cholesterol-lowering drugs (statins) - Ethnicity (Stronger genetic predisposition in Native Americans, Mexican Americans)
- Genetics (family history of gallstones)
