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Med Con Test 3 > Hepatic and Biliary > Flashcards

Hepatic and Biliary Flashcards

1
Q

Liver function

A

filtering blood from GI; cleans blood and excreting bilirubin; metabolized nutrients and

provides: albumin, plasma proteins and clotting factors
stores: vitamins, carbs, fats

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2
Q

aging hepatic system

A
  • decreased liver function
  • decreased enzymes
  • decreased blood flow to liver
  • increased fibrosis
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3
Q

liver healing

A

impacted by age, nutrition, vascular supply

only tissue in body able to regenerate itself

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4
Q

Liver pathologies

A 
hepatitis
cirrhosis
liver neoplasms 
total hypertension 
hepatic encephalopathy
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5
Q

liver manifestations

A

jaundice

ascites

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6
Q

liver disease signs and symptoms

A 
GI symptoms
edema/ascites
neurologic changes
RUQ pain
back or R shoulder pain 
jaundice/skin changes
pruritus
light colored stool
dark urine
coagulopathy
Terry's nails (redness in nail)
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7
Q

MKS pain w/ hepatic disease

A 
thoracic pain
R shoulder
R upper trap
R inter scapular area
R sub scapular area
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8
Q

skin changes w/ hepatic disease

A 
pallor
jaundice (bilirubin 2-3mg/dL)
orange skin
green skin 
bruising
spider angiomas (face)
palmar erythema "liver palms"
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9
Q

normal bilirubin

A

.1 - 1 mg/dL

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10
Q

Hepatic disease neurological symptoms

A 
confusion
sleep disturbances
muscle tremors
hyperactive reflexes
asterixis - "flapping tremor"
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11
Q

asterixis

A

inability to maintain wrist extension w/ forward flexion of the upper extremities

commonly result of metabolic encephalopathies

Test: ask pt to extend wrist and hand w/ arm supported –> hand will “flap” into flexion if +

tremor absent at rest

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12
Q

pruitis

A

d/t accumulation of bile salts in skin

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13
Q

light colored shit

A

secondary to lack of bile in shit

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14
Q

dark urine

A

abnormal excretion of bile

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15
Q

jaundice

A

pre-hepatic - increased destruction of erythrocytes
hepatic - damage to liver cells
post-hepatic - bile duct obstruction or dysfunction

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16
Q

management of jaundice

A

referral to MD
treat underlying cause (surgery)
resolves in 4-6 weeks
resume exercise as tolerated once jaundice clears

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17
Q

ascites

A

presence of excess fluid in peritoneal cavity

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18
Q

portal hypertension

A

excessive lymph produced and released into abdominal cavity
85% cases d/t liver failure
CHF and malnutrition other causes
Palm tree sign - tortuous vessels around umbilicus - sign of chirrosis

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19
Q

management of ascites

A 
restrict Na
diuretics
restrict fluid
therapeutic paracentesis
monitor electrolytes
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20
Q

PT implications for ascites

A 
high fowlers position most comfortable 
breathing techniques
monitor for infection
prevention of ulcers
monitor fluid retention in LE
fluid intake and output may be measured/restricted
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21
Q

Hepatitis

A

acute or chronic liver inflammation

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22
Q

hepatitis risk factors

A 
unprotected sex
injection/drug use
health care workers
living with ppl w/ hepatitis
travel to hepatitis prevalent areas
tattoos
blood clotting disorder
blood transfusion 
liver transplant recipient
compromised immune system
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23
Q

hepatitis A

A

transmitted by oral-fecal route

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24
Q

hepatitis B

A

transmitted percutaneously or through mucosal contact. STD

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25
hep C
associated w/ injection drug use (only type w/ no vaccine)
26
hep D
individuals w/ HBV are at risk for HDV - superinfection of Hep B
27
hep E
transmitted through contaminated water-oral/fecal route
28
hep G
most prevalent in African countries
29
prevention/management of hepatitis
``` prevention of infection & toxins lifestyle changes vaccines medications: interferons, immunoglobulins rest to recover energy energy conservation and time management activities to prevent loss of flexibility liver transplant ```
30
Cirrhosis
scarring of liver that involves formation of fibrous (scar) tissue associated w/ destruction of normal tissue result of long-standing injury/alcohol use Hep C
31
Cirrhosis signs and symptoms
``` fatigue, pruritus jaundice clubbed, white nails darkening in skin fluid retention in legs/abdomen abnormal blood vessels easy bruising enlargement of breasts in men ```
32
late stage cirrhosis signs/symptoms
vomiting of blood - requires emergency care
33
management of cirrhosis
medication (early), exercise (following osteoporosis protocol), energy conservation, time management, treatment of other symptoms as appropriate
34
cirrhosis life expectancy
5-10 years after diagnosis
35
normal portal pressure
3-5 mmHg
36
portal hypertension
>25 mmHg
37
varices
distended, tortuous veins vomited blood comes from hemorrhage of esophageal varices
38
splenomegaly
enlargement of spleen d/t pooling blood
39
management of portal hypertension
``` manage symptoms liver transplant stent and/or shunt (TIPSS) education to reduce intra-abdominal pressure: - splinting for cough/sneeze - proper lifting - diet - mild exercise ```
40
Hepatocellular Carcinoma (HCC)
asymptomatic til advanced stage initial symp: ab pain and weight loss metastases to bone/lung looks a lot like cirrhosis, goes undetected
41
management of HCC
trans-artieral chemoembolization or radioembolization surgical resection liver transplant prognosis is comparable to other cancers
42
management of hepatic encephalopathy
``` reduce protein intake antibiotics bowel cathartic peritoneal dialysis liver transplant ```
43
PT management hepatic encephalopathy
similar treatment of neuro pt w/ varying degrees of sensory, motor, cognitive and behavioral disorders
44
Pancreas exocrine function
produce digestive enzymes | transport digestive enzymes to duodenum
45
pancreas endocrine function
secretion of glucagon and insulin by islet of Langerhans cells to reg carb metabolism
46
normal aging of pancreas
increased fibrosis increased fatty acid deposit atrophy fx relatively unimpaired until 90% damaged
47
pancreas pathologies
pancreatitis pancreatic cancer DM
48
Pancreatitis
severe ab/back pain sudden onset - gallstone gradual onset - alcoholic pancreatitis
49
Pancreatitis pain reduction w/
- sitting up and leaning forward | - large dose of parenteral narcotics
50
pancreatitis pain increases w/
- coughing - vigorous movement - deep breathing
51
pancreatitis symptoms
unrelenting nausea/vomiting, dry heaving | bluish discoloration at periumbilical area
52
acute pancreatitis
sweating, HR 100-140bpm, shallow respiration, semi-comatose, rigid upper abdomen (not entire abdomen)
53
chronic pancreatitis
persistent/reoccuring epigastric and L UQ pain, upper L LS pain, anorexia, nausea, constipation/flatulence, may occur 12-48 hours after drinking or large meal
54
pancreatic cancer symptoms
``` pain in back/stomach weight loss bloating diarrhea nausea jaundice anorexia light colored stool enlarged, painless lymph nodes ```
55
gallbladder function
reservoir for bile expels bile in response to food bile alkalinizes intestinal contents signal for bile release cholecystokinin
56
aging gallbladder
releases less bile in intestine moderate to vigorous physical activity enhances gallbladder function in aging
57
biliary pathologies
cholelithiasis (gallstones) | gallbladder and biliary neoplasms
58
gallstones
``` may be asymptomatic severe/abdominal pain pain in R UQ or R shoulder muscle guarding rebound pain + Murphy's sign ```
59
gallstone treatment
surgical removal
60
gallbladder and biliary cancer
R UQ pain radiating to upper back | typical S&S of CA
61
treatment of gallbladder cancer
surgical removal or radiation
62
PT management of gallbladder cancer
exercise precautions for chemo

Med Con Test 3 (4 decks)

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