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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
Q

hep C

A

associated w/ injection drug use (only type w/ no vaccine)

26
Q

hep D

A

individuals w/ HBV are at risk for HDV - superinfection of Hep B

27
Q

hep E

A

transmitted through contaminated water-oral/fecal route

28
Q

hep G

A

most prevalent in African countries

29
Q

prevention/management of hepatitis

A 
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
Q

Cirrhosis

A

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
Q

Cirrhosis signs and symptoms

A 
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
Q

late stage cirrhosis signs/symptoms

A

vomiting of blood - requires emergency care

33
Q

management of cirrhosis

A

medication (early), exercise (following osteoporosis protocol), energy conservation, time management, treatment of other symptoms as appropriate

34
Q

cirrhosis life expectancy

A

5-10 years after diagnosis

35
Q

normal portal pressure

A

3-5 mmHg

36
Q

portal hypertension

A

> 25 mmHg

37
Q

varices

A

distended, tortuous veins

vomited blood comes from hemorrhage of esophageal varices

38
Q

splenomegaly

A

enlargement of spleen d/t pooling blood

39
Q

management of portal hypertension

A 
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
Q

Hepatocellular Carcinoma (HCC)

A

asymptomatic til advanced stage
initial symp: ab pain and weight loss
metastases to bone/lung

looks a lot like cirrhosis, goes undetected

41
Q

management of HCC

A

trans-artieral chemoembolization or radioembolization
surgical resection
liver transplant
prognosis is comparable to other cancers

42
Q

management of hepatic encephalopathy

A 
reduce protein intake
antibiotics
bowel cathartic
peritoneal dialysis
liver transplant
43
Q

PT management hepatic encephalopathy

A

similar treatment of neuro pt w/ varying degrees of sensory, motor, cognitive and behavioral disorders

44
Q

Pancreas exocrine function

A

produce digestive enzymes

transport digestive enzymes to duodenum

45
Q

pancreas endocrine function

A

secretion of glucagon and insulin by islet of Langerhans cells to reg carb metabolism

46
Q

normal aging of pancreas

A

increased fibrosis
increased fatty acid deposit
atrophy
fx relatively unimpaired until 90% damaged

47
Q

pancreas pathologies

A

pancreatitis
pancreatic cancer
DM

48
Q

Pancreatitis

A

severe ab/back pain
sudden onset - gallstone
gradual onset - alcoholic pancreatitis

49
Q

Pancreatitis pain reduction w/

A
  • sitting up and leaning forward

- large dose of parenteral narcotics

50
Q

pancreatitis pain increases w/

A
  • coughing
  • vigorous movement
  • deep breathing
51
Q

pancreatitis symptoms

A

unrelenting nausea/vomiting, dry heaving

bluish discoloration at periumbilical area

52
Q

acute pancreatitis

A

sweating, HR 100-140bpm, shallow respiration, semi-comatose, rigid upper abdomen (not entire abdomen)

53
Q

chronic pancreatitis

A

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
Q

pancreatic cancer symptoms

A 
pain in back/stomach 
weight loss 
bloating
diarrhea
nausea
jaundice
anorexia
light colored stool
enlarged, painless lymph nodes
55
Q

gallbladder function

A

reservoir for bile
expels bile in response to food
bile alkalinizes intestinal contents
signal for bile release cholecystokinin

56
Q

aging gallbladder

A

releases less bile in intestine

moderate to vigorous physical activity enhances gallbladder function in aging

57
Q

biliary pathologies

A

cholelithiasis (gallstones)

gallbladder and biliary neoplasms

58
Q

gallstones

A 
may be asymptomatic
severe/abdominal pain
pain in R UQ or R shoulder
muscle guarding
rebound pain
\+ Murphy's sign
59
Q

gallstone treatment

A

surgical removal

60
Q

gallbladder and biliary cancer

A

R UQ pain radiating to upper back

typical S&S of CA

61
Q

treatment of gallbladder cancer

A

surgical removal or radiation

62
Q

PT management of gallbladder cancer

A

exercise precautions for chemo

Med Con Test 3 (4 decks)

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