Hepatic and Pancreatic Disorders Flashcards
1
Q
What is cirrhosis?
A
irreversible scarring of liver due to hepatic inflammation and necrosis
2
Q
What are some complications of cirrhosis?
A
– complications depend of amount of damage
- portal hypertension – major complication
- development of nodular tissue – blocks bile ducts and blood flow
- hepatomegaly – due to blockage of bile and blood, causing fluid to accumulate
- ascites – free fluid accumulation in abdominal cavity –> hypoperfusion of kidneys –> renal failure –> more ascites
- bleeding esophageal varices
- coagulation defects – clotting factors 2, 7, 9, 10
- jaundice – due to inability to excrete bilirubin
-
hepatic encephalopathy – toxins that cannot be cleared by the liver accumulate in the blood and travel to the brain, impacting brain function
- end-stage liver failure
- ALOC – from elevated ammonia
- elevated ammonia
- hepatorenal syndrome – impaired kidney function due to liver disease
-
bacterial peritonitis
- presents as increased leukocytes
3
Q
What are the 3 types of cirrhosis?
A
- Laennec’s: alcoholic
-
postnecrotic: viral hepatitis or drugs
- usually caused by hep C
- biliary: biliary obstruction in gallbladder or autoimmune disease
4
Q
What are some causes of liver disease?
A
- hepatitis C – leading cause of cirrhosis
- alcohol
- drugs and toxins
- IV drug use can cause liver disease
- acetaminophen
- gallbladder disease – obstruction in common bile duct –> enlarged liver and liver damage
- metabolic / genetic causes
- cardiovascular disease
5
Q
What are the early and late signs and symptoms of liver disease?
A
– early:
- fatigue
- weight changes
- GI symptoms
- N/V
- anorexia
- abdominal pain
- liver tenderness
- pruritis
– late:
- jaundice and icterus (jaundice sclera)
- dry skin
- rashes
- petechiae
- ecchymoses
- warm, bright red palms
- spider angioimas
- peripheral dependent edema
- extremities
- sacrum
6
Q
What are some assessments that might indicate liver disease?
A
- ascites
- protrusion of umbilicus
- caput medusae (dilated abdominal veins) – AKA medusa veins in abdomen
- hepatomegaly
- bloody stools
- fector hepaticus (fruity/musty breath)
- amenorrhea
- genital changes
- asterixis (inability to sustain posture, resulting in rapid, jerking movements)
7
Q
What are the lab values to look out for with liver disease?
A
- increased ALT
- specific to liver
- increased AST
- specific to cardiac, muscle, kidney, brain
- increased lactate dehydrogenase (LDH)
- due to destruction of liver cells
- increased alkaline phosphatase
- due to biliary obstruction
- increased total bilirubin
- increased total urobilinogen
- increased prothrombin time
- damaged liver cannot produce enough prothrombin, decreasing clotting time
- increased ammonia
- increased creatinine
- decreased total protein
- decreased albumin
- decreased platelets
- decreased H&H
8
Q
What are some interventions for ascites?
A
- nutrition
- low sodium
- fluid restrictions
- vitamin supplements and electrolyte replacements
- banana bags = thiamine, folic acid, magnesium sulfate
- drugs
- diuretics
- paracentesis
- important to assess for hypovolemia since body has become accustomed to excess fluid
- elevate HOB to minimize SOB
- sit in chair
- surgical
- shunting fluid out of venous system
- peritoneovenous
- portocaval
- transjugular intrahepatic portosystemic shunt (TIPS) – controls long-term ascites; reduces variceal bleeding
- shunting fluid out of venous system
9
Q
How are pts assessed for hemorrhage?
A
endoscopy – screen pts early, especially UGIB
10
Q
What are some interventions for esophageal bleeds?
A
- drugs
- non-selective beta blockers
- sandostatin
- vasopressin
- endural
- coreguard
- non-selective beta blockers
- gastric intubation
- esophagogastric tamponade – short-term control of bleeds
- blood transfusion
- vasoactive therapy
- endoscopic procedures
- magnet at base of esophagus
- esophageal variceal ligation
- sclerotherapy
- TIPS
11
Q
What are some interventions for hepatic encephalopathy?
A
- control elevated ammonia levels
- ammonia is toxic to brain
- liver filters out
- produced from protein breakdown
- restricted protein diet
- drugs
- lactulose – promotes ammonia excretion
- neomycin sulfate
- intestinal antiseptic – eliminates good bacteria to decrease ammonia production
- metronidazole – intestinal antiseptic
12
Q
What is hepatits? Why are they important?
A
– hepatitis: viral inflammation of liver cells by
- hepatitis A
- hepatitis B
- hepatitis C
- hepatitis D
- hepatitis E
– important because hepatitis cases must be reported to local health department who will then notify the CDC
13
Q
Describe hepatitis A (HAV).
A
- typical viral syndrome – flu-like symptoms
- often goes unrecognized
- non-specific GI symptoms
- spread via fecal-oral route
- contaminated water, shellfish, foods
- spread via oral-anal sexual activity
- susceptible to chlorine bleach
- incubation = 15 - 50 days
- not life-threatening
- more severe in pts 40+
14
Q
Describe hepatitis B (HBV).
A
- spread via
- unprotected sex
- sharing needles/needle sticks
- blood transfusions
- hemodialysis
- maternal-fetal route
- healthcare works often get this type
- incubation = 25 - 180 days
- symptoms:
- anorexia
- N/V
- fever
- fatigue
- RUQ pain
- dark urine
- light stool
- joint pain
- jaundice
- carriers can infect others even without symptoms
15
Q
Describe hepatitis C (HCV).
A
- spread via
- sharing needles/needle sticks
- blood/blood products
- organ transplants prior to 1992
- tattoos
- intranasal cocaine
- incubation = 21 - 140 days
- pts are often asymptomatic
- damage occurs slowly over decades
- can be a carrier without symptoms
- leading cause for liver transplants in US
16
Q
Describe hepatitis D (HDV).
A
- spread via
- parenteral route
- sexual contact
- incubation = 14 - 56 days
