Hepatic & Biliary

Question 1

liver lobule

Answer 1

functional unit of the liver

Question 2

blood pathway through the liver lobules

Answer 2

blood goes through the afferent arterioles, moves through the lobule and starts to flow with hepatocytes

Question 3

S&S of hepatic disease

Answer 3

• N/V/D
• edema/ascites
• dark urine
• light/clay colored stool
• RUQ abdominal pain
• neurological involvement - increased ammonia
• hepatic osteodystrophy
• osteoporosis
• skin changes

Question 4

jaundice

Answer 4

• symptoms not a disease
• bilirubin breakdown product of RBC
• increased bilirubin production and decreased processing of bilirubin

Question 5

cirrhosis

Answer 5

• late stage of scarring of liver caused by many forms of liver disease
• alcoholism or hepatitis
• healthy tissue replaced with fibrotic

Question 6

what does liver inflammation cause

Answer 6

tissue damage and necrosis

Question 7

PT implication

Answer 7

• osteoporosis
• impaired posture bc of pain
• impaired muscle performance
• loss of balance
• ascites
• rest to reduce metabolic demand on the heart is recommended, rest during treatment sessions and avoid unnecessary fatigue

Question 8

portal vein

Answer 8

conveying blood to the liver from the spleen, stomach, pancreas, gall bladder and intestines

Question 9

what pressure system does the portal vein have and what is the result of that

Answer 9

low, so it can affect spleen, stomach, pancreas, gall bladder and intestines when its damaged

Question 10

where does the portal vein conduct blood from

Answer 10

SI to capillary bed in the liver - not a true vein

Question 11

portal vein HTN =

Answer 11

increase in BP >6mmHg

Question 12

hepatic system function

Answer 12

• conversion and excretion of bilirubin and ammonia
• sole source of albumin
• produce bile
• synthesize clotting factors
• absorb and process nutrients from gut
• storage
• synthesize cholesterol

Question 13

MSK location of pain from hepatic disease

Answer 13

posterior thoracic pain - inter scapular, R shoulder, R upper trap, R subscapular

Question 14

if you have fibrosis and an abnormal liver, what happens

Answer 14

a mechanical barrier to blood flow forms and increases resistance in the hepatic portal system

Question 15

increased portal pressure causes what

Answer 15

retrograde flow of blood back into the stomach, spleen, large and small intestine, rectum and esophagus

Question 16

what does an increase in portal pressure result in

Answer 16

varices, abnormal dilated vessel

Question 17

consequences of portal vein HTN

Answer 17

• ascites
• splenomegaly
• hemorrhoids
• varices - esophagus, stomach, rectum or umbilical area
• PV may rupture and bleed

Question 18

hepatic encephalopathy

Answer 18

• secondary to hepatic injury
• caused by elevated blood ammonia and altered neurotransmitter status in the brain
• liver cannot metabolize ammonia

Question 19

symptoms of hepatic encephalopathy

Answer 19

stupor
decerebrate posturing
positive babinski’s
dilated pupils

Question 20

PT implications for hepatic encephalopathy

Answer 20

pt safety
impaired motor and sensory integrity
risk for pressure ulcers - secondary to malnutrition, immobility and edema

Question 21

ascites

Answer 21

abnormal accumulation of fluid in peritoneal cavity

- cirrhosis, PV HTN

Question 22

implications for ascites

Answer 22

accompanying impaired cardiac and respiratory fxn

muscle degradation

Question 23

viral hepatitis

Answer 23

• inflammation of the liver
• acute or chronic
• 3 types

Question 24

hepatitis A

Answer 24

• infectious
• fecal/oral
• benign and self limiting diagnosis
• most recovering w no long last effects
• highly contagious
• preventable

Question 25

hepatitis B

Answer 25

• serum
• spread by blood transfusion, needle sticks, dialysis, sexual, exchange of body fluids
• vaccina available

Question 26

who is at a higher risk for chronic infxn with hep B

Answer 26

younger

Question 27

hepatitis C

Answer 27

• leading cause of chronic liver disease
• contact of blood w infected person, needles
• asymptomatic
• no vaccine

Question 28

causes of liver disease

Answer 28

drug and toxin induced

fatty liver

Question 29

what does glucagon favor

Answer 29

energy utilization