Hepatic & Biliary Flashcards
liver lobule
functional unit of the liver
blood pathway through the liver lobules
blood goes through the afferent arterioles, moves through the lobule and starts to flow with hepatocytes
S&S of hepatic disease
- N/V/D
- edema/ascites
- dark urine
- light/clay colored stool
- RUQ abdominal pain
- neurological involvement - increased ammonia
- hepatic osteodystrophy
- osteoporosis
- skin changes
jaundice
- symptoms not a disease
- bilirubin breakdown product of RBC
- increased bilirubin production and decreased processing of bilirubin
cirrhosis
- late stage of scarring of liver caused by many forms of liver disease
- alcoholism or hepatitis
- healthy tissue replaced with fibrotic
what does liver inflammation cause
tissue damage and necrosis
PT implication
- 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
portal vein
conveying blood to the liver from the spleen, stomach, pancreas, gall bladder and intestines
what pressure system does the portal vein have and what is the result of that
low, so it can affect spleen, stomach, pancreas, gall bladder and intestines when its damaged
where does the portal vein conduct blood from
SI to capillary bed in the liver - not a true vein
portal vein HTN =
increase in BP >6mmHg
hepatic system function
- 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
MSK location of pain from hepatic disease
posterior thoracic pain - inter scapular, R shoulder, R upper trap, R subscapular
if you have fibrosis and an abnormal liver, what happens
a mechanical barrier to blood flow forms and increases resistance in the hepatic portal system
increased portal pressure causes what
retrograde flow of blood back into the stomach, spleen, large and small intestine, rectum and esophagus
what does an increase in portal pressure result in
varices, abnormal dilated vessel
consequences of portal vein HTN
- ascites
- splenomegaly
- hemorrhoids
- varices - esophagus, stomach, rectum or umbilical area
- PV may rupture and bleed
hepatic encephalopathy
- secondary to hepatic injury
- caused by elevated blood ammonia and altered neurotransmitter status in the brain
- liver cannot metabolize ammonia
symptoms of hepatic encephalopathy
stupor
decerebrate posturing
positive babinski’s
dilated pupils
PT implications for hepatic encephalopathy
pt safety
impaired motor and sensory integrity
risk for pressure ulcers - secondary to malnutrition, immobility and edema
ascites
abnormal accumulation of fluid in peritoneal cavity
- cirrhosis, PV HTN
implications for ascites
accompanying impaired cardiac and respiratory fxn
muscle degradation
viral hepatitis
- inflammation of the liver
- acute or chronic
- 3 types
hepatitis A
- infectious
- fecal/oral
- benign and self limiting diagnosis
- most recovering w no long last effects
- highly contagious
- preventable
hepatitis B
- serum
- spread by blood transfusion, needle sticks, dialysis, sexual, exchange of body fluids
- vaccina available
who is at a higher risk for chronic infxn with hep B
younger
hepatitis C
- leading cause of chronic liver disease
- contact of blood w infected person, needles
- asymptomatic
- no vaccine
causes of liver disease
drug and toxin induced
fatty liver
what does glucagon favor
energy utilization
