Hepatic Disorders Flashcards
Exam 3
1
Q
The liver serves several functions: What are they?
A
Blood storage, blood filtration, production of bilirubin, synthesis of clotting factors, removal of clotting factors
Metabolism of carbohydrates, fat, and protein
Detoxify the blood
Storage area for vitamins A, D, E, and K and iron
2
Q
Hepatitis: What causes Hepatitis?
A
Several viruses cause hepatitis
3
Q
Hepatitis: How is Hepatitis transmitted?
A
Fecal-oral contamination or blood and body fluid exposures
4
Q
Hepatitis: How many types of autoimmune hepatitis are there?
A
2 types of autoimmune hepatitis
5
Q
Hepatitis: Pathophysiology
A
Inflammation of liver cells most commonly caused by a virus that impairs its ability to function normally
6
Q
Hepatitis: Pathophysiology
What does inflammation do?
A
This inflammation limits the ability of the liver to detox substances and
limits the production of proteins and clotting factors.
7
Q
Hepatitis: Other risk factors?
A
Other risk factors for hepatitis include:
chronic alcohol use,
exposure of some prescriptions and over the counter medications,
as well as toxins.
8
Q
In autoimmune hepatitis, what occurs? What is it classified as?
A
In autoimmune hepatitis, an immune system response causes inflammation in the liver, which is classified either as type one or type 2.
9
Q
Pathophysiology of hepatitis
How can the virus of hepatitis be categorized? How do the categories vary?
A
The virus of hepatitis can be categorized according to letters ranging from A to G, which each having different incubation periods, modes of transmissions and other characteristics.
10
Q
HEPATITIS- Clinical manifestations?
A
Abdominal pain,
irritability,
pruritus,
malaise,
fever,
nausea,
vomiting,
jaundice
11
Q
HEPATITIS: What are lab abnormalities?
A
Elevated liver enzymes and alanine transaminase, elevated bilirubin, elevated serum ammonia, and decreased albumin
12
Q
What is the most common type of viral hepatitis?
A
Hepatitis A is the most common Type of hepatitis
13
Q
Viral hepatitis A: How is Hepatitis A primarily spread?
A
Is primarily spread through the oral route from food, water or shellfish that has been infected with the virus.
14
Q
Viral hepatitis A: How else is Hepatitis A spread? (not primary way)
A
It can also be spread through close contact with infected persons, such as in households or daycare centres, with an increased incidence in unsanitary conditions.
15
Q
Viral hepatitis A: Where is Hepatitis A normally found?
A
The hepatitis A vaccine is found on surfaces but is destroyed by cooking food for orally
16
Q
Hepatitis B: How is it spread?
A
Is spread by blood and body fluids or secretions such as semen.
17
Q
Hepatitis B: What are examples of how Hep B is spread?
A
The virus can be spread through the mucosa membrane or contact with infected.
Fluids during childbirth or through skin puncture with needles or other instruments.
18
Q
Hepatitis B: How are patient infected with Hepatitis B? What are they considered?
A
Patients infected with hepatitis B have acute or chronic infections and are considered infectious as long as the antigen is present in the bloodstream.
19
Q
What vaccine is required for all healthcare workers?
A
There is a vaccine for hepatitis B and it is required for all healthcare personnels.
20
Q
Hep B: How is the vaccine administered?
A
This vaccine is multi. Series injection is given in. Special intervals.
21
Q
Hepatitis C: What was it previously known as? How is it spread?
A
Previously known as non, a knobby is spread through blood and body fluids from the mother to child during childbirth.
22
Q
How do a significant number of Hepatitis C cases occur?
A
A significant number of cases also occur through sharing contaminated needles from Ivy drug users.
23
Q
What are other settings where Hep C can occur?
A
Other settings include tattoos or body piercing establishments.
24
Q
What is the most common indication of a liver transplantation?
A
Hepatitis C is most common indication of a liver transplantation.
25
Hepatitis D: What kind of people is Hep D seen in?
Are only in people who have been infected with hepatitis B
26
Hepatitis D: Why is the Hep D virus only seen in people who have been infected with Hep B?
Because Hep D requires the Hep B antigen to replicate.
27
Hepatitis D: How is Hep D spread?
It is spread through the contact with infectious blood and most commonly found in patients who are drug users
People who receive hemodialysis or have received multiple transplants
28
What types of vaccine have a vaccine?
There is no vaccination for hepatitis D.
29
Hepatitis E: What is it caused by?
It is caused by hepatitis E virus
30
Hepatitis E: How is it transmitted?
Is transmitted via the fecal oral route primarily through water or contamination areas of poor sanitation.
31
Hepatitis G: How is it known to be transmitted?
Hepatitis G was discovered in 1996 and is known to be transmitted by infected blood or blood products.
32
Hepatitis G: How may is be transmitted?
It may be transmitted through sexual contact and IV drug use.
33
Hepatitis G: Who is at greatest risk of developing Hep G?
Patients with hemophilia or those who require blood transfusions at greatest risk.
34
People who have hepatitis B&C can often be infected with what?
People who have hepatitis B&C can often be infected with hepatitis G.
35
What are symptoms of jaundice? -
Yellowing of sclera
Yellowing of skin
Elevated bilirubin in the blood
36
What shows up secondary to hepatitis? Why?
Jaundice shows up secondary because of decreased expulsion of bilirubin in the stool.
There is more bilirubin circulating the body.
37
What are the two types of Hepatitis? (Not autoimmune)
Nonviral forms of hepatitis
Hepatitis can be acute or chronic
38
Types of hepatitis:
Nonviral forms of hepatitis: What is it caused by?
Caused by ingested, inhaled, or injected toxins or medications
39
Types of hepatitis:
Nonviral forms of hepatitis: How is it similar to viral hepatitis?
Patients with non viral forms of hepatitis have clinical presentations similar to those of viral hepatitis, such as nausea, vomiting, jaundice, anorexia, and hepatomegaly.
40
Types of hepatitis:
Nonviral forms of hepatitis: What does diagnosis include?
How can recovery occur?
Diagnosis includes detailed history and physical examination and a history of exposure to potential toxins.
41
Types of hepatitis:
Nonviral forms of hepatitis: What If it is determined that a person has been exposed to a liver toxin or a toxin is removed?
If it is determined that a person has been exposed to a liver toxin or a toxin is removed, recovery can be rapid.
42
Types of hepatitis:
Nonviral forms of hepatitis: What happens if there is a prolonged period between exposure to toxin and development of manifestations?
However, if there is a prolonged time period between the exposure to the toxin and the development of clinical manifestations, recovery can be prolonged.
43
Types of hepatitis:
What differentiates acute from chronic hepatitis?
Hepatitis can be both chronic or acute and is differentiated by the period of time.
44
Types of hepatitis
Hepatitis can be acute or chronic:
How long is acute hepatitis? What is the course of the infection?
Acute hepatitis infection lasts less than 6 months and most shed the virus and recover from all of their symptoms
45
Types of hepatitis
Hepatitis can be acute or chronic:
How long is chronic hepatitis? What is the course of the infection?
Chronic hepatitis is an infection that lasts longer than 6 months and can span the patient’s lifetime
46
HEPATITIS:
Hepatitis can be acute or chronic: Having a virus that is prolonged for a period of time leads to what?
Having a virus that is prolonged for a period of time increases the patience chances of developing complications such as cirrhosis, liver failure and liver cancer.
47
Contracting Hepatitis B or C can lead to?
Patients who contract hepatitis B and hepatitis C can develop chronic hepatitis that leads to the progression of liver damage and causes 80% of primary liver cancer.
48
How is the risk of liver cancer decreased in patients with chronic Hepatitis C?
In patients with chronic hepatitis C, the risk of liver cancer is decreased for the patients on anti viral therapy because this therapy prevents the virus from replicating, thus slowing the progression of liver damage.
49
HEPATITIS:
What is management?
Laboratory and diagnostic testing includes assessments that determine the extent of liver damage
50
HEPATITIS: What are medications?
Oral antiviral agents,
pegylated interferon injections, and vaccinations for hepatitis B and hepatitis A
51
HEPATITIS: What is surgical management of Hepatitis?
Liver transplantation (Cadaver or living donor)
52
HEPATITIS:
Diet and activity:
Dichromate recommendations for patients with hepatitis are similar to a healthy diet, low in fats and high in fruits and vegetables as well as whole grains.
53
Diet and activity.
What is important for hydration?
Adequate liquid intake Fluid intake is also important to ensure hydration.
54
HEPATITIS:
Diet and activity.
What should patients avoid?
Patients should avoid alcohol and any medication that is toxic to the liver, such as incitement, Alphen.
55
Hepatitis: Diet and Activity
What kind of vitamins are beneficial?
Vitamin supplies of A,D,E and K are also beneficial.
56
Hepatitis: Diet and Activity
What is an exercise regimen recommended for Hepatitis?
There is no exercise program recommended for hepatitis.
Activities such as walking and resilience training as well as low impact aerobics help to strengthen and minimize fatigue.
57
HEPATITIS:
Eating how much fat is recommended?
Eating low fat foods decrease indigestion ingestion due to liver inability to produce bile.
58
HEPATITIS:
Liver transplant: What is the most common reasons for liver transplants?
Hepatitis C, related to cirrhosis, is the most common reason for liver transplants.
59
HEPATITIS:
Liver transplant: What is one way a liver transplant can occur?
Liver transplant can occur in which a lobe of the liver, usually the right lobe, is removed from the donor and transplanted to the recipient after the recipient's disease liver has been removed.
60
What is a major complication of liver transplant?
Major complication after liver transplant is organ rejection and infection.
61
When does organ rejection present?
Organ rejection typically presents between two to four days postoperatively
62
What are symptoms of organ rejection?
Organ rejection typically presents between two to four days postoperatively and is categorized by fever, upper, right, upper. Quadrant pain, tachycardia, and changes in the bile and jaundice period.
63
What is done to reduce the risk of organ rejection?
To reduce the risk of rejection after the liver transplant, the patient is placed on immunosuppressant medications.
64
Immunosuppressant medications increase the risk of what?
These medications also increase the risk of infection.
65
CIRRHOSIS: Epidemiology
How many deaths in the US annually?
35,000 deaths annually in in U.S.
66
What is the 9th leading cause of death in the US?
CIRRHOSIS
67
What is the leading cause of chronic hepatitis and cirrhosis? What is it followed by?
Hepatitis C is the leading cause of chronic hepatitis and cirrhosis, followed by alcoholic liver disease
68
CIRRHOSIS:
Pathophysiology
Chronic disease that causes cell destruction and fibrosis or scarring of hepatic tissues
69
CIRRHOSIS:
Clinical manifestations
Ascites
Portal hypertension with varices
Hepatic encephalopathy
Coagulopathy
Hepatorenal syndrome (HRS)
Spontaneous bacterial peritonitis
Confusion because of toxin build up
70
CIRRHOSIS:
Management:
Laboratory and diagnostic testing
71
Cirrhosis: What are Diagnostic testing that can be done?
CT scan
Liver biopsy
ERCP
72
ERCP
Used to diagnose and treat the cause of any type of obstruction in the biliary tree
73
Cirrhosis: What is the treatment?
Limiting the person's proteins
Sometimes giving them a lot of diuretics
74
Cirrhosis: What should you encourage the patient to do?
They may be treated for portal hypertension; look out for complications of bleeding. Tell patient to eat small frequent meals, stay away from protein and give them lactulose.
75
Cirrhosis: What kind of medications may be given?
Broad spectrum antibiotics
Lactulose
76
Purpose of lactulose in cirrhosis?
Lactulose causes bowel movements
Lactulose helps remove ammonia that is built up within the circulatory system.
77
Cirrhosis: Because lactulose causes frequent bowel movement, what should be checked?
maybe 3 or 4 times a day, they're going to have very frequent bowel movements.
you have to make sure that you're checking skin integrity.
78
Cirrhosis: Because of increased bleeding, patients are at risk for what? What kind of precautions should be done?
They have an increased risk of bleeding.
you have to be very careful because skin and tend to bruise very easily.
79
LIVER CANCER:
Epidemiology: How does it affect women and men?
15,000 men and 6,000 women diagnosed with primary liver cancer
80
LIVER CANCER: What age is most effected?
Most over the age of 64 years
81
LIVER CANCER:
Epidemiology: How is the incidence rates of liver cancer?
The incidence rates of liver cancer has more than tripled since 1980.
82
LIVER CANCER: What are risk factors?
Risk factors for liver cancer, including alcohol consumption and chronic infections that have to do with both hepatitis B and hepatitis C.
83
LIVER CANCER: Pathophysiology
What is the most prevalent type of primary liver cancer?
Hepatocellular carcinoma is most prevalent type of primary liver cancer
84
LIVER CANCER: Pathophysiology
How does secondary liver cancer metastasize?
Secondary liver cancer often metastasizes from colon
85
Look at notes on slide 10 make no sense to me
86
LIVER CANCER:
Clinical manifestations
Abdominal pain,
weight loss,
anorexia,
weakness,
fatigue,
jaundice, and
ascites
87
LIVER CANCER:
Clinical manifestations: How are symptoms before liver becomes enlarged?
Often asymptomatic until the liver becomes enlarged
88
Liver Cancer: Management
Routine screening
Combination of chemotherapy and radiation
89
Liver Cancer: What is treatment?
Some patients may undergo a combination of chemotherapy and radiation.
90
Liver Cancer: How is radiation and chemo done?
The radiation alone itself is ineffective for slowing down the growth.
Systemic chemotherapy may be used in liver cancer but is generally ineffective.
91
LIVER CANCER: Surgical management of liver cancer.
What are surgical options dependent on?
Surgical options for treatment of cancer are dependent on the degree of normal liver function and whether it is primary or secondary cancer.
92
LIVER CANCER:
Surgical management of liver cancer: What is it used for?
Surgical options for metastatic disease is typically palliative for symptoms of pain relief and distension.
93
Liver cancer: What is the surgical intervention of choice? What kind of qualities do these patients have?
Surgical resection is the treatment of choice for those patients who do not have cirrhosis and are not demonstrating significance physical portal hypertension.
94
LIVER CANCER:
What is a treatment option for patients with small or single primary liver cancer?
Liver transplant may also be an option in patients with small and single primary liver cancer.
95
Liver Trauma:
What is the most vulnerable organ in the abdominal cavity? Why?
Liver is the most vulnerable organ in the abdominal cavity because of its size, vascular structure, and location near ribs
96
Liver Trauma: What is included?
Include lacerations, contusions, hematomas, bile leaks, and bleeding
97
What is the second most vulnerable organ?
spleen
98
Liver Trauma:
Pathophysiology
Because of the vascularity of the liver, any type of trauma increases the risk of hemorrhage
99
Liver Trauma
Clinical manifestations
Patients may complain of RUQ pain
Guarding and rebound tenderness of the abdomen may be observed
100
Liver Trauma: What part of the liver is more susceptible to injury? Why?
The right lobe of the liver is more susceptible to injury than the left because of the proximity of the ribs.
101
Liver Trauma: What is the most common cause of death in patients with liver trauma?
Hemorrhage is the most common cause of death in patients with liver trauma.
102
Liver Trauma: What is the outcome of patients with liver injury dependent on?
The outcome of patients with liver injury is dependent on the mechanism of the injury and the presentation of the patient on admission to the hospital, the patient's age and severity of the injury.
103
Liver Trauma:
Management
Abdominal trauma work-up and an abdominal CT scan
104
Liver Trauma:
Management: How are patients initially treated?
Initially on bed rest, then activity restrictions for up to 6 weeks with no strenuous activity and no contact sports
105
CHOLECYSTITIS: Epidemiology: What is it?
Cholecystitis is inflammation of the gallbladder due to an obstruction of bile flow
106
CHOLECYSTITIS:
How is the incidence of gallstones and cholecystitis?
The incidence of gallstones and cholecystitis increased with age, and gallstones are more common in women than they are in men and more common in individuals of European descent then of people in Africa with African descent.
107
CHOLECYSTITIS: What are the signs and symptoms of this?
One approach in remembering the signs and symptoms associated with gallstones is the five. FFS.
Fair,
Fat
females,
fertile and
over 40 years old.
108
What are risk factors for gallstones?
Risk factors for gallstones include obesity or rapid weight loss., weight loss surgery or eating large amount of foods with saturated fats.
109
What kind of medications can lead to gallstones?
Some medications including cholesterol lowering medications and estrogen.
110
CHOLECYSTITIS:
What do gallstones cause?
Gallstones often cause obstruction of ducts
111
Pathophysiology of Cholecytitis
What are gallstones? How many categories are they grouped in?
Gallstones are hot deposits that form in the gallbladder, and they are generally categorized in three categories.
112
Pathophysiology of Cholecytitis:
What are the three categories of gallstones?
Cholesterol stones
Pigmented
Mixed stones
113
Pathophysiology of Cholecytitis:
Three categories of gallstones:
Cholesterol stones
are the most common.
114
Pathophysiology of Cholecytitis:
Three categories of gallstones: Pigmented
Which are formed from excessive bilirubin
115
Pathophysiology of Cholecytitis:
Three categories of gallstones: Mixed stones?
have which have a combination of both. (cholesterol stones and pigmented)
116
CHOLECYSTITIS:
What do gallstones block?
Patients with multiple stones or a single stone.
It commonly blocks the cystic duct.
117
Clinical manifestations of Cholecystitis:
Pain and tenderness at the right upper quadrant.
Sometimes with rebound tenderness and guarding, tachycardia.
Fever.
None or RUQ pain
118
Clinical manifestations of Cholecystitis: How is the pain usually described?
The pain is described as intermediates and radiates to the back.
119
Clinical manifestations of Cholecystitis: What may patients experience a positive sign of?
Patients may experience a positive Murphy sign.
120
What is a positive Murphy sign test?
To test the presence of Murphy sign, the examiner's fingers are placed on the right upper quadrant of the abdomen, and then the examiner presses gently down while asking the patient to take a deep breath.
The test is positive if the patient has pain on deep inhalation.
121
CHOLECYSTITIS:
What is management of disease?
Diagnostic tests
Use of antibiotics is typically a short course
Several foods contribute to gallstone formation and should be avoided
122
CHOLECYSTITIS:
What is treatment?
Lithotripsy for small gallstones
Preferred method is laparoscopic surgery
123
CHOLECYSTITIS:
What is surgical management of this?
Laparoscopic cholecystectomy
Open cholecystectomy
124
CHOLECYSTITIS:
Medical management of the diagnosis of Cholecystitis: What do nurses need to be aware of?
The nurse needs to be aware of the patient's allergies to Iodine.
125
CHOLECYSTITIS:
What are diagnostic tests?
Diagnostic tests include abdominal X-rays
AC
An ERCP
126
CHOLECYSTITIS:
Diagnostic tests include abdominal X-rays: What are they used for?
Diagnostic tests include abdominal X-rays that are occasionally used to detect calcified gallstones
127
CHOLECYSTITIS:
Diagnostic tests include AC: What does it do?
AC can be used to visualize the entire abdomen and detect the presence of gallstones.
128
CHOLECYSTITIS:
Diagnostic tests include ERCP: What does it do?
An ERCP allows visualization of the common bile ducts where gallstones can be removed.
129
CHOLECYSTITIS:
Diagnostic tests include ERCP: What precautions should be taken for this test?
Patients who undergo an ERCP should not eat or any or drink anything the night before the procedure, but can take cardiac and blood pressure medications in the morning of the examination.
Patients are sedated for their tests and need to have someone to drive them home.
130
CHOLECYSTITIS:
Medications used for Cholecystitis: What needs to be done?
Patient needs to be NPO
IV Hydration.
Correction of electrolytes
Pain management and IV antibiotics as indicated.
131
Medications used for Cholecystitis: What is usually contraindicated for pain management? why?
Morphine is usually contraindicated for pain management because it causes spasms in the sprinter.
