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Module 7 > Hepatic Lecture > Flashcards

Hepatic Lecture Flashcards

1
Q

Functions of the liver “People Drink So Much”

A

Produces clotting factors , proteins and bile
Detox- remove byproducts of medication and remove bacteria from the blood
Storage- glycogen , vitamins and minerals
Metabolizes - nutrients from food

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2
Q

What protein does the liver specifically produce?

A

Albumin

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3
Q

Glycogen

A

Sugar that is released in an emergency for energy
Impacted during acute liver failure or chronic liver failure

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4
Q

What is impaired when it comes to the improper storage of vitamins , and minerals

A

Wound healing and overall nutrition

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5
Q

Why is beer belly a thing?

A

Improper storage or the liver not correctly storing

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6
Q

What is a pt no able to process correctly?

A

Fats, carbs, and proteins

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7
Q

Acute liver failure

A

Less than 6 months in time

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8
Q

Chronic liver failure

A

Greater than 6 months in time

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9
Q

Common cause of acute liver failure

A

Tylenol over dose

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10
Q

Antidote for tylenol

A

Mucomyst ( acetylcysteine)

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11
Q

Viruses that causes acute liver failure

A

Hepatitis a,b and c

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12
Q

Drugs that cause acute liver failure

A

Acetaminophen overdose
Tuberculosis medications

Coupled with alcohol use

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13
Q

Genetic disease that causes acute liver failure

A

Wilsons disease

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14
Q

Ingestion of what poisonous substance causes acute liver failure

A

Mushrooms

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15
Q

Treatment of HE

A

Mannitol
Lactulose
Rifaximin therapy

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16
Q

Manitol

A

Comes in a glass bottle and needs a special filter
Diuretic that passes the blood brain barrier
White color and stains the scrubs
Short lived

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17
Q

Lactulose

A

Given in treatment of hepatic encephalopathy to decrease ammonia 3-5 stools a day is the goal for pt

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18
Q

Rifaximin therapy

A

Decreases ammonia production by eliminating bacteria in the intestines
This will also help to get pressure off the brain

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19
Q

What does your body make every day

A

Good n bad cells ( that can turn into cancer cells)

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20
Q

Correlation with cancer pt

A

Vitamin d deficiency

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21
Q

Cirrhosis

A

Black rocks, liver has necrotic and is dead in some parts

No blood flow in those areas causing high bp (portal hypertension)

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22
Q

What is the goal once we get cirrhosis

A

To prevent it from happening again or spreading

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23
Q

What should we teach the pt if their liver starts cirrhosis it

A

Honest about the degree of damage.. do you want to live 5 yrs or 20 yrs

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24
Q

Number 1 drug that causes acute liver failure

A

Acetaminophen

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25
Q

Since a liver failure pt can’t have Tylenol any more what do they opt for and what do we teach?

A

Ibuprofen

It’s bad for kidneys , watch for bleeding in your stomach .. so give it with something that coats the stomach like milk or eat with it

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26
Q

When someone comes in with acute liver failure what is the first thing we want to rule out

A

Tylenol overdose

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27
Q

Antidote for Tylenol

A

Mucomyst… acetylcysteine

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28
Q

Viruses that cause acute liver failure

A

Hep a , b , c

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29
Q

Drug use coupled with which meds cause acute liver failure

A

Acetaminophen OD
And
Tuberculosis meds

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30
Q

Genetic diseases that cause acute liver failure

A

Wilsons disease due to excess copper in the Iris
Targets the brain and the liver causing a brown ring around the irises

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31
Q

How many hours in between ibuprofen

A

Q6

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32
Q

Early signs of liver failure

A

Jaundice
Bruising
Poor apetite
Nausea
Change in mentation

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33
Q

First thing we do when someone comes in with signs of acute liver failure

A

Get a neuro status due to altered LOC so we can know the baseline of how altered they are

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34
Q

Priority when someone comes in with early signs of acute liver failure

A

Fluid and electrolytes
GI bleed
Risk of infection

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35
Q

If pt has a 1000 ml in abdomen and we take it out … what is the patient at risk for?

A

Fluid and electrolyte imbalance.. hypovolemia

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36
Q

Why dont we ever want more than 100 mL at a time when removing fluid from the abdomen

A

It will affect the hemodynamics

But when we first put it in we will expect a huge amount due to so much fluid in the belly so we watch for fluid and electrolyte imbalance

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37
Q

Paracentesis acute care

A

Pt void immediately before
Monitor for hypovolemia and electrolyte imbalance
Monitor BP and HR
Monitor dressing for bleeding/leakage

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38
Q

How do you know the bladder got punctured during a paracentesis?

A

Hematuria and abdominal pain

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39
Q

Complications of paracentesis

A

Hypovolemic shock and electrolyte imbalance
Punctured bladder

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40
Q

Signs of hypovolemic shock after paracentesis

A

Decrease in urine output and Tachy cardia (<30 mL/hr)
Decrease BP

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41
Q

What kind of procedure is a paracentesis

A

Sterile

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42
Q

If a pt coded before during a paracentesis what happens if they need another one

A

Not done at bed side but in the OR

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43
Q

Why is the skin itchy during liver failure

A

Due to the excess billiruben but it is not our primary concern

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44
Q

Leukopenia

A

WBC- our army in an infection
Typically 5,000-10,000
In liver failure (low WBC)

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45
Q

Normal hemoglobin

A

12-18

Less than 7 transfuse

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46
Q

For anemia in liver failure.. what labs do we monitor

A

H&h
Hemoglobin

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47
Q

Asterixis

A

Palm of hand twitching

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48
Q

Dyspepsia

A

Indigestion

49
Q

Fetor hepaticus

A

Strong musky breath

50
Q

Capital Medusa

A

On abdomen , head of Medusa
In major ascites vein ruptures

51
Q

Why would we see a decrease in protein in someone with liver failure (hypoalmuniemia)

A

Not eating because. It alters their drunken state
And the liver is not making albumin

52
Q

Normal ammonia

A

10-80 mcg/dL

Not concerned about 85. But if it is at 200 it is major concern

53
Q

When is platelet count a medical emergency

A

Patients under 20,000

54
Q

Priority care for pt with cirrhosis and varicese

A

Prevention of hemorrhage

55
Q

AST tells us

A

Goes up If the liver is diseased or damaged it is released into the blood stream and the amount correlates to the degree of tissue damage

56
Q

ALT

A

Measures how damage and diseased the liver is

57
Q

You have a pt with low albumin , low wbc , and low platelet..what do you treat first?

A

Platelets - so you dont bleed out

58
Q

You have a pt with low albumin and low glucose .. what do you treat first?

A

Glucose- if you get to 0 you’re dead and no glycogen source

59
Q

If you had a low WBC and low potassium what do you fix first

A

Potassium.. causes heart issues

60
Q

Why does the spleen enlarge in liver failure

A

It stores platelets

61
Q

Alkaline phosphate

A

Increases in cirrhosis but may be lower in liver failure

Tends to be lower or normal in acute liver failure but high in chronic liver failure

62
Q

Ultra sound

A

Tells us yes we have cirrhosis

63
Q

Fibrous can

A

Tells us how much cirrhosis we have
It measures fibrosis , scarring and stiatosis ( fatty changes in liver)

64
Q

Upper endoscopy

A

Upper GI inside the esophagus (sedated)

65
Q

Definitive diagnosis of cirrhosis of the liver

A

Liver biopsy and tells us liver changes

66
Q

Risk of liver biopsy

A

Very high risk of bleeding.. due to clotting factors and taking a chunk of liver

Also at increase risk of infection at the site
And risk for peritonitis

67
Q

S/s of hemorrhage with liver biopsy

A

Diaphoretic , bleeding at the site , increase hr and decrease BP

68
Q

Antidotes for Tylenol OD

A

Activated charcoal
N-acetylcysteine

69
Q

What is benzodiazepines used for

A

Alcohol with draw
Such as lorazepam and midazolam

Also prescribed beer
Can also use versed or Ativan

70
Q

What should you do before administering benzodiazepines

A

Assess neuro status and have baseline

GCS before **

71
Q

Antidote for benzodiazepine OD

A

Flumazenil

72
Q

Anesthetic agent for liver failure

A

Propofol
Used for sedation
Used to ventilate and procedure but assess neuro state first and also secure an airway

73
Q

Transfusion included

A

Albumin , platelets , FFP and or whole blood

74
Q

Portal hypertension

A

Elevated pressure in the Venus system
If the Venus pressure is more than 5 mmHg than the inferior vena cava pressure than that what it is

75
Q

Hepatorenal syndrome

A

Kidneys fail because your liver does

76
Q

What does portal hypertension cause with cirrhosis

A

Esophageal and or gastric varices
Splenomegaly
Ascities

77
Q

Varices

A

Most lie threatening complication of cirrhosis and medical emergency

78
Q

Sandostatin

A

Vasoconstrictor used to stop bleeding for varices

79
Q

In varices what is a beta blocker used for

A

To prevent bleeding

80
Q

When someone comes in bleeding from varices

A

Air way
2 large bore IV
Fluids and blood products
Vasopresser
Endoscopy therapy

81
Q

If a pt has a sudden drop of o2 and increase RR with a Sengstaken -Blake more tube.. what is our priority

A

Confirm airway and if it is obstructed we will deflate the balloon and remove the tube
Once it is out we apply o2

82
Q

What should be at the bed side when someone has a Sengstaken -Blake more tube

A

Scissors

83
Q

Long term measures

A

Change your diet and what can we do?
Encourage to stop drinking or decrease the concentration of alcohol ..make a treatment plan for the patient ..use resources , printouts and support groups

84
Q

Balloon tamponade therapy

A

Treatment for varices
Buys us time for the OR

85
Q

Portacaval shunt

A

For portal hypertension and makes a connection between the portal vein .. the portal vein takes 75% of the blood from the liver to the superior vena cava
Helps with another gate way
Treatment for varices

86
Q

Tips procedure

A

It is a trans jugular intrahepatic portal system shunt .. it connects a vein that brings blood from the GI tract to the intraabdominal organs to the liver .. so if they are not getting blood flow to their liver becuase they have so much cirrhosis the tips procedure helps get blood there and it will also take the blood from the liver up to the superior vena cava

Only do this if blood was blocked in the liver due to cirrhosis

87
Q

Stage 1 of hepatic encephalopathy

A

Milk lack of awareness
Shortened attention span
Impaired addition or subtraction
Milk asterixis or tremor

88
Q

2nd stage of hepatic encephalopathy

A

Lethargic
Disoriented, inappropiate behavior
Obvious asterixis , slurred speech

89
Q

Lactulose

A

Given in treatment of increase ammonia for hepatic encephalopathy.

Must have 3-5 stools a day

90
Q

Manitol

A

Only diuretic that crosses the blood brain barrier
Treatment of HE

91
Q

If a pt comes in alert and oriented x2 what should we not do

A

Give a sedative or xanax

92
Q

How often to do neuro assessments

A

Every hour , every 15 minutes if something happens
Every 2 hours if pt is more stable

93
Q

What skin care can we teach pt with hepatic failure

A

Don’t itch , can slap or wear mittens, cut nails , no hot showers , moisterisze , leukewarm bath

94
Q

Nutritional therapy for liver failure

A

3,000 cal a day
Protien supplement (careful)
Low NA - if ascites and edema
Increase carb
Moderate to low fat
Total tpn (adek)
Consult dietician

95
Q

What is important to be cautious about when a pt with liver failure is taking a protien supplement

A

It is a bi product of ammonia

96
Q

A pt with hepatic failure and is taking feurosimide .. what do we teach them

A

Daily weights

97
Q

Why do we give a new born a vit k shot?

A

Starts clotting cascades because they are born with an immature liver
Which is why babies are yellow (jaundice) under UV light

98
Q

If a person is undergoing liver failure what should we avoid?

A

Hepatotoxic drugs

99
Q

Vitamin D

A

Valuable for immune health
20 minutes outside to get
Or supplement it.
Someone with liver failure .. they do not have good immune health

100
Q

Since we have inssues in metabolizing in liver failure what does this do to our body

A

We will end up having a build of ammonia
And increase risk of infection

101
Q

IB profin issues

A

Causes kidney issues
And
Watch for bleeding in the stomach
So encourage to take something that coats the stomach

102
Q

If a pt presents in the ER with s/s of acute liver failure.. what is our priority ?

A

Neuro status
Fluid and electrolyte
GI bleed
Infection

103
Q

What brings someone in the ED with flicker failure

A

Change in LOC

104
Q

Ascites treatment

A

Diuretics to get fluid off
Paracentesis

105
Q

Most important concern in a paracentesis

A

Fluid and electrolyte imbalance
And hypovolemia

106
Q

Aldosterone

A

Causes you to hold on to things such as sodium , water but decrease potassium

107
Q

Low platelets put us at risk for

A

Bleeding
DIC
Infection

108
Q

Cirrhosis with no complication

A

Compensated

109
Q

Cirrhosis with complication

A

Decompensated

110
Q

Goal if someone comes in with ruptured esophageal varices

A

Stop the bleeding first and then replace the fluid

111
Q

Scleratherapy

A

Trying to preserve you until we can get you stable
Like a volcano so one more shot off strong alcohol can rip the top off and causes bleeding again
Treatment for varices

112
Q

If a pt with liver failure and history of cirrhosis and has bright red bleeding .. what is our first thought

A

Varices

And nausea is not our priority

113
Q

Goal of procedures to treat varices

A

Increase blood flow
And get blood flow from the liver and back to the corazon

114
Q

Why is infection important to catch in HE

A

Because their immune health is poor
Low WBC

115
Q

Priority in HE

A

Risk for bleeding, fluid and electrolytes and risk of infection

116
Q

Other things we see in 1st stage of HE

A

Mild mentation , can’t focus, distracted easily , impaired hand writing

117
Q

Other things seen in 2nd stage of HE

A

Mentation issues LOC will start to change and will be disoriented.. not going to be alert and oriented x3
May see clonus
( muscle contractions in ankles )

118
Q

How often neuro assessment should be done for someone with hepatic encephalopathy

A

Every hour

Module 7 (24 decks)

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