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
2
Q
What protein does the liver specifically produce?
A
Albumin
3
Q
Glycogen
A
Sugar that is released in an emergency for energy
Impacted during acute liver failure or chronic liver failure
4
Q
What is impaired when it comes to the improper storage of vitamins , and minerals
A
Wound healing and overall nutrition
5
Q
Why is beer belly a thing?
A
Improper storage or the liver not correctly storing
6
Q
What is a pt no able to process correctly?
A
Fats, carbs, and proteins
7
Q
Acute liver failure
A
Less than 6 months in time
8
Q
Chronic liver failure
A
Greater than 6 months in time
9
Q
Common cause of acute liver failure
A
Tylenol over dose
10
Q
Antidote for tylenol
A
Mucomyst ( acetylcysteine)
11
Q
Viruses that causes acute liver failure
A
Hepatitis a,b and c
12
Q
Drugs that cause acute liver failure
A
Acetaminophen overdose
Tuberculosis medications
Coupled with alcohol use
13
Q
Genetic disease that causes acute liver failure
A
Wilsons disease
14
Q
Ingestion of what poisonous substance causes acute liver failure
A
Mushrooms
15
Q
Treatment of HE
A
Mannitol
Lactulose
Rifaximin therapy
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
17
Q
Lactulose
A
Given in treatment of hepatic encephalopathy to decrease ammonia 3-5 stools a day is the goal for pt
18
Q
Rifaximin therapy
A
Decreases ammonia production by eliminating bacteria in the intestines
This will also help to get pressure off the brain
19
Q
What does your body make every day
A
Good n bad cells ( that can turn into cancer cells)
20
Q
Correlation with cancer pt
A
Vitamin d deficiency
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)
22
Q
What is the goal once we get cirrhosis
A
To prevent it from happening again or spreading
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
24
Q
Number 1 drug that causes acute liver failure
A
Acetaminophen
25
Since a liver failure pt can’t have Tylenol any more what do they opt for and what do we teach?
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
26
When someone comes in with acute liver failure what is the first thing we want to rule out
Tylenol overdose
27
Antidote for Tylenol
Mucomyst… acetylcysteine
28
Viruses that cause acute liver failure
Hep a , b , c
29
Drug use coupled with which meds cause acute liver failure
Acetaminophen OD
And
Tuberculosis meds
30
Genetic diseases that cause acute liver failure
Wilsons disease due to excess copper in the Iris
Targets the brain and the liver causing a brown ring around the irises
31
How many hours in between ibuprofen
Q6
32
Early signs of liver failure
Jaundice
Bruising
Poor apetite
Nausea
Change in mentation
33
First thing we do when someone comes in with signs of acute liver failure
Get a neuro status due to altered LOC so we can know the baseline of how altered they are
34
Priority when someone comes in with early signs of acute liver failure
Fluid and electrolytes
GI bleed
Risk of infection
35
If pt has a 1000 ml in abdomen and we take it out … what is the patient at risk for?
Fluid and electrolyte imbalance.. hypovolemia
36
Why dont we ever want more than 100 mL at a time when removing fluid from the abdomen
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
37
Paracentesis acute care
Pt void immediately before
Monitor for hypovolemia and electrolyte imbalance
Monitor BP and HR
Monitor dressing for bleeding/leakage
38
How do you know the bladder got punctured during a paracentesis?
Hematuria and abdominal pain
39
Complications of paracentesis
Hypovolemic shock and electrolyte imbalance
Punctured bladder
40
Signs of hypovolemic shock after paracentesis
Decrease in urine output and Tachy cardia (<30 mL/hr)
Decrease BP
41
What kind of procedure is a paracentesis
Sterile
42
If a pt coded before during a paracentesis what happens if they need another one
Not done at bed side but in the OR
43
Why is the skin itchy during liver failure
Due to the excess billiruben but it is not our primary concern
44
Leukopenia
WBC- our army in an infection
Typically 5,000-10,000
In liver failure (low WBC)
45
Normal hemoglobin
12-18
Less than 7 transfuse
46
For anemia in liver failure.. what labs do we monitor
H&h
Hemoglobin
47
Asterixis
Palm of hand twitching
48
Dyspepsia
Indigestion
49
Fetor hepaticus
Strong musky breath
50
Capital Medusa
On abdomen , head of Medusa
In major ascites vein ruptures
51
Why would we see a decrease in protein in someone with liver failure (hypoalmuniemia)
Not eating because. It alters their drunken state
And the liver is not making albumin
52
Normal ammonia
10-80 mcg/dL
Not concerned about 85. But if it is at 200 it is major concern
53
When is platelet count a medical emergency
Patients under 20,000
54
Priority care for pt with cirrhosis and varicese
Prevention of hemorrhage
55
AST tells us
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
ALT
Measures how damage and diseased the liver is
57
You have a pt with low albumin , low wbc , and low platelet..what do you treat first?
Platelets - so you dont bleed out
58
You have a pt with low albumin and low glucose .. what do you treat first?
Glucose- if you get to 0 you’re dead and no glycogen source
59
If you had a low WBC and low potassium what do you fix first
Potassium.. causes heart issues
60
Why does the spleen enlarge in liver failure
It stores platelets
61
Alkaline phosphate
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
Ultra sound
Tells us yes we have cirrhosis
63
Fibrous can
Tells us how much cirrhosis we have
It measures fibrosis , scarring and stiatosis ( fatty changes in liver)
64
Upper endoscopy
Upper GI inside the esophagus (sedated)
65
Definitive diagnosis of cirrhosis of the liver
Liver biopsy and tells us liver changes
66
Risk of liver biopsy
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
S/s of hemorrhage with liver biopsy
Diaphoretic , bleeding at the site , increase hr and decrease BP
68
Antidotes for Tylenol OD
Activated charcoal
N-acetylcysteine
69
What is benzodiazepines used for
Alcohol with draw
Such as lorazepam and midazolam
Also prescribed beer
Can also use versed or Ativan
70
What should you do before administering benzodiazepines
Assess neuro status and have baseline
GCS before **
71
Antidote for benzodiazepine OD
Flumazenil
72
Anesthetic agent for liver failure
Propofol
Used for sedation
Used to ventilate and procedure but assess neuro state first and also secure an airway
73
Transfusion included
Albumin , platelets , FFP and or whole blood
74
Portal hypertension
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
Hepatorenal syndrome
Kidneys fail because your liver does
76
What does portal hypertension cause with cirrhosis
Esophageal and or gastric varices
Splenomegaly
Ascities
77
Varices
Most lie threatening complication of cirrhosis and medical emergency
78
Sandostatin
Vasoconstrictor used to stop bleeding for varices
79
In varices what is a beta blocker used for
To prevent bleeding
80
When someone comes in bleeding from varices
Air way
2 large bore IV
Fluids and blood products
Vasopresser
Endoscopy therapy
81
If a pt has a sudden drop of o2 and increase RR with a Sengstaken -Blake more tube.. what is our priority
Confirm airway and if it is obstructed we will deflate the balloon and remove the tube
Once it is out we apply o2
82
What should be at the bed side when someone has a Sengstaken -Blake more tube
Scissors
83
Long term measures
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
Balloon tamponade therapy
Treatment for varices
Buys us time for the OR
85
Portacaval shunt
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
Tips procedure
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
Stage 1 of hepatic encephalopathy
Milk lack of awareness
Shortened attention span
Impaired addition or subtraction
Milk asterixis or tremor
88
2nd stage of hepatic encephalopathy
Lethargic
Disoriented, inappropiate behavior
Obvious asterixis , slurred speech
89
Lactulose
Given in treatment of increase ammonia for hepatic encephalopathy.
Must have 3-5 stools a day
90
Manitol
Only diuretic that crosses the blood brain barrier
Treatment of HE
91
If a pt comes in alert and oriented x2 what should we not do
Give a sedative or xanax
92
How often to do neuro assessments
Every hour , every 15 minutes if something happens
Every 2 hours if pt is more stable
93
What skin care can we teach pt with hepatic failure
Don’t itch , can slap or wear mittens, cut nails , no hot showers , moisterisze , leukewarm bath
94
Nutritional therapy for liver failure
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
What is important to be cautious about when a pt with liver failure is taking a protien supplement
It is a bi product of ammonia
96
A pt with hepatic failure and is taking feurosimide .. what do we teach them
Daily weights
97
Why do we give a new born a vit k shot?
Starts clotting cascades because they are born with an immature liver
Which is why babies are yellow (jaundice) under UV light
98
If a person is undergoing liver failure what should we avoid?
Hepatotoxic drugs
99
Vitamin D
Valuable for immune health
20 minutes outside to get
Or supplement it.
Someone with liver failure .. they do not have good immune health
100
Since we have inssues in metabolizing in liver failure what does this do to our body
We will end up having a build of ammonia
And increase risk of infection
101
IB profin issues
Causes kidney issues
And
Watch for bleeding in the stomach
So encourage to take something that coats the stomach
102
If a pt presents in the ER with s/s of acute liver failure.. what is our priority ?
Neuro status
Fluid and electrolyte
GI bleed
Infection
103
What brings someone in the ED with flicker failure
Change in LOC
104
Ascites treatment
Diuretics to get fluid off
Paracentesis
105
Most important concern in a paracentesis
Fluid and electrolyte imbalance
And hypovolemia
106
Aldosterone
Causes you to hold on to things such as sodium , water but decrease potassium
107
Low platelets put us at risk for
Bleeding
DIC
Infection
108
Cirrhosis with no complication
Compensated
109
Cirrhosis with complication
Decompensated
110
Goal if someone comes in with ruptured esophageal varices
Stop the bleeding first and then replace the fluid
111
Scleratherapy
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
If a pt with liver failure and history of cirrhosis and has bright red bleeding .. what is our first thought
Varices
And nausea is not our priority
113
Goal of procedures to treat varices
Increase blood flow
And get blood flow from the liver and back to the corazon
114
Why is infection important to catch in HE
Because their immune health is poor
Low WBC
115
Priority in HE
Risk for bleeding, fluid and electrolytes and risk of infection
116
Other things we see in 1st stage of HE
Mild mentation , can’t focus, distracted easily , impaired hand writing
117
Other things seen in 2nd stage of HE
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
How often neuro assessment should be done for someone with hepatic encephalopathy
Every hour
