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Hepatic Renal System Flashcards

1
Q

Liver is the largest _______

A

Gland

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2
Q

How many lobes does liver have

A

4

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3
Q

Liver functions

A

Digestion, remove waste form blood

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4
Q

Where is perceived pain for liver

A

R shoulder and mid back

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5
Q

Blood supply for liver 3

A

Hepatic a, portal V, hepatic v’s return to inferior vena cava

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6
Q

What does bile do

A

Increase fat absorption, excretes bilirubin (material from breakdown of RBC)

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7
Q

2 fxns of biliary system

A

-drain bile into sm intestine to aid digestion and breakdown fat
-drain waste into sm intestine

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8
Q

Function of GB

A

Bile production, storage, release in response to fat digestion

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9
Q

What is a gallstone

A

Hard cholesterol plaque buildups

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10
Q

S/s gall stone

A

-abdom pain
-n/v
-jaundice
-cholecystitis
-pancreatitis

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11
Q

Tx for gallstone

A

Lifestyle mod, meds, surgery

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12
Q

What is acute pancreatitis

A

Life threatening (rare)

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13
Q

What is chronic pancreatitis

A

Decreased production and release of insulin

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14
Q

S/s of pancreatitis

A

-pain LUQ, may radiate to L sh and mid back
-n/v
-greasy stools
-tachycardia
-worse SUPINE, better sitting or leaning fwd

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15
Q

Tx for pancreatitis

A

Meds, avoid alcohol, diet, surgery

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16
Q

Red flag for hepatitis

A

Enlarged —> palp under rib cage

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17
Q

How is hepatitis a multi system disease

A

Integ: nail, skin tone, spider v’s, edema

MSK: thoracic, R sh inter scap pain, hone pain, osteop, kyphosis, non specific ankle and wrist pain

Neuro: confusion, tremors, hyper reflexes

GIL n/v, anorexia, abdom feels full

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18
Q

Clinical present of hepatitis (all systems)

A

Neuro: confusion, sleep, hyper reflexes, asterixis, mus tremor

MSK: R sh, thoracic, carpal/tarsal tunnel, osteop, bone pain

Integ: spider angioma, jaundice, Terry’s nail or clubbing, pallor, organ

Hepatic: dark urine, o Liguria, light chalky poo, edema, ascities, RUQ pain

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19
Q

How do you get hep a

A

Fecal-oral transmission - contaminated food/water

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20
Q

Hep a symps

A

-extreme fatigue
-anorexia
-fever
-arthralgia
-RUQ pain
-dark urine
-clay colored poo
-altered smell/taste
-HA

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21
Q

How to prevent hep a

A

Immunization, hand hygiene

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22
Q

How do you get hep b

A

Transmission via blood, body fluids, oral/sexual contact

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23
Q

Symps of hep b

A

-jaundice
-arthralgia
-n/v
-abdominal bloating
-fever, pain
-anorexia
-dark urine

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24
Q

Prevention of hep b

A

Edu, universal precautions, immunizations

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25
How do you get hep c
Same as hep b, transfusion and needle most common
26
Prevention of hep c
Edu and universal precautions (NO immunizations)
27
What is chronic hep? Symps
>6 m’s inflam Asymp RUQ pain Fatigue Arthralgia Jaundice Fever, weak Ascitres Malaise Anorexia Abdominal pain
28
What is non-alcoholic fatty liver disease
>5-10% of wt from fat (steatosis) Silent condition
29
S/s of non-alcoholic fatty liver diseases
-wt loss -fatigue -weakness -decreased appetite -abdominal pain -jaundice -LE edema -ascites -confusion
30
Mgt for non-alcoholic fatty liver
Lifestyle mod, wt loss, diet, ex, decreased saturated fats and alcohol
31
What does poor managed NAFLD lead to
Cirrhosis and liver failure
32
What is the most common cause of cirrhosis? Other risk factors?
Hep c Alcohol abuse, hep b, fatty liver disease
33
Complications of cirrhosis
-edema -ascites -hepatic encephalopathy -liver cancer
34
Management for cirrhosis
-fluid balance -dietary and behavior mods -vit/electrolyte replacement -paracentesis
35
What to monitor in cirrhosis pt
-LE edema -ascites -abnorm blood loss -excessive bruising -avoid valsalva -don’t push to fatigue
36
S/s of cirrhosis
-wt loss/gain -fatigue -fever -jaundice -LE edema -anorexia -decreased urine -dark yellow/amber urine -bowel changes -GI bleed -RUQ pain -n/v Altered mental
37
Complications with progressive cirrhosis
-backflow, increased pressure to esophagus —> esophageal varices -dark eyes is or melena (poo) -spleen enlg -blocked portal v —> portal v HTN -increased risk of liver cancer
38
What is the portal vein formed by
Sup and inf me sent Eric v’s
39
How does portal v HTN affect body
Causes liver damage, obstructs venous BF via liver, affects BF to other structures
40
Common cause for portal v HTN
Causes liver damage, obstructs venous BF via liver, affects BF to other structures
41
S/s of portal V HTN
GI bleed (black ,tarry stools) Vomit/poo blood Ascites Encephalopathy/confusion Decreased blood count Splenomegaly
43
S/s Wilson’s disease
-jaundice -invol movement -tremors -ascites -dysphagia -dysarthria -impaired coordination -asterixis -LE edema -rigidity -PD
44
Most common risk factor for liver cancer
Hep b/c
45
Symps of liver cancer
-unexplained wt loss -pain RUQ, R scap or back -hard lump -mus wk -liver dysfxn >80% replaced with cancer
46
What is hemochromatosis
Rare genetic disorder Most common disorder causing liver failure Excess iron build up stored in liver
47
Symps of hemochromatosis
-mem fog -fatigue -abdom pain -irregular heart beat -palpitations -arthralgia -hair loss -vertigo
48
Population at risk for hemochromatosis
M >40 yo W after menopause
49
If chromatosis untx leads to
-OA and osteop -cirrhosis and cancer -skin: BRONZE -CHF -endocrine: diabetes, hypothyroid
50
What is hepatic encephalopathy
Liver damage can’t filter out toxins, AMMONIA
51
What does hepatic encephalopathy lead to
Altered mental status
52
S/s of AMS
-acute confusion -disorient -poor judgement -slur speech -musty breath -shakiness -personality changes
53
S/s of hepatic encephalopathy
Impaired mental status and NMSK dysfxn -personality change -jaundice -ascites -sleep probs -edema
54
PT implications for hepatic encephalopathy
-AMS: pt difficult follow commands, hx not accurate -asterixis: grade 1-4 -bilateral: metabolic encephalopathy -unilateral: brain pathology
55
When is a liver transplant needed
End stage liver disease
56
SE of immunosuppressant therapy
-diabetes -osteoporosis -HTN -high cholesterol -kidney/GI issue
57
Liver transplant precautions
-primary focus: infect/reject RISK (contact precautions)
58
Liver transplant infection s/s
HA, SOB, n/v Diarrhea Fatigue Sore throat Burning with pee
59
In pt precautions for liver transplant
-lift < 20 lbs 6 wks -abdominal splint for cough -diaphragmatic breathing -log roll -disinfect equipment -OH, AMS, valsalva
60
Immediate referral for hepatic
-new onset myopathy, esp older adults with statins -signs of hepatic disease (especially h/o cancer or hep risk) -unknown cause arthralgia and h/o hep or risk factors -B carpal and tarsal tunnel -neuropathy unknown cause
61
Common causes of kidney disease
Diabetes and HTN
62
What is renal failure
Can’t filter toxins and waste from blood
63
How does kidney disease rate to PT
-strict fluid monitoring -frequent breaks with urge to void -urine output measurement critical for team
64
How much fluid do kidneys filter in a day
150-200 Qts
65
Respiratory acidosis causes
COPD Drug OD Pulmonary edema CHF Obstructive sleep apnea Trauma to chest wall
66
Causes of respiratory alkalosis
-high altitude -anxiety/fear -pregnancy -PE -sepsis -fever -asthma -liver disease -hyperthyroidism
67
Causes of metabolic acidosis
-lactic acidosis -renal failure -sepsis -ketoacidosis (diabetes, starvation, alcoholism, diarrhea)
68
Causes of metabolic alkalosis
-vomiting -diuretics -steroids -excessive ingestion antacids -Cushing syndrome -liver disease (cirrhosis)
69
Metabolic acidosis s/s
-bicarbonate deficit -hyperventilation -stupor -coma -tachycardia -mental dullness -HA -hyperkalemia -arrhythmias
70
Respiratory acidosis s/s
-HA -tremor -visual disturbances -confusion -drowsy -tremor -asterixis -decreased reflex Hyperkalemia
71
Metabolic alkalosis s/s
-tetany -lethargy -hypokalemia -arrhythmia -seizure -confusion -depression respiratory
72
Respiratory alkalosis s/s
-hypocapnia -lightheaded -parenthesis -syncope -convulsions -hypokalemia -cramps -arrhythmia -tetany
73
What is acute renal failure? When common?
Acute function change Post-op, meds, contrast imaging solution
74
Symps of AKI
-asymp -edema -oliguria -Na retain -change mental status -anemia -fatigue
75
Tx for AKI
-fluid mgt -reverse underlying cause -possible dialysis
76
Causes of AKI
-hypoperfusion -obstruction -kidney damage
77
5 types of chronic kidney disease
-glomerulonephritis -PCKD -obstructions -UTI -autoimmune (lupus)
78
S/s of chronic kidney disease
-fatigue -lethargy -HA -poor appetite -sleep probs -ft/ankle edema -dry/itchy skin -nocturia -mus cramps -pulm edema -coma
79
Immediate MD referral for renal system
-bloody pee -back or sh pain and abnorm pee - + murphys percussion
80
Kidney cancer risk factors
-overwt, HTN -misuse pain meds -fam hx
81
S/s kidney cancer
Bloody pee Abdom lump Ongoing lat side pain Loss appetite Wt loss Anemia
82
4 stages of kidney cancer
1. < 7 cm 2. > 7 cm 3. Any size and limb, blood, renal 4. Organs and distal lymph
83
What is intermittent hemodialysis
For chronic conditions with fistula 3-4x/wk, 3-5 hrs each
84
What is peritoneal dialysis
-abdom cavity -can be done at home -can’t be accepted to SNF
85
PT implications with hemodialysis
-pts in hospital too fatigued -decreased intensity, give rest breaks -monitor OH, n/v -monitor signs of peritonitis (fever, distention, tachycardia)
86
Screen clues for renal system
-SLR - w/ BP in kidney referral pattern -BP at kidney lvl -change in body position doesn’t relieve pain -constitutional symps
87
What is pH is low? Range
Acidosis, < 7.35
88
What if pH is high? Range
Alkalosis, > 7.45
89
What if pH and HCO3 is high
Metabolic alkalosis
90
What is pH and HCO3 is both down
Metabolic acidosis
91
What if pH and PaCO2 opposite; pH high
Respiratory alkalosis
92
What is pH and PaCOs opposite; pH low
Respiratory acidosis
93
What is Wilson’s disease
Rare genetic disorder Impaired removal of copper, builds up and affects brain and liver

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