Hepatic System Flashcards
1
Q
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
= ?
Hepatic System
A
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
2
Q
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
= ?
Hepatic System
A
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
3
Q
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
= ?
Hepatic System
A
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
4
Q
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
= ?
Hepatic System
A
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
5
Q
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
= ?
Hepatic System
A
(a) Healthy
(b) Fatty
(c) Fibrosis
(d) Cirrhosis
(e) Cancer
6
Q
Reddish brown organ, 4 lobes, receives 25% of resting cardiac output= ?
Hepatic System
A
Liver:
- Reddish brown organ with 4 lobes
- Receives 25% of resting cardiac output
- Posteriorly, liver is located between T9-L1 at the midline
- Gallbladder primarily stores bile , Base of gallbladder at the tip of the 9th costal margin
7
Q
Posteriorly, liver is located between = ?
Hepatic System
A
- Posteriorly, liver is located between T9-L1 at the midline.
8
Q
Gallbladder primarily stores = ?
Hepatic System
A
- Gallbladder primarily stores bile.
Bile
- Greenish yellow secretion that is produced in the liver and passed to the gallbladder for concentration, storage, or transport into the first region of the small intestine, the duodenum.
Function
- Aid in the digestion of fats in the duodenum.
9
Q
Base of gallbladder at the tip of = ?
Hepatic System
A
Base of gallbladder at the tip of the 9th costal margin.
10
Q
Arterial blood to the liver = ?
Hepatic System
A
Arterial blood to the liver=
(a) Hepatic Artery:
- Branch of celiac artery
11
Q
Carries partially deoxygenated blood from GI, spleen and associated organs to liver = ?
Hepatic System
A
Portal vein:
- Carries partially deoxygenated blood from GI, spleen and associated organs to liver.
12
Q
Functions of the liver include = ?
Hepatic System
A
Liver Functions:
- Metabolism: Carbohydrates, fats, and protein.
- Secretory: Bile acids, bile salts, and pigments.
- Excretory: Bilirubin, drugs, toxins
- Synthesis: Albumin, coagulation factors
- Storage: Vitamins, carbohydrates, etc.
- Detoxification: Toxins, ammonia, etc.
13
Q
Bilirubin is produced in = ?
Hepatic System
A
Bilirubin:
- Produced in bone marrow and also in the liver as end product of hemoglobin breakdown.
- Gives feces and urine it’s characteristic color.
- Normal levels: less than 1.5 mg/dl
14
Q
Bile is
- Required for = ?
- Contains = ?
Hepatic System
A
Bile:
- Required for digestion of dietary fats and absorption of fats and fat-soluble vitamins from the intestine.
- Bile contains bile salts, water, bilirubin.
15
Q
The liver produces how much bile daily= ?
Hepatic System
A
Liver produces 500-600 ml of bile daily.
16
Q
Jaundice:
- What is it = ?
- Two signs & symptoms = ?
- Etiology = ?
Hepatic System
A
Jaundice:
- Abnormal high amounts of bilirubin in the blood.
- Bilirubin levels 2-3 mg/dl: Sclera of eye as yellow.
- Bilirubin levels 5-6 mg/dl: changes in skin color
Etiology:
- Imbalance between synthesis and clearance of bilirubin.
- Excessive destruction of erythrocytes.
- Excessive production of bilirubin.
- Obstruction of bile flow
17
Q
Three examples of skin changes associated with Jaundice = ?
Hepatic System
A
Skin Changes:
- Jaundice, pallor, and orange or green skin in Caucasians.
- Bruising/ itching
- Spider angiomas: Dilatations of superficial capillaries, increased estrogen levels (liver unable to metabolize and inactivate estrogen).
- Palmar erythema: Warm redness of skin over palms, due to increased estrogen level, and associated with throbbing and tingling.
18
Q
Pain Patterns:
Referred Pain Location:
- Thoracic spine, T7-T10, midline to the right
- Right upper trapezius and shoulder
Systemic Cause= ?
Hepatic System
A
Referred Pain Location:
- Thoracic spine, T7-T10, midline to the right
- Right upper trapezius and shoulder
Systemic cause:
- Liver disease (abscess, tumor, cirrhosis, hepatitis).
Primary pain: Right upper quadrant abdominal pain.
19
Q
Referred Pain Location:
- Right upper trapezius and shoulder
- Right interscapular area(T4 or T5-T8)
- Right subscapular area
Systemic Cause= ?
Hepatic System
A
Referred Pain Location:
- Right upper trapezius and shoulder
- Right interscapular area(T4 or T5-T8)
- Right subscapular area
Systemic Cause:
- Gallbladder
Primary pain: Right upper quadrant abdominal pain.
20
Q
Hepatic osteodystrophy = ?
A
Hepatic Osteodystrophy: Hepatic osteodystrophy(HO) is the generic term defining the group of alterations in bone mineral metabolism:
- Osteomalacia
- Osteoporosis
- Vertebral wedging
- Vertebral crush fractures
- Kyphosis
21
Q
- Altered CNS function
- Alterted metabolism
- Confusion
- Tremors
- Asterixis
These are examples of = ?
Hepatic System
A
Neurologic signs and symptomsassociated with liver disfunction:
- Altered CNS function
- Alterted metabolism
- Confusion
- Tremors
- Asterixis: Flapping tremor/ liver flap
22
Q
Connection between liver disfunction and edema = ?
Hepatic System
A
Edema due to decreased serum albumin levels.
Bile converted from bilirubin causes brown coloration of stool
Light clay colored stool
Urine color of tea or cola (dark colored urine)
23
Q
When bile is converted from bilirubin, what can happen to stool = ?
Hepatic System
A
Bile converted from bilirubin causes brown coloration of stool.
- Light clay colored stool
- Urine color of tea or cola (dark colored urine).
24
Q
Chronic progressive inflammation of the liver due to reduced blood flow = ?
Hepatic System
A
Cirrhosis:
- Chronic progressive inflammation of the liver.
- Represents end stage chronic liver disease.
- Reduced blood flow to liver = death of hepatocytes.
- The progressive loss of normal tissue leads to liver tissue being replaced with fibrous and nodular regeneration.
- 12th leading cause of death
Most common causes in US:
- Alcohol abuse
- Hepatitis C
- Toxic reactions to drug
25
Clinical manifestations of liver disfunction include = **?**
## Footnote
*Hepatic System*
Clinical Manifestations of Liver Disfunction:
* Hepatomegaly (enlargement of liver) to liver failure.
* Weight loss
* Weakness
* Anorexia
* Jaundice
* **Pain**: Epigastric area or in upper right quadrant, described as dull, aching causing sensation of fullness.
* Fatigue with mild exertion
* **Impaired coagulation**: nose bleeds, easy bruising, bleeding gums.
* **Portal hypertension**: Elevated pressure in portal veins;
* + **Splenomegaly**: Enlargement of the spleen.
* + **Esophageal Varices**: Dilated veins of the lower esophagus, concern is rupture, hemorrhage, and death.
* **Hepatic Encephalopathy**: Increased levels of ammonia.
* + **Hepatic Coma**: Difficulty ambulating, and is unsteady, protection from falling, memory loss, irritability
26
Abnormal accumulation of fluid consisting of large amount to protein and electrolytes in the peritoneal cavity as a result of portal back up = **?**
## Footnote
*Hepatic System*
**Ascites**:
* Abnormal accumulation of fluid consisting of large amount to protein and electrolytes in the peritoneal cavity as a result of portal back up.
* Common symptom associated with **cirrhosis**.
* Can also be caused due to malnutrition, heart failure, infection, malignancy.
* Positioning: Semi fowler is most comfortable = ?
* Breathing techniques = ?
* Pressure relief, shoes unlaced, fluid restriction = ?
27
Ascites presents as = **?**
## Footnote
*Hepatic System*
**Ascites presents as**:
* Distended abdomen
* Protruding, displaced umbilicus
* Bilateral edema of feet and ankle
* Pain in groin and low back
**Ascites**:
* Abnormal accumulation of fluid consisting of large amount to protein and electrolytes in the peritoneal cavity as a result of portal back up.
28
Liver enzymes to know = **?**
## Footnote
*Hepatic System*
Liver enzymes:
* Alanine aminotransferase (ALT)
* Aspartate aminotransferase (AST)
* Serum bilirubin
* Serum albumin
* Gamma-glutamyltransferase (GGT)
29
Liver enzymes:
* Alanine aminotransferase (ALT) = **?**
* Aspartate aminotransferase (AST) = **?**
* Serum bilirubin = **?**
* Serum albumin = **?**
* Alkaline phosphatase (ALP) = **?**
* Gamma-glutamyltransferase (GGT) = **?**
## Footnote
*Hepatic System*
Liver enzymes:
(1) **Alanine aminotransferase** (ALT):
* High
* More specific indicator of liver dysfunction as it is found predominantly in liver and lesser quantities in kidneys, heart, skeletal muscles.
(2) **Aspartate aminotransferase** (AST):
* High
(3) **Serum bilirubin**:
* High
(4) **Serum albumin**:
* Low
* CT / ultrasonography (lesion, tumor, soft tissue)
(5) **Alkaline phosphatase** (ALP):
* High
* Found in other tissues like bone
(6) **Gamma-glutamyltransferase** (GGT):
* High levels in the blood may be a sign of liver disease or damage to the bile ducts.
(7) **Alanine aminotransferase** (ALT):
30
Hepatitis = **?**
## Footnote
*Hepatic System*
**Hepatitis**:
* Acute/chronic inflammation of liver caused by virus, chemical, drug reaction or alcohol abuse.
31
Hepatitis risk factors include = **?**
## Footnote
*Hepatic System*
**Hepatitis Risk factors**:
* Injection drug users
* Acupuncture
* Tattoo inscription/ removal
* Ear and body piercing
* Recent operative procedure
* Hemodialysis (if sterilization issue)
* Health care worker exposed to blood products/ body fluids
* Exposure to certain chemicals/ medications
* Unprotected homosexual/ bisexual activity
* Travel to high-risk areas
* Consumption of raw shellfish
32
Hepatitis A
* Transmission = **?**
* Incubation = **?**
* Carrier State = **?**
* Chronic = **?**
* Vaccine = **?**
* Diagnosis = **?**
## Footnote
*Hepatic System*
**Hepatitis A**:
(**a**) Transmission:
* Fecal - oral froom another infected person; contaminated food and water supplies.
(**b**) Incubation:
* 1-2 months
(**c**) Carrier State:
* No
(**d**) Chronic:
* No
(**e**) Vaccine:
* Yes
(**f**) Diagnosis:
* Blood detection
33
Hepatitis B
* Transmission = **?**
* Incubation = **?**
* Carrier State = **?**
* Chronic = **?**
* Vaccine = **?**
* Diagnosis = **?**
## Footnote
*Hepatic System*
**Hepatitis B**:
(**a**) Transmission:
* Contact with infected blood and body fluids; infected mother to fetus.
(**b**) Incubation:
* 1-2 months
(**c**) Carrier State:
* Yes
(**d**) Chronic:
* Yes
(**e**) Vaccine:
* Yes
(**f**) Diagnosis:
* Blood detection of HBsAg
34
Hepatitis C
* Transmission = **?**
* Incubation = **?**
* Carrier State = **?**
* Chronic = **?**
* Vaccine = **?**
* Diagnosis = **?**
## Footnote
*Hepatic System*
**Hepatitis C**:
(**a**) Transmission:
* Contact with infected blood
(**b**) Incubation:
* 2-3 months
(**c**) Carrier State:
* Yes
(**d**) Chronic:
* Yes
(**e**) Vaccine:
* No
(**f**) Diagnosis:
* Blood detection of anti-HCV
35
Hepatitis D
* Transmission = **?**
* Incubation = **?**
* Carrier State = **?**
* Chronic = **?**
* Vaccine = **?**
* Diagnosis = **?**
## Footnote
*Hepatic System*
**Hepatitis D**:
(**a**) Transmission:
* Contact with infected blood and body fluids; infected blood and body fluids; infected mother to fetus; MUST have HBaAg to be infected with hepatitis D.
(**b**) Incubation:
* 2-3 months
(**c**) Carrier State:
* Yes
(**d**) Chronic:
* Yes
(**e**) Vaccine:
* No
(**f**) Diagnosis:
* Blood detection of anti-HDV
36
Hepatitis E
* Transmission = **?**
* Incubation = **?**
* Carrier State = **?**
* Chronic = **?**
* Vaccine = **?**
* Diagnosis = **?**
## Footnote
*Hepatic System*
**Hepatitis E**:
(**a**) Transmission:
* Fecal - oral form another infected person.
(**b**) Incubation:
* 1-2 months
(**c**) Carrier State:
* No
(**d**) Chronic:
* No
(**e**) Vaccine:
* No
(**f**) Diagnosis:
* Blood detection of anti-HEV
37
Hepatitis cilinical manifestations = **?**
## Footnote
*Hepatic System*
Hepatitis Cilinical Manifestations:
Incubation / preclinical period (10-50 days): asymptomatic
Prodromal / preicteric (1-3 weeks): dark urine, light colored stools, vague GI symptoms, constitutional symptoms (fatigue, malaise, weight loss, nausea, vomiting, diarrhea), aversion to food, alcohol, cigarette smoking, enlarged tender liver, itching, arthralgias (joint stiffness)
Icteric (2-4 weeks): jaundice, GI symptoms subside, liver tenderness, enlarged spleen, enlarged cervical lymph nodes
Recover/convalescence (3-4 months): easily fatigued, liver enlarged and tender
38
Hepatitis implications to PT = **?**
## Footnote
*Hepatic System*
Hepatitis implications to PT:
* Must wear personal protective equipment
* Balance of activity and rest
Side effects of medications:
* Muscle pain
* Headache
* Skin irritation
* Depression
* Hair loss
* Cough
* + Intolerable side effects , report to physician
39
Alcohol related liver disease = **?**
## Footnote
*Hepatic System*
Spectrum of alcoholic liver disease include:
* Fatty liver disease
* Alcoholic hepatitis
* Cirrhosis
**Other Facts**:
* 14 million alcoholics in US, 10% develop problems related to chronic alcohol abuse and severe liver disease.
* More men than women acquire liver disease.
* Women develop after shorter exposure to alcohol and while consuming lower quantities of alcohol as compared to men.
* Women produce less alcohol dehydrogenase (breaks ethanol down in the stomach), therefore they absorb more alcohol in stomach.
* 90% of heavy drinkers develop fat accumulation in liver (first sign of alcohol abuse).
* Only minority progress to cirrhosis/ severe liver disease.
40
Stages of liver disease = **?**
## Footnote
*Hepatic System*
Stages of liver disease:
41
Pancreatitis = **?**
## Footnote
*Hepatic System*
**Pancreatitis**:
* Serious inflammation of pancreas, buildup of pancreatic enzymes- autodigestion.
Notes:
* Severe ischemia, inflammation: disrupt ducts - leakage of pancreatic fluid and formation of pseudocysts that contain necrotic tissue and pancreatic enzymes
* Can get infected with bacteria - pain, fever, leukocytosis.
* Treatment / Managemnet: Low fat diet, alcohol forbidden.
42
Three pancreatic enzymes and their functions = **?**
## Footnote
*Hepatic System*
Different pancreatic enzymes:
* **Trypsin** = digest protein
* **Amylase** = digest carbohydrate
* **Lipase** = digest fat
43
Acute pancreatitis
**vs**.
Chronic pancreatitis
## Footnote
*Hepatic System*
Pancreatitis:
(a) **Acute**:
* Mild, reversible
* Mild nonspecific pain to profound shock with coma and possible death.
* Abdominal pain abruptly in mid epigastrium, increases in severity for several hours, can last for days or weeks.
* Pain radiates to back and worse by lying or supine, relieved by sitting and leaning forward.
(b) **Chronic**:
* Recurrent or persisting
* Persistent or recurrent episodes of epigastric and left upper quadrant pain, mid thoracic pain and to left shoulder.
**Both**:
* Triggered by eating meals/ drinking alcohol
* Nausea, vomiting, anorexia, fever, tachycardia, jaundice
44
Most common causes of pancreatitis = **?**
## Footnote
*Hepatic System*
Most common causes of pancreatitis:
* Gall stones
* Alcohol
* **Toxins**: acetaminophen
45
Cues to screening for hepatic issues = **?**
## Footnote
*Hepatic System*
Cues to Screening:
* **Liver involvement**: Right shoulder / scapular or upper mudpack pain of unknown case.
* Shoulder motion not limited by painful symptoms.
* Client unable to localize the pain/ tenderness.
* Presence of GI symptoms
* Bilateral carpal tunnel syndrome (B/L CTS)
* History of cancer/ liver/ gallbladder disease
* History of use of statin or other hepatotoxic drugs.
* Recent injection drug use / body piercing / tattoo.
* Changes in skin
* **Lifestyle**: Alcohol consumption
46
Referral = **?**
## Footnote
*Hepatic System*
**Referral**:
* New onset of myopathy
* Obvious signs of hepatic disease, with history of previous cancer or risk factors for hepatitis.
* Development of arthralgias of unknown cause in anyone with risk factors or history of hepatitis.
* Presence of bilateral carpal tunnel syndrome (B/L CTS)
* Presence of sensory neuropathy of unknown cause associated with hepatic system impairment.
