Hepatic System Flashcards
Hepatic Portal System
- sm intestine absorbs products of digestion
- Nutrient molecules travel in hepatic portal vein to liver
- liver filters/cleanses blood content
- blood enters general circulation by way of hepatic ven
Liver is responsible for:
- filtering all blood from GI system (toxins out)
- convert and excrete bilirubin
- provide albumin & other plasma proteins
- produce clotting factors
- store vitamins
- absorbs/metabolizes nutrients
- metabolize & eliminate toxins/drugs
Bilirubin
-breakdown product of hemoglobin
Aging and Hepatic System
- decreased liver function
- decreased liver enzymes
- decreased blood to liver
- increased fibrosis of liver
Liver Enzymes
- Aspartate Transaminase (AST)
- Alanine Transaminase (ALT)
- Gamma-Glutamyl Transpeptidase (GGTP)
Liver Healing
- parenchymal cells renew slowly and can renew after tissue loss
- if unable to renew–>scar tissue/fibrosis
- healing impacted by age, nutrition, vascular supply
Ex of Liver Patologies
- Jaundice
- ascites
- hepatitis
- cirrhosis
- liver neoplasms
- portal hypertension
- hepatic encephalopathy
Most common S/Sx of liver disease
- GI symptoms
- edema/ascites
- neurologic changes
- abdominal pain (RUQ)
- back/R shoulder pain
- Jaundice
- skin changes
- skin changes
- pruritis
- light colored stools
- dark-colored urine
- osteodystrophy
- coagulopathy
MSK Pain with Hepatic Disease
- T spine pain (between scap)
- R shoulder
- R UT
- R interscapular areas
- R subscap areas
Skin S/Sx Hepatic Disease
-pallor
-jaundice
-orange skin
green skin
-bruising
-spider angiomas
-palmar erythema or “liver palms”
Normal Bilirubin
0.1-1.0 mg/dL
Jaundice
- sign of hyperbilirubinemia
- yellow discoloration of skin/sclerae
- liver/gallbladder disorders
Jaundice Causes
- increased destruction of RBC
- damaged liver cells
- bile duct obstruction or dysfunction
Management of Jaundice
- refer to doc
- treat underlying cause
- resolves in 4-6 weeks
- exercise after jaundice is gone
- ex’s to tolerance
- can walk/do functional activities with jaundice
Ascites
- presence of excess fluid in peritoneal cavity
- from portal hypertension (fluid leaks out into abdominal cavity
Ascites Management
- restrict Na+
- diuretics
- restrict fluid
- Therapeutic paracentesis
- monitor electrolytes
PT Implication of Ascites
- high Fowlers position most comfortable
- breathing techniques
- monitor signs of infection
- prevention of ulcers
- monitor fluid retention in LE
- fluid intake/output measured & restricted
Hepatitis
-acute/chronic liver inflammation
Risk Factors of Hepatitis
- unprotected sex
- injection/drug abuse
- health care workers
- living with family members with hepatitis
- travel to areas with high incidence of hepatitis
- tattoo inscription/removal
- blood clotting disorder
- blood transfusion
- liver transplant recipient
- compromised immune system
Types of Hepatitis
-Chronic (6 months+)
-Fulminant
-Viral (A, B, C, D, E, G)
-Toxic
-Autoimmune (idiopathic)
Alcoholic (acute/chronic)
Fulminant Hepatitis
-rapidly progresses and becomes hepatic encephalopathy
Toxic Hepatitis
-exposure to alcohol, chemicals, drugs etc
Types of Viral Hepatitis
-A, B, C, D, E, G
Hep A
-transmitted by oral-fecal route
- vaccine
- treat w/ immunoglobulins
Hep B
- transmitted percutaneously or through mucosal contact
- Considered an STD
- vaccine
- treat with interferon
Hep C
-associated with injection drug use
- no vaccine
- treat with interferon
Hep D
-only individuals with HBV are at risk for HDV–superinfection of Hep B
- vaccine
- treat with interferon
Hep E
-transmitted through contaminated water-oral/fecal route
- vaccine
- treat: prevention only
Hep G
-Most prevalent in African countries
Prevention/Management of Hepatitis
- prevent infection/toxins
- lifestyle changes
- vaccines
- medications: interferons, immunoglobulins, ribovirin
- rest to recover energy
- energy conservation/time management
- activities to prevent loss of flexibility/strength
- liver transplant
Cirrhosis
-scarring of liver that involves formation of fibrous tissue associated with destruction of normal architecture of organ
Cirrhosis is the result of:
- long-standing injury
- most commonly due to alcohol
- hepatitis C is another common cause
Cirrhosis S/Sx
-fatigue
-pruritis
-jaundice
-clubbed, white nails
-darkening of skin
-fluid retention in legs/abdomen
-abnormal blood vessels (caput medusae)
-easy bruising
enlargement of breats in men
Late stage S/Sx Cirrhosis
- vomiting blood (ulcers/leaking varicose veins in esophagus)
- require emergency care
Management of Cirrhosis
- medication (early stages)
- exercise
- energy conservation
- time management
- treatment of other symptoms
Cirrhosis may cause:
-osteoporosis 2* to impaired osteoblastic activity
Life Expectancy of Cirrhosis
-5-10 years after diagnosis
Portal Hypertension:
> 25mmHg
Normal Portal Pressure
3-5mmHg
Portal Venous System carries blood from_____ to the ______
- GI, gallbladder, pancreas, spleen
- to liver
Portal HTN: if there is a blockage or resistance to flow the blood backs up_____
-into GI tract and pools in spleen
new collateral channels equilize pressure
Varices
-distended, tortuous veins
Splenomegaly
- enlarged spleen
- caused by pooling of blood
Management of Portal HTN
- management of Sx
- liver transplant
- stent and or shunt (TIPSS)
- education to reduce intra-abdominal pressure by PT
Other S/Sx of Hepatic Disease
- dark urine (abnormal excretion of bile)
- light-colored/clay-colored feces (lack of bile in stools)
- pruritis (accum of bile salts in skin)
- RUQ pain
Neurologic Sx of Hepatic Disease
- confusion
- sleep disturbances
- muscle tremors
- hyperactive reflexes
- asterixis (flapping tremor)
liver dysfunction increases:
-serum ammonia & urea levels
–>impaired nerve and brain function
Asterixis
- inability to mntn wrist extension with forward flexion of upper extremities
- altered neurotranmission in reticular formation alters movement
- may be seen in any skeletal muscle including tongue
Management of Hepatic Encephalopathy
- reduce protein intake
- antibiotics
- bowel cathartic
- peritoneal dialysis
- liver transplant
- PT (like neuro pt)
Hepatic Osteodystrophy
- abnormal bone development
- bone pain with osteomalacia/porosis
Cause of Hepatic Osteodystrophy
-production (osteoblastic) defect rather than excessive resorption
Hepatic Osteodystrophy can cause:
- vertebral wedging
- vertebral crush Fx
- kyphosis
- decalcification of rib cage
- pseudofractures
Liver Neoplasms:
- benign/malignant
- primary or metastatic site
- in parenchymal (hepatocytes) or matrix cells
Primary malignant liver cancer is often:
a complication of cirrhosis
Hepatocellular Carcinoma (HCC) clinical manifestations
- asymptomatic until late stages
- initial symptoms: abdominal pn, weight loss
- jaundice=rare
- metastases to bone/lungs common
Management of HCC
- transarterial chemoembolization/radioembolization
- surgical resection
- liver transplant
