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Medical Conditions II > Hepatic System > Flashcards

Hepatic System Flashcards

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USMLE® Step 1 flashcards
1
Q

Hepatic Portal System

A
  1. sm intestine absorbs products of digestion
  2. Nutrient molecules travel in hepatic portal vein to liver
  3. liver filters/cleanses blood content
  4. blood enters general circulation by way of hepatic ven
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2
Q

Liver is responsible for:

A
  • 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
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3
Q

Bilirubin

A

-breakdown product of hemoglobin

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4
Q

Aging and Hepatic System

A
  • decreased liver function
  • decreased liver enzymes
  • decreased blood to liver
  • increased fibrosis of liver
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5
Q

Liver Enzymes

A
  • Aspartate Transaminase (AST)
  • Alanine Transaminase (ALT)
  • Gamma-Glutamyl Transpeptidase (GGTP)
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6
Q

Liver Healing

A
  • parenchymal cells renew slowly and can renew after tissue loss
  • if unable to renew–>scar tissue/fibrosis
  • healing impacted by age, nutrition, vascular supply
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7
Q

Ex of Liver Patologies

A
  • Jaundice
  • ascites
  • hepatitis
  • cirrhosis
  • liver neoplasms
  • portal hypertension
  • hepatic encephalopathy
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8
Q

Most common S/Sx of liver disease

A
  • 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
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9
Q

MSK Pain with Hepatic Disease

A
  • T spine pain (between scap)
  • R shoulder
  • R UT
  • R interscapular areas
  • R subscap areas
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10
Q

Skin S/Sx Hepatic Disease

A

-pallor
-jaundice
-orange skin
green skin
-bruising
-spider angiomas
-palmar erythema or “liver palms”

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11
Q

Normal Bilirubin

A

0.1-1.0 mg/dL

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12
Q

Jaundice

A
  • sign of hyperbilirubinemia
  • yellow discoloration of skin/sclerae
  • liver/gallbladder disorders
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13
Q

Jaundice Causes

A
  • increased destruction of RBC
  • damaged liver cells
  • bile duct obstruction or dysfunction
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14
Q

Management of Jaundice

A
  • 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
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15
Q

Ascites

A
  • presence of excess fluid in peritoneal cavity

- from portal hypertension (fluid leaks out into abdominal cavity

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16
Q

Ascites Management

A
  • restrict Na+
  • diuretics
  • restrict fluid
  • Therapeutic paracentesis
  • monitor electrolytes
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17
Q

PT Implication of Ascites

A
  • high Fowlers position most comfortable
  • breathing techniques
  • monitor signs of infection
  • prevention of ulcers
  • monitor fluid retention in LE
  • fluid intake/output measured & restricted
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18
Q

Hepatitis

A

-acute/chronic liver inflammation

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19
Q

Risk Factors of Hepatitis

A
  • 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
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20
Q

Types of Hepatitis

A

-Chronic (6 months+)
-Fulminant
-Viral (A, B, C, D, E, G)
-Toxic
-Autoimmune (idiopathic)
Alcoholic (acute/chronic)

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21
Q

Fulminant Hepatitis

A

-rapidly progresses and becomes hepatic encephalopathy

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22
Q

Toxic Hepatitis

A

-exposure to alcohol, chemicals, drugs etc

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23
Q

Types of Viral Hepatitis

A

-A, B, C, D, E, G

24
Q

Hep A

A

-transmitted by oral-fecal route

  • vaccine
  • treat w/ immunoglobulins
25
Q

Hep B

A
  • transmitted percutaneously or through mucosal contact
  • Considered an STD
  • vaccine
  • treat with interferon
26
Q

Hep C

A

-associated with injection drug use

  • no vaccine
  • treat with interferon
27
Q

Hep D

A

-only individuals with HBV are at risk for HDV–superinfection of Hep B

  • vaccine
  • treat with interferon
28
Q

Hep E

A

-transmitted through contaminated water-oral/fecal route

  • vaccine
  • treat: prevention only
29
Q

Hep G

A

-Most prevalent in African countries

30
Q

Prevention/Management of Hepatitis

A
  • 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
31
Q

Cirrhosis

A

-scarring of liver that involves formation of fibrous tissue associated with destruction of normal architecture of organ

32
Q

Cirrhosis is the result of:

A
  • long-standing injury
  • most commonly due to alcohol
  • hepatitis C is another common cause
33
Q

Cirrhosis S/Sx

A

-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

34
Q

Late stage S/Sx Cirrhosis

A
  • vomiting blood (ulcers/leaking varicose veins in esophagus)
  • require emergency care
35
Q

Management of Cirrhosis

A
  • medication (early stages)
  • exercise
  • energy conservation
  • time management
  • treatment of other symptoms
36
Q

Cirrhosis may cause:

A

-osteoporosis 2* to impaired osteoblastic activity

37
Q

Life Expectancy of Cirrhosis

A

-5-10 years after diagnosis

38
Q

Portal Hypertension:

A

> 25mmHg

39
Q

Normal Portal Pressure

A

3-5mmHg

40
Q

Portal Venous System carries blood from_____ to the ______

A
  • GI, gallbladder, pancreas, spleen

- to liver

41
Q

Portal HTN: if there is a blockage or resistance to flow the blood backs up_____

A

-into GI tract and pools in spleen

new collateral channels equilize pressure

42
Q

Varices

A

-distended, tortuous veins

43
Q

Splenomegaly

A
  • enlarged spleen

- caused by pooling of blood

44
Q

Management of Portal HTN

A
  • management of Sx
  • liver transplant
  • stent and or shunt (TIPSS)
  • education to reduce intra-abdominal pressure by PT
45
Q

Other S/Sx of Hepatic Disease

A
  • 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
46
Q

Neurologic Sx of Hepatic Disease

A
  • confusion
  • sleep disturbances
  • muscle tremors
  • hyperactive reflexes
  • asterixis (flapping tremor)
47
Q

liver dysfunction increases:

A

-serum ammonia & urea levels

–>impaired nerve and brain function

48
Q

Asterixis

A
  • 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
49
Q

Management of Hepatic Encephalopathy

A
  • reduce protein intake
  • antibiotics
  • bowel cathartic
  • peritoneal dialysis
  • liver transplant
  • PT (like neuro pt)
50
Q

Hepatic Osteodystrophy

A
  • abnormal bone development

- bone pain with osteomalacia/porosis

51
Q

Cause of Hepatic Osteodystrophy

A

-production (osteoblastic) defect rather than excessive resorption

52
Q

Hepatic Osteodystrophy can cause:

A
  • vertebral wedging
  • vertebral crush Fx
  • kyphosis
  • decalcification of rib cage
  • pseudofractures
53
Q

Liver Neoplasms:

A
  • benign/malignant
  • primary or metastatic site
  • in parenchymal (hepatocytes) or matrix cells
54
Q

Primary malignant liver cancer is often:

A

a complication of cirrhosis

55
Q

Hepatocellular Carcinoma (HCC) clinical manifestations

A
  • asymptomatic until late stages
  • initial symptoms: abdominal pn, weight loss
  • jaundice=rare
  • metastases to bone/lungs common
56
Q

Management of HCC

A
  • transarterial chemoembolization/radioembolization
  • surgical resection
  • liver transplant

Medical Conditions II (34 decks)

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