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PPP Unit 3 > Hepatic System > Flashcards

Hepatic System Flashcards

1
Q

What are the major functions of the liver?

A

Manufactures Bile
Manufactures heparin, prothrombrin, fibrinogen, and albumin
Has Kupffer cells (break down RBCs)
Contains enzymes that break down ammonia to give urea
Activation of Vit D (Ca absorption

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2
Q

Common SxS of hepatic disease

A 
GI symptoms
Edema/ascites
Dark urine
Light colored stools (no bile forming)
Right UQP 
Musculoskeletal pain
Hepatic osteodystrophy
Jaundice
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3
Q

What are some common skin changes with hepatic disease?

A

Jaundice
Bruising (clotting factors gone)
Spider angioma
Palmar erythema

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4
Q

What are some neurological involvements with hepatic disease?

A

Confusion
Sleep disturbance
Muscle tremors
Asterixis (flapping tremor)

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5
Q

What is flapping tremor?

A

Asterixis (most common neuro involvement with liver failure)

When wrist is in extension, usually bilateral, decreased by intentional muscle involvement

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6
Q

What are some effects aging has on the liver?

A 
Decrease in liver size & weight
Longer time for liver functions
Liver lab tests still usually normal
increase in liver fibrosis
Pancrease also begins to fibrosis
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7
Q

What is cirrhosis?

A

Regenerated nodules separated by bands of fibrous connective tissue

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8
Q

What are some common things clients may show with cirrhosis?

A 
Fatigue
weight loss
jaundice
coagulopathies
loss of ability to metabolize drugs
hypoalbuminemia
Acites
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9
Q

What is the clinical presentation for cirrhosis?

A 
Jaundice
Emaciation (abnormally thin or weak)
Spider angiomata 
Gynocomastia
Portal hypertension
Altered hair distribution
Testicular atrophy
Palmar erythema 
Increased risk of infections (leukopenia)
Esophageal varices
splenomegaly
Lower leg edema
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10
Q

What are common lab value findings with cirrhosis?

A 
Increase
ALT (alanine aminotransferase)
AST (aspartate aminotransferase)
LDH (Lactate dehydrogenase)
PT (prothrombin time)
Decrease
BSP dye excretion 
Albumin
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11
Q

What are normal levels of bilirubin and what levels are high?

A

1.2 mg/dl is normal
3 mg/dl shows jaundice in eyes
5-6 ml/dl skin becomes yellow, urine turns dark, stool is light colored

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12
Q

What are the 3 types of hyperbilirubinemia?

A

Unconjugated - prehepatic caused by excess bilirubin formation secondary to hemolysis
Mixed and unconjugated - liver cell necrosis
Conjugated - already conjugated in liver cells may be due to obstruction of bile flow

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13
Q

How do you diagnose and treat jaundice?

A

Diagnose by bilirubin blood test (can only tell total bilirubin and conjugated bilirubin levels)
Treat the underlying cause

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14
Q

What can cause the skin to turn yellow that isn’t jaundice?

A

Indulgence of carotene (carrots, pumpkins)

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15
Q

What are some risk factors for hepatitis A (HAV)?

A

Household contacts or sexual contacts of infected persons
Injections/non-injection illegal drug users
Living in areas with increased rates of HAV
Tattoo inscription with unsterile needles

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16
Q

What are risk factors for hepatitis B (HBV)?

A

Injection drug use
unprotected sex
Incarceration (drug use, unsafe sex)
Certain ethnic groups and adoptees from Asia, South America, Mexico,
Occupational risk: (morticians, dental workers, EMTs,
Liver transplant recipient

17
Q

What are risk factors for hepatitis C (HCV)?

A 
Same really
Blood transfusions
Tattooing
Liver disease
Drug injections
18
Q

What are some special implications for PT with viral hepatitis?

A 
Immunizations for Hep B and Hep A
Universal precautions
Change clothes when leaving building
1/3 of patients complain of joint pain
Energy conservation for ADLs
Watch for signs of fluid shift
Watch for adverse drug reactions
19
Q

What are some common causes of cirrhosis?

A 
Alcohol
Hepatitis B, C, D
Hereditary metabolic diseases (hemochromatosis, wilson's, Alpha1 antitrypsin deficiency
Autoimmune diseases
Drugs
Biliary obstruction
Cryptogenic (unknown)
20
Q

How does alcoholic cirrhosis differ than viral infection toxins cirrhosis?

A

Alcohol - Repeated damage and scarring

Viral infection - liver cell necrosis, inflammation, and fibrosis

21
Q

What can the extent of damage be determined by with cirrhosis?

A

Size of the liver - usually smaller
Size and shape of nodules - usually smaller
distribution of the nodules and fibrous scars - a lot of scaring
Color

22
Q

How much of the liver is damaged before seeing significant loss of function?

A

80-90%

23
Q

What are some classic manifestations of Ascites?

A

Distended abdomen
Dilated upper abdominal veins (spider angiomata)
Inverted umbilicus
Peripheral edema may be observed by the therapists

24
Q

What are some things a PT will want to do with a patient with portal hypertension?

A

Teach patient how to reduce pressure such as coughing, straining at stool, or improper lifting.

25
Q

What are some stage 3 symptoms of hepatic encephalopathy?

A 
(Arousal)
Hyperventilation
Marked Confusion
Incoherent speech
Asterixis (liver flap, tremor)
Muscle rigidity
Hyporeactive DTR
Sleeps most of the time
26
Q

What are the stage 4 symptoms of hepatic encephalopathy?

A 
(comotose)
No asterixis
Positive Babinski
Oculocephalic (doll's eye) reflex
Decereberate posturing
Dilated pupils
Lack of response to stimuli
27
Q

What are some PT implications for Ascites?

A

Patients may be more comfy in high Fowlers position (head of bed raised with knees elevated)
Teach breathing techniques with exercises and ADLs
Watch for fever, chills, abd pain, abd tenderness (bacterial peritonitis)
Monitor fluid intake and output (daily weights)
Decrease in serum albumin

28
Q

What does a decrease in serum albumin do?

A

Decrease in oncotic pressure in blood vessels causing edema
Albumin binds to Ca++
Slows healing time
Important with clotting factors

29
Q

What are the 2 types of Gallstones (cholelithiasis)

A

Cholesterol - (4 risk factors - female, forty, fertile, fat)

Pigmentary - Calcium

30
Q

What are some risk factors associated with gallstones?

A 
Age
Decreased physical activity
Pregnancy
Obesity
DM
Rheumatoid arthritis
Diseases of terminal ileum
TPN
Rapid weight loss
liver disease
biliary strictures
31
Q

What are some clinical features associated with gallstones?

A

Most are asymptomatic
SxS usually related to obstruction of cystic or common bile duct
Sharp abdominal pain that may radiate (might think its an MI)
Get sick after eating high fat food

PPP Unit 3 (7 decks)

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