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z_NUR411_Medsurge: UNIT 2 > Hepatic System: Liver Function and Hepatitis > Flashcards

Hepatic System: Liver Function and Hepatitis Flashcards

1
Q

What is hepatitis?

A

• Inflammation of the liver due to a virus or hepatotoxic drugs/chemicals

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2
Q

What is the pathology of hepatitis?

A
  • Exposure to a causative agent results in liver inflammation, hepatocyte injury and necrosis
  • Chronic hepatitis can lead to cirrhosis and liver cancer
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3
Q

What are the risk factors for hepatitis?

A

• IV drug use, body piercings/tattoos, high-risk sexual practices, travel to underdeveloped countries

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4
Q

What are the s/s of hepatitis?

A
  • Fever
  • Lethargy
  • N/V
  • Jaundice, Dark-colored urine, Clay colored stools
  • Arthralgia
  • Abdominal pain
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5
Q

What lab results indicate hepatitis infection?

A

• ↑ ALT, AST, Bilirubin, ↓ Albumin

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6
Q

What is the general tx for Hepatitis?

A
  • Rest, supportive tx
  • Anti-viral meds
  • Hep A & B vaccinations
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7
Q

What causes liver inflammation?

A
  • drugs
  • excessive alcohol usage
  • medications
  • viruses (most common and referred to as viral hepatitis)
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8
Q

What happens with viral hepatitis?

A

• a virus attacks the cells of the liver causing them to malfunction.

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9
Q

How many types of Hepatitis are there, name each.

A
  • 5

* A, B, C, D, E

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10
Q

What are the main functions of the liver?

A 
•	Storage
o	Minerals, Vitamins A, D, E, K
•	Protection 
o	Kupffer cells: Kill, engulf, detoxify
•	Metabolism
o	Absorption of CHO, Protein and Fat
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11
Q

The liver receives blood from what two sources?

A
  • Hepatic artery

* Hepatic portal vein

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12
Q

What is the flow of blood from the heart to the liver and what does it deliver?

A
  • Left ventricle → aorta → hepatic artery

* It delivers oxygen rich/nutrient poor blood to the liver

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13
Q

Where does the hepatic portal vein receive its blood from and what does it deliver?

A
  • From the mesenteric system of the GI tract

* It delivers oxygen poor/nutrient rich blood to the liver

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14
Q

What does bile help digest and where is it stored?

A
  • Fats

* Gallbladder

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15
Q

How does the liver regulate glucose?

A

• Stores it and creates it based on the body’s needs

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16
Q

How is ammonia created and what does the liver do with it?

A
  • Ammonia is created by the breakdown of proteins

* The liver converts ammonia into urea which is sent to the kidneys for excretion

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17
Q

If the liver fails to convert ammonia, what happens?

A 
•	Elevated concentrations of ammonia in the brain leads to cerebral dysfunction :
o	impaired memory
o	confusion/shortened attention span
o	sleep-wake inversions 
o	brain edema
o	intracranial hypertension 
o	seizures, ataxia and coma
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18
Q

What does the liver due with RBCs?

A

• Breaks them down w/ bilirubin as a biproduct

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19
Q

How are Hep A and E similar?

A

• Xmission: fecal-oral
• Acuity: acute infections ONLY
• Tx: supportive and rest
• Hepatitis A has a vaccine and immune globulin
o IgM when virus present
o IgG post infection/vax
• Hepatitis E does NOT have a vaccine in the US or post-exposure immune globulin

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20
Q

How are Hep B, C, D similar

A
  • Xmission: blood/body fluids
  • Acuity: acute and chronic infections
  • Tx: can include antivirals and interferon
  • Only Hepatitis B has a vaccine and post-exposure immune globulin.
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21
Q

What is the acronym for remembering the nursing education to provide patients with hepatitis and what does each letter stand for?

A
  • HEPATITIS
  • H: handwashing
  • E: eat low fat/high carbs
  • P: personal hygiene products not shared
  • A: activity conservation (REST)
  • T: toxic substances avoided (alcohol, sedatives, aspirin, acetaminophen)
  • I: individual bathroom
  • T: testing results
  • I: interferon (subQ)
  • S: small but freq meals
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22
Q

What are the 3 phases of viral hepatitis?What are the 3 phases of viral hepatitis?

A
  • Preicteric
  • Icteric
  • Posticteric
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23
Q

Explain the Preicteric phase of viral hepatitis.

A

• Prodromal phase
o the period after incubation and before the characteristic symptoms of infection occur.
o Gradual onset of s/s
• Nonspecific symptoms occur; they include profound anorexia, malaise, nausea and vomiting, and often fever or right upper quadrant abdominal pain. Urticaria (hives) and arthralgias (joint pain) occasionally occur

24
Q

Explain the Icteric phase of viral hepatitis.

A

• DECREASE in body symptoms but will have
o jaundice and dark urine (from build-up of bilirubin),
o clay-colored stool (bilirubin not going to stool to give it’s normal brown color)
o Hepatomegaly (enlarged liver) and
o RUQ pain

25
Q

Explain the Posticteric phase of viral hepatitis.

A
  • Jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal
  • Some degree of malaise and susceptibility to fatigue may persist for weeks and even months following viral hepatitis.
26
Q

ALT and AST levels are part of what labwork?

A

• LFT or CMP (Completel Metabolic Panel)

27
Q

Where do we want to see ALT, AST and GGT levels?

A
  • ALT/AST: < 30

* GGT: < 60

28
Q

What level do we want for bilirubin and albumin?

A
  • Bilirubin 0.3-1

* Albumin 3.5-5

29
Q

Will Albumin increase or decrease with Hep B?

A

• Decrease

30
Q

Will bilirubin levels increase or decrease with Hepatitis?

A

• Increase

31
Q

What prothrombin time do we want to see?

A

• >17 sec

32
Q

What does the presence of AFP (alpha-fetoprotein) indicate?

A
  • Liver damage/cancer (in absence of pregnancy)

* Expected during pregnancy, which fades quickly after birth

33
Q

What is ferritin and what does it indicate?

A
  • A protein that stores iron
  • RBCs need iron to form normally and carry O2
  • Low ferritin leads to iron-deficiency anemia
34
Q

What is a HBV DNA test?

A

• A hepatitis B virus dna test measures the viral load of the hepatitis B virus in the blood to monitor the progression of hep B

35
Q

What does HBsAg stand for and indicate?

A
  • Hep B Surface antigen
  • Neg = no current infection
  • Pos = infection present, can spread to others
36
Q

What does HBsAb stand for and indicate?

A
  • Hep B Surface antibody
  • Neg = no protection, vaccine needed
  • Pos = past infection recovery or vaccine taken. Protection from Hep B is present
37
Q

What does HBcAb stand for and indicate?

A
  • Hep B Core antibody
  • It does not provide protection
  • Pos = past or present infection
38
Q

What is the dx for: HBsAg (neg), HBsAb (neg), HBcAb (neg)?

A
  • No Hep B infection past or present
  • Not immune
  • Vaccine required
39
Q

What is the dx for: HBsAg (neg), HBsAb (pos), HBcAb (neg/pos)?

A
  • No infection present
  • Immune
  • Past infection or vaccine has been taken
  • Cannot infect others
40
Q

What is the dx for: HBsAg (pos), HBsAb (neg), HBcAb (neg/pos)?

A
  • Infection present
  • No immunity
  • Can spread to others
  • Need medical guidance
41
Q

What is the dx for: HBsAg (neg), HBsAb (neg), HBcAb (pos)?

A
  • Indicates past or present infection

* Medical attn needed

42
Q

What are the main causes of hepatitis?

A
  • Virus (most common)
  • Alcohol
  • Meds/Chemicals
  • Autoimmune disease
  • Metabolic problems
43
Q

What is the incubation period for Hep A?

A

• 2-6 wks

44
Q

When should a child get the Hep A vaccine?

A

• 1yr

45
Q

What is the incubation period for Hep B?

A

• 30-160 days

46
Q

True or False

A pregnant woman with Hep B can pass it along to her baby though the placenta or vagina.

A

• True

47
Q

True or False

Most that get Hep B will be carriers for life

A

• True

48
Q

What is the vax procedure for Hep B?

A
  • 3 shots over 6 months

* 1st shot, 2nd @1mos later, 3rd @5mos later

49
Q

What is lifelong tx for pt w/ Hep B?

A
  • Can live an active life with proper lifestyle and regular health care
  • @every 6mos, check ALT (liver damage) and AFP (liver cancer)
  • Ultrasound annually
50
Q

Which cells of the liver are responsible for detoxification?

A

• Kupffer cells

51
Q

Explain the immune tolerance stage of hep B

A
  • Immune tolerance is clinically described as HBeAg positivity with DNA levels at or above 20,000 IU/mL and no significant immune response to the virus
  • These patients have persistently normal alanine aminotransferase (ALT) levels
52
Q

Explain the immune clearance stage of Hep B

A
  • The immune clearance phase is characterized by high levels of HBV DNA, elevated ALT levels, and active liver inflammation.
  • Initially, those in the immune clearance phase will be HBeAg-positive that most will eventually clear and develop antibody to hepatitis B
53
Q

What vaccine is used for prevention of Hep D?

A

• Hep B vax

54
Q

What is Albumin?

A
  • Albumin is a protein that is produced in the liver and then enters the bloodstream where it is carried to other parts of the body.
  • Albumin’s biological functions are to keep fluid from leaking out of the blood and to carry substances like hormones, enzymes, and vitamins in the body.
55
Q

How is the liver related to clotting factors?

A

• The liver produces multiple proteins involved in the normal clotting process including coagulation factors, fibrinogen, and plasminogen

z_NUR411_Medsurge: UNIT 2 (25 decks)

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