Hepatic System: Liver Function and Hepatitis Flashcards
What is hepatitis?
• Inflammation of the liver due to a virus or hepatotoxic drugs/chemicals
What is the pathology of hepatitis?
- Exposure to a causative agent results in liver inflammation, hepatocyte injury and necrosis
- Chronic hepatitis can lead to cirrhosis and liver cancer
What are the risk factors for hepatitis?
• IV drug use, body piercings/tattoos, high-risk sexual practices, travel to underdeveloped countries
What are the s/s of hepatitis?
- Fever
- Lethargy
- N/V
- Jaundice, Dark-colored urine, Clay colored stools
- Arthralgia
- Abdominal pain
What lab results indicate hepatitis infection?
• ↑ ALT, AST, Bilirubin, ↓ Albumin
What is the general tx for Hepatitis?
- Rest, supportive tx
- Anti-viral meds
- Hep A & B vaccinations
What causes liver inflammation?
- drugs
- excessive alcohol usage
- medications
- viruses (most common and referred to as viral hepatitis)
What happens with viral hepatitis?
• a virus attacks the cells of the liver causing them to malfunction.
How many types of Hepatitis are there, name each.
- 5
* A, B, C, D, E
What are the main functions of the liver?
• Storage o Minerals, Vitamins A, D, E, K • Protection o Kupffer cells: Kill, engulf, detoxify • Metabolism o Absorption of CHO, Protein and Fat
The liver receives blood from what two sources?
- Hepatic artery
* Hepatic portal vein
What is the flow of blood from the heart to the liver and what does it deliver?
- Left ventricle → aorta → hepatic artery
* It delivers oxygen rich/nutrient poor blood to the liver
Where does the hepatic portal vein receive its blood from and what does it deliver?
- From the mesenteric system of the GI tract
* It delivers oxygen poor/nutrient rich blood to the liver
What does bile help digest and where is it stored?
- Fats
* Gallbladder
How does the liver regulate glucose?
• Stores it and creates it based on the body’s needs
How is ammonia created and what does the liver do with it?
- Ammonia is created by the breakdown of proteins
* The liver converts ammonia into urea which is sent to the kidneys for excretion
If the liver fails to convert ammonia, what happens?
• 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
What does the liver due with RBCs?
• Breaks them down w/ bilirubin as a biproduct
How are Hep A and E similar?
• 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
How are Hep B, C, D similar
- 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.
What is the acronym for remembering the nursing education to provide patients with hepatitis and what does each letter stand for?
- 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
What are the 3 phases of viral hepatitis?What are the 3 phases of viral hepatitis?
- Preicteric
- Icteric
- Posticteric
Explain the Preicteric phase of viral hepatitis.
• 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
Explain the Icteric phase of viral hepatitis.
• 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
Explain the Posticteric phase of viral hepatitis.
- 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.
ALT and AST levels are part of what labwork?
• LFT or CMP (Completel Metabolic Panel)
Where do we want to see ALT, AST and GGT levels?
- ALT/AST: < 30
* GGT: < 60
What level do we want for bilirubin and albumin?
- Bilirubin 0.3-1
* Albumin 3.5-5
Will Albumin increase or decrease with Hep B?
• Decrease
Will bilirubin levels increase or decrease with Hepatitis?
• Increase
What prothrombin time do we want to see?
• >17 sec
What does the presence of AFP (alpha-fetoprotein) indicate?
- Liver damage/cancer (in absence of pregnancy)
* Expected during pregnancy, which fades quickly after birth
What is ferritin and what does it indicate?
- A protein that stores iron
- RBCs need iron to form normally and carry O2
- Low ferritin leads to iron-deficiency anemia
What is a HBV DNA test?
• 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
What does HBsAg stand for and indicate?
- Hep B Surface antigen
- Neg = no current infection
- Pos = infection present, can spread to others
What does HBsAb stand for and indicate?
- Hep B Surface antibody
- Neg = no protection, vaccine needed
- Pos = past infection recovery or vaccine taken. Protection from Hep B is present
What does HBcAb stand for and indicate?
- Hep B Core antibody
- It does not provide protection
- Pos = past or present infection
What is the dx for: HBsAg (neg), HBsAb (neg), HBcAb (neg)?
- No Hep B infection past or present
- Not immune
- Vaccine required
What is the dx for: HBsAg (neg), HBsAb (pos), HBcAb (neg/pos)?
- No infection present
- Immune
- Past infection or vaccine has been taken
- Cannot infect others
What is the dx for: HBsAg (pos), HBsAb (neg), HBcAb (neg/pos)?
- Infection present
- No immunity
- Can spread to others
- Need medical guidance
What is the dx for: HBsAg (neg), HBsAb (neg), HBcAb (pos)?
- Indicates past or present infection
* Medical attn needed
What are the main causes of hepatitis?
- Virus (most common)
- Alcohol
- Meds/Chemicals
- Autoimmune disease
- Metabolic problems
What is the incubation period for Hep A?
• 2-6 wks
When should a child get the Hep A vaccine?
• 1yr
What is the incubation period for Hep B?
• 30-160 days
True or False
A pregnant woman with Hep B can pass it along to her baby though the placenta or vagina.
• True
True or False
Most that get Hep B will be carriers for life
• True
What is the vax procedure for Hep B?
- 3 shots over 6 months
* 1st shot, 2nd @1mos later, 3rd @5mos later
What is lifelong tx for pt w/ Hep B?
- Can live an active life with proper lifestyle and regular health care
- @every 6mos, check ALT (liver damage) and AFP (liver cancer)
- Ultrasound annually
Which cells of the liver are responsible for detoxification?
• Kupffer cells
Explain the immune tolerance stage of hep B
- 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
Explain the immune clearance stage of Hep B
- 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
What vaccine is used for prevention of Hep D?
• Hep B vax
What is Albumin?
- 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.
How is the liver related to clotting factors?
• The liver produces multiple proteins involved in the normal clotting process including coagulation factors, fibrinogen, and plasminogen
