lewis ch 43 liver, biliary tract and pancreas problems Flashcards
causes hepatitis (6)
- viral (most common)
- alcohol
- meds
- chemicals
- autoimmune diseases
- metabolic problems
types viral hepatitis (5)
A B C D E
transmission hep a
fecal oral
transmission hep b (3)
- percutaneous or mucosal exposure to blood/blood products
- sexual contact
- perinatal transmission
how long are hep b carriers infectious
for life
transmission hep c (3)
- percutaneous or mucosal exposure to blood/blood products
- high risk sexual contact
- perinatal contact
what type hepatitis must precede hep d
hep b
transmission hep e (2)
- fecal oral
- contaminated water
people at risk for hep b (6)
- men who have sex with men
- household contact o chronically infected
- patients on hemodialysis
- health care and public safety workers
- IV drug users
- recipients of blood products
people at risk for hep c (4)
- IV drug use
- unprotected sex
- occupational exposure
- blood transfusions before 1992 (highest risk)
what type hepatitis is most common cause of liver disease and liver failure, and is most common reason for liver transplant in US
hep c
a chronic degenerative disease of the liver where the lobes are covered with fibrous tissue, the parenchyma degenerate and the lobules are infiltrated with fat
cirrhosis
S+S chronic hepatitis (4)
- lower extremity edema
- asterixis (liver flap)
- bleeding abnormalities
- jaundice
how long can the acute phase of hepatitis last (maximal infectivity)
1-6 months
S+S acute hepatitis (5)
- N/V
- RUQ pain
- reduced sense of smell and taste
- distaste for cigarettes
- flu like symptoms
3 classifications jaundice
- hemolytic jaundice
- hepatocellular jaundice
- obstructive jaundice
causes of hemolytic jaundice (3)
- blood transfusion reactions
- hemolytic anemia
- sickle cell crisis
causes hepatocellular jaundice (3)
- cirrhosis
- hepatitis
- liver cancer
causes obstructive jaundice (4)
- cirrhosis
- hepatitis
- liver cancer
- common bile duct obstruction
what is common in acute phase in hep a
itching with jaundice
icteric
jaundice
anicteric
without jaundice
2 major problems in convalescent phase of hepatitis
malaise
easy fatigability
5 complications hepatitis
- acute liver failure
- chronic hepatitis
- cirrhosis
- portal hypertension
- liver cancer
risk factors cirrhosis (4)
- male gender
- alcohol use
- concomitant fatty liver disease
- excess iron deposition in liver
later S+S cirrhosis (7)
- jaundice
- changes in mental responsiveness
- spider angiomas
- anemia, coagulation disorders
- hemorrhoids
- edema
- peripheral neuropathy
what hyperosmotic laxative can be given to remove ammonia from the body during hepatic encephalopathy
lactulose
S+S hepatic encephalopathy (4)
- decreased LOC
- neuromuscular disturbances
- asterixis (liver flap)
- hyperreflexia
Accumulation of excess fluid in peritoneal cavity
ascites
what causes ascites (2)
- reduced protein levels in blood
- reduced plasma oncotic pressure
what type of drug can be used to treat hepatitis (blocks activity of polymerase enzyme)
antiviral drugs
what type of drug can be used to reduce viral load
nucleoside and nucleotide analogs
5 examples nucleoside and nucleotide analogs
- lamivudine (epivir)
- adefovir (hepsera)
- entecavir (baraclude)
- telbivudine (tyseka)
- tenoovir (viread)
4 drugs given as antiviral drug therapy for hep b
lamivudine
tenofovir
telbivudine
alfa-interferon
adverse effects interferon drug therapy hep b (2)
- flu like symptoms
- depression
4 drugs used for treatment of hep c
- interferon
- ribavirin
- simeprevir
- sofosbuvir
end stage of liver disease, extensive degeneration and destruction of liver cells
cirrhosis
2 most common causes cirrhosis
- chronic hep c
- alcohol induced liver disease
6 complications of cirrhosis
- portal hypertension
- esophageal and gastric varices
- peripheral edema
- abdominal ascites
- hepatic encephalopathy
- hepatorenal syndrome
obstruction of blood flow in and out of liver, increased pressure in liver
portal hypertension
complex of tortuous, enlarged veins that are fragile and do not tolerate high pressure, result from portal hypertension, can bleed easily, life threatening **
esophageal and gastric varices
accumulation of serous fluid in peritoneal or abdominal cavity
ascites
factors that contribute to ascites (5)
- decreased serum colloidal oncotic pressure
- hyperaldosteronism
- impaired water excretion
- increased flow hepatic lymph
- portal hypertension
drug therapies for hepatic encephalopathy (4)
- vancomycin
- lactulose
- cathartics
- enemas
musty sweet odor of breath associated with hepatic encephalopathy
fetor hepaticus
normal bilirubin range
0-1 mg/dL
normal protein level range
6-8.5 gm/dL
normal albumin level range
3.5-5 gm/dL
normal globulin level range
2-3.5 gm/dL
2 options drug therapy for esophageal or gastric varices (vasoconstrictors)
- octreotide
- vasopressin
