Liver Flashcards
Biliary System
_____ + ____ = _____ , empties into small intestine (helps digest fats after a meal)
Hepatic duct (liver) + cystic duct (GB)=common bile duct
Hepatic Blood Supply
Largest visceral organ~dual blood supply:
The liver can store up to ___ mL blood to use during shock and hypovolemia.
Where does portal HTN occur?
portal vein 80% and hepatic artery (20%).
450
Portal hypertension is high blood pressure in the portal vein
Metabolic functions of the liver
Able to regenerate, metabolizes drugs (first pass effect: oral meds absorbed from Gi tract, metabolized by liver, may need to be given different route or larger dose),
stores Vit ADEK, maintains blood glucose levels,
synthesizes plasma proteins (albumin),
degrades toxins converts ammonia to urea excreted in urine),
synthesis of fibrinogen and coagulation factors;
Makes bile 600-1200 ml/day
____: bile
_____: slowing or stoppage of bile
______: gallstones
_____: inflammation of gallbladder
_____: gallbladder removal
_____: endoscopic retrograde cholangiopancreatography
“chole”
Cholestasis
Cholelithiasis
Cholecystitis
Cholecystectomy
ERCP
Diagnostic Evaluation
Liver function tests (LFTs)
Alanine transaminase (ALT): enzyme, an increase indicates liver damage.
Aspartate transaminase (AST): enzyme, an increase indicates liver or muscle damage/disease.
Alkaline phosphatase (ALP): an enzyme in liver, bile ducts, and bone; an increase indicates liver damage or blocked bile duct, or bone disease.
Liver function tests
These enzymes help metabolize ____
Liver function tests may look normal with _____
proteins
cirrhosis
Other labs
____: protein, made in the liver; _____ levels with liver damage or disease.
______: protein made by the liver; ____ in liver damage/dz ; monitor ____
______: a substance produced during the normal breakdown of red blood cells. ____ in liver damage/dz and certain anemias.
____: (NH3), a byproduct of amino acid catabolism. _____ with hepatic encephalopathy.
Albumin
decreased
Prothrombin time (PT)
prolonged
INR
Bilirubin (Tbili)
Increased
Ammonia
Increased
_____ helps keep your fluid in your bloodstream and binds with hormones and fatty acids
Need ____ for synthesis of PT/Internationalized Normalized Ratio (INR), calculated based on the PT test result, for people who are receiving the anticoagulant warfarin.
Prothrombin time (PT)
is a test that helps evaluate your ability to appropriately form blood clots. When the PT is ____, it takes longer for the blood to clot~
____ risk (TX with blood components: ________).
What is treatment for Coumadin overdose?
Albumin
Vit. K
high
hemorrhagic
clotting factors, platelets, plasma. Vit K
Vit. K
Labs help with identifying disease process & stagesFor example…
48 y.o. client with acute hepatitis B: elevated ALT, AST, bilirubin,& HBsAG
10 y.o. client with bone disease: elevated ALP, no liver disease
62 y.o. with end-stage cirrhosis, hepatorenal failure, and encephalopathy: normal ALT*, elevated BUN, creat, elevated ammonia, decreased albumin, prolonged PT
*ALT and AST return to normal when liver cells are no longer able to create an inflammatory response
Diagnostic Evaluation continued
Liver biopsy
US
CT
MRI
Endoscopy
Laparoscopy
Liver bx: ____ or ____
US guided helpful to diagnose If lab tests nondiagnostic.
______ complication
Health hx impt:
percutaneously or laprascopic.
Peritonitis
med hx, OTC, herbal, hx etoh and drug use (IV), occupational, recreational, travel hx, any exposure to hepatotoxic substances or infectious agents.
Manifestations of Hepatic Dysfunction
Jaundice
Portal HTN
Hepatic encephalopathy & coma
Manifestations of Hepatic Dysfunction 1. Jaundice
High levels of ____ in the blood
Jaundice: serum bilirubin levels > ____ mg/dL
Different causes
Can cause :
bilirubin in the blood (hyperbilirubinemia)
2-2.5
pruritus, urine bilirubin, and elevated liver function tests
Bilirubin is a substance produced during the normal breakdown of RBC.
It’s a waste product and that’s what causes the color.
Sometimes first sign; affinity for elastic tissues:
Causes:
sclera,mucous membranes.
prehepatic (hemolytic anemia)
intrahepatic (hepatitis, cirrhosis), posthepatic ( gallstones)
Types of jaundice:
Physiologic (newborn): immature gut, put under light, light absorbed by the skin and changes bilirubin into products which can pass thru urine
hepatocellular urine urobilogen, bilirubin excreted in urine
obstructive jaundice (gall stones : cholelithiasis)
Manifestations of Hepatic Dysfunction
2. Portal HTN
____ blocks the flow of blood through the liver and slows its processing functions portal HTN
Consequences:
Scar tissue
Ascites
Esophageal varices
Ascites treatment
Low Na diet
Diuretics (spironolactone)
Albumin
May require paracentesis
Nursing management
What kind of diuretic is spironolactone? first line therapy Potassium sparing, antagonizes aldosterone – reduces sodium retention
Why albumin? Increases intravascular fluid
Paracentesis complications? depending on cause…fill right back up, need paracentesis monthly, then weekly…
What is SBP? Spontaneous bacterial peritonitis- infection
Hyperaldosteronism –
Paracentesis- may need ultrasound, have the urinate prior to, may just fill back up
Nursing mgmt.- monitor vital signs (BP may drop), I&O, daily weights, resp. status,
Bedrest helps
Ascites is a result of portal hypertension
Esophageal & gastricvarices
treatment
Band ligation (next slide)
Administration of FFP, PRBC, PPI, Vitamin K, lactulose, antibiotics, meds to stop bleeding
Sclerotherapy
Balloon tamponade
Shunting procedures (TIPS)
Bleeding esophageal varices life-threatening!!
Observe for any signs of bleeding from varices, such as:
hematemesis & melena, s/symptoms of hypovolmic shock
