Liver Flashcards
Widespread fibrotic (scarred) bands of connective tissue
Tissue becomes nodular
Nodules block blood flow and lymph
Liver shrinks and hardens
Cirrhosis
Laennec’s cirrhosis is caused by
Alcoholism
______ a rare autoimmune disease that slowly destroys the liver’s bile ducts. This causes bile and other toxins to build up in the liver, a condition known as cholestasis.
The inflammation and scarring of the bile ducts can lead to cirrhosis
Biliary (cirrhosis)
Ascites is…
Fluid in the peritoneal space
Portal hypertension
Ascites
Esophageal varices
Biliary obstruction
Hepatic Encephalopathy
Are all complications of…
Cirrhosis
Biliary obstruction =
Lower
Bile, Vit. K, Clotting Factors
Which has an increased risk for…
Bleeding
Pruritus….
Itching
Hep B, C, D
NAFLD (Obesity)
Alcohol use
Contribute to
Cirrhosis
Why is employment history important to a health history
Exposure to toxins
Esophageal varices usually develop when blood flow to the liver is blocked. They often occur in people with advanced liver disease.
Usually there are no symptoms
Symptoms include vomiting blood, tar-like or bloody stools, and, in severe cases, shock.
Treatments include
This medicine ____
Medical procedures to stop bleeding, and, in rare cases, liver transplant
Beta blockers
Lactate dehydrogenase (LDH) is …
an enzyme that helps the body convert glucose (sugar) from food into usable energy for cells
Cirrhosis has this effect on
AST, ALT, LDH
Alkaline phosphate
GGT
Serum bilirubin
Ammonia
Increase
Norms
AST 10 - 36
ALT 4 - 36 alanine transaminase
LDH 140 - 280
ALP 44 - 146
Serum Bilirubin <1mg/dl
Ammonia < 30
Cirrhosis has this affect on
Albumin
Platelets
Hgb
Hct
RBC
Lower
Norms
Albumin 3.5 - 5.3
Platelets 150,000 and 450,000 microliter of blood
Hgb 12 - 17
Hct 36 - 50
RBC: 4 - 6 million
US transient elastography (TE) is….
Ultrasound elastography or FibroScan, is a non-invasive method that uses ultrasound to measure liver stiffness
EGD & ERCP may be used to test for cirrhosis
T or F
T
EGD esophagastroduodeno
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that uses an endoscope and X-rays to examine and treat problems with the bile and pancreatic ducts
Why pruritis from cirrhosis
Increased serum bilirubin & jaundice
Why acute confusion from cirrhosis
Increased ammonia level
Alcohol withdrawal
How can a hemorrhage occur from cirrhosis
HTN in portal hypertension
Fluid Overload occurs from cirrhosis how
Lack of albumin
Paracentesis is….
A procedure for ascites, during which a needle is inserted into the peritoneal cavity to obtain ascitic fluid
A patient undergoing a paracentesis (drainage of fluid from the peritoneal cavity using a needle) must ______ prior to the procedure.
Measure the patient’s abdominal girth and vital signs before and after the procedure, and assess for signs of ____
Empty bladder
hypovolemia
Cirrhosis hemorrhage intervention
Decrease HR & Hepatic Pressure by giving
Beta blockers
Propranolol
Transfusion management for hemorrhage
What do the following mean
PRBC, FFPs, albumin, platelets
Packed Red Blood Cells
Fresh Frozen Plasma
Albumin keeps fluid inside veins
Transfusion management
What kind of study is
PT, PTT, INR, platelets
Coagulation
Sengstaken-Blakemore tube is used for…
How does it work
Treatment of Esophageal Varices
Tube is inserted down throat
Pumped up to 20 - 40 mm Hg to put pressure on the fundal vein
Preventing or managing confusion in cirrhosis
(2)
Lactulose (titrate 2 - 3 soft stools daily)
Non- absorbable antibiotics
Neomycin Sulfate
Rifaximin
2 meds given to help with alcohol withdrawal
Benzodiazepine
Thiamine
Asterixis …
To assess for…
Neurological condition that causes people to lose motor control in their fingers and wrists
Patient makes Stop with hands like directing traffic
Closes eyes
Observe for 30 seconds
Fetor hepaticus…
Seen in this disease…
also known as breath of the dead
breath, in urine, or in sweat of people with severe liver diseaseIt’s a late sign of liver failure
Clinical feature of hepatic encephalopathy
Alcohol Withdrawal Symptoms
Withdrawal is Oppsite of its effects
Alcohol is a downer so Withdrawal is UPPER
Whole body: restlessness, shakiness, sweating, or loss of appetite
Gastrointestinal: nausea or vomiting
Behavioral: agitation or irritability
Mood: anxiety or nervousness
Also common: fast heart rate, tremor, disorientation, headache, insomnia, or seizures
Asterixis
Fetor hepaticus
Alcohol Withdrawal Symptoms
Assess this body system
LOC
Corticosteroids creams & SSRI (Sertraline) can be used to manage this symptom of Cirrhosis
Pruritus
Avoid which medication with cirrhosis
Acetaminophen (Tylenol)
Not an NSAID
Viral Hep A can be caught from
Shell fish
Feces to mouth- food contamination
Viral hep B & C are caught how?
Sex
Needles
Blood Transfusion prior 92
Birth
How are Hep D & E caught
D: defective RNA virus needs helper function of HBV
E: Waterborn epidemic in some countries
Which hep have cirrhosis & liver cancer risks
B & C
Most common blood born infection in US
No vaccine
HCV
Which hep has vaccines
A & B
Icterus …
also known as jaundice, is a condition that causes the skin, mucous membranes, and whites of the eyes to turn yellow.
It’s caused by too much bilirubin, a yellow chemical in hemoglobin that carries oxygen in red blood cells
Arthralgia is
Joint pain, or soreness where two or more bones meet at a joint.
It can be a symptom of injury, infection, illness, or an allergic reaction to medication
Laboratory assessment
Hepatitis
Liver enzymes
ALT, AST, Bilirubin
Increase
Hepatitis
Staging/ grading of liver damage/ cancer
Which procedure…
Liver biopsy
Nutrition in Hepatitis
High carbs and calories
Mod protein & fat
Small frequent meals
Vitamins
Normal albumin range
3.5 - 5.3
Same as K
Platelets: normal range
150,000 and 450,000 microliter of blood
