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NSG 121 > liver > Flashcards

liver Flashcards

1
Q

liver recycling

A

People (produce)
Drink (detox)
So (storage)
Much (metabolize)

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2
Q

Produce

A

albumin
bile
coagulation factor

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3
Q

detox

A

everything is detoxed by liver (1st pass)

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4
Q

storage

A

stores glycogen

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5
Q

metabolize

A

converting/breaking things down for bodily use

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6
Q

albumin

A

binds with calcium
attracts/transports drugs
attracts fluid to vascular space

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7
Q

bile

A

transports bilirubin and cholesterol out of system (goes unchecked causes jaundice)

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8
Q

coagulation factor

A

decreased bleeding time
PT, PTT, INR

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9
Q

cells responsible for detox

A

kupfter cells

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10
Q

wall of bricks

A

wall= glycogen
bricks= glucose

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11
Q

protein bar
wrapper gets thrown away and recycled

A

wrapper= ammonia
thrown away= metabolized
recycled= urea

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12
Q

damaged liver labs

A

al ↓
bili ↑
TC ↑(200)
LDL ↑(100)
HDL ↓ (40)
PT(12-15 sec) ↑ clotting time
PTT (<15sec) ↑ clotting time
INR (25-30sec) ↑ clotting time
ammonia ↑
total protein ↓
AST (in tissue and muscle) ↑
ALT (more liver function) ↑
ALP (muscle) ↑

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13
Q

liver
general symptoms

A

fatigue (no glycogen= no energy)
fever (inflamed liver)
jaundice (↑bili = yellowing)
itching (no protection = no bile)

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14
Q

liver
neuro symptoms

A

sleep disturbance
mood changes
confusion
coma
(build up of ammonia in system)

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15
Q

liver
cardiopulmonary symptoms

A

dyspnea (↑ fluid retention= difficulty breathing)

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16
Q

liver
GI symptoms

A

N/V
hematemesis (throwing up blood)
melena (black tarry stool)
hematochezia (stool with blood)
abd. pain
abd. girth ↑ (ascites)
actives (fluid retention, fluid leaking into third space)

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17
Q

liver
hematologic symptoms

A

↑ bruising
bleeding
dependent edema (liver makes clotting factor)
(↓ liver= ↓clotting factor)

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18
Q

liver
endocrine symptoms

A

↓libido (↓ detox ↑androgen/estrogen= affected libido)

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19
Q

hepatitis types

A

viral
non-viral
drug induced

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20
Q

hepatitis manifestations

A

jaundice
N/V
pain/tender/ enlarged liver
dark urine
anorexia
flu symptoms

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21
Q

Viral hepatitis

A

HEP A
HEP B
HEP C
HEP D
HEP E

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22
Q

HEP A
route

A

fecal- oral (contaminated food/water)

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23
Q

HEP A
acute or chronic

A

acute

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24
Q

HEP A
who is at risk

A

health care, travelers, older adults, pre-existing liver conditions, 3rd world country

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25
Q

HEP A
incubation period

A

15-50 days

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26
Q

HEP A
vaccine?

A

vaccine

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27
Q

HEP B
route

A

contact with infected body fluids

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28
Q

HEP B
acute or chronic

A

both
chronic becomes carriers

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29
Q

HEP B
who is at risk

A

healthcare, multiple sex partners, blood transfusion, sharing razor/tooth brush, tattoo, piercing, drug users, shared needles, transplant, immunocompromised

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30
Q

HEP B
incubation period

A

25-180 days

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31
Q

HEP B
vaccine?

A

vaccine

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32
Q

HEP C
route

A

contact with body fluids/ blood products

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33
Q

HEP C
acute or chronic

A

both

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34
Q

HEP C
at risk

A

men-men, drug users, blood transfusion, transplant, health care, prison, baby, sharing razor/tooth brush, tattoo, piercing, needle stick injury, syringe

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35
Q

HEP C
incubation period

A

2wk-6mo

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36
Q

HEP C
vaccine?

A

treatment only

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37
Q

HEP D
route

A

body fluids, blood

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38
Q

HEP D
acute or chronic

A

chronic

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39
Q

HEP D
at risk

A

un protected sex, previously had HEP B, health care immunocompromised, parenteral routes

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40
Q

HEP D
incubation period

A

14-56 days

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41
Q

HEP D
vaccine?

A

no vaccine

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42
Q

HEP E
route

A

fecal-oral (contaminated food/water)
undercooked meat

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43
Q

HEP E
acute or chronic

A

acute
self limiting

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44
Q

HEP E
at risk

A

3rd world country, poor sanitation, health care

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45
Q

HEP E
incubation period

A

15-64 days

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46
Q

HEP E
vaccine?

A

no vaccine

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47
Q

Non-viral hepatitis

A

alcoholic

48
Q

alcoholic hepatitis

A

excessive ETOH consumption

49
Q

Alcoholic hepatitis treatment

A

ETOH cessation, fluid management, rest, therapy

50
Q

Drug induced hepatitis

A

acetaminophen

51
Q

acetaminophen hepatitis

A

d/c medication

52
Q

cirrhosis

A

scaring of the liver (obstructs normal blood flow, bile flow, and hepatic metabolites)

53
Q

types of cirrhosis

A

alcoholic
post necrotic
biliary
cardiac

54
Q

alcoholic cirrhosis

A

reversible with alcohol cessation

55
Q

post necrotic cirrhosis

A

viral hepatitis
autoimmune hepatitis
steato hepatitis

56
Q

biliary cirrhosis

A

obstructed bile ducts = damaged hepatocytes

57
Q

cardiac cirrhosis

A

right sided HF (rare)

58
Q

NAFID

A

NON-FATTY LIVER DISEASE
age
obesity
diabetes 2
metabolic syndrome

59
Q

early manifestations of cirrhosis

A

GI issues
abd. pain
fever
fatigue
wt. loss
enlarged liver/spleen

60
Q

last manifestations of cirrhosis

A

hepatocellular failure
portal hypertension
jaundice

61
Q

hepatic encephalopathy

A

altered LOC
(portal hypertension= ↑ toxin in blood)

62
Q

portal hypertension

A

↑ pressure in portal vein from black flow/blockage of liver

63
Q

ascites

A

Normal:
collection of fluid it peritoneal space
fluid shift into third space
Massive:
sodium and water retention
renal vasoconstriction

64
Q

splenomegaly

A

enlarged spleen from backup of blood

65
Q

hemmorrhoids

A

in and out of rectum

66
Q

hepatorenal syndrome

A

decr. urine output (500mL> 24 hr)
↑BUN and creatinine

67
Q

alcohol withdraw

A

cognitive changes
tremors
tachycardia

68
Q

hepatopulmonary syndrome

A

dyspnea from incr. ascites

69
Q

spontaneous bacteria peritonitis

A

advanced liver disease
encephalopathy
jaundice

70
Q

esophageal varices

A

LIFE THREATENING EMERGENCY
fragile listened veins
decr. prothrombin, incr. bleeding

71
Q

esophageal varices treatment

A

vasopressin (slows blood flow)
beta blockers (prevent bleeding)
ligation (bands around varies)
sclerotherapy (burn bleeding)
Blakemore tube(balloon, ↑mortality)
TIPS (shunt, decr portal pressure)

72
Q

metabolic syndrome ↑ risks for

A

diabetes, heart disease, stroke

73
Q

high sugar in veins destroys vital organs and blood vessels

A

kidney failure
neuropathy
blindness
hypertension
MI

74
Q

Types of diabetes

A

type 1
type 2

75
Q

TYPE 1

A

type ONE we have nONE
bOrn (autoimmune/ genetics) pancreas CANNOT produce insulin (the body destroyed the pancreas)
insulin dependent FOR LIFE

76
Q

TYPE 2

A

Terrible TWOs
type TWO and YOU & FEW
problem is YOU, DIET, LIFESTYLE
FEW insulin receptors working
(cells not responding to insulin, insulin resistance)

77
Q

S/S of type 1

A

ABRUPT onset
thin
DKA (hyperglycemic) (can be mistaken as drunk)

78
Q

S/S of type 2

A

GRADUAL onset
obese
fatigue
HHNS (hyperglycemic)
Wt loss=no diabetes

79
Q

S/S of type 1&2

A

S (slow healing)
U (blUrry vision)
G (glycosuria)
A (acetone [fruity breath])
R (retention of acetone [decr. renal function])
HTN
kidney damage
heart damage
eye damage
skin damage
Stroke
neuropathy (decr. mobility)
↑infection (amputation)
Polyuria (urinate glucose out)
Polydypsia ( thirst to dilute glucose)
Polyphangia (cells starving because there is not insulin)
↑triglycerides
↑cholesterol
↑albumine in urine
BUN/Cretinine

80
Q

Type 1 treatment

A

LIFELONG INSULIN
yearly eye exam
assess feet daily
A1c
diet
urine check
finger stick
continuous glucose monitoring

81
Q

Type 2 treatment

A

DIET
EXERCISE
ORAL MEDS (metformin)
INSULIN
yearly eye exam
assess feet daily
A1c
diet
urine check
finger stick
continuous glucose monitoring
diet education (watch sugar/starches, white carbs, lean meat veggies)
limit alcohol consumption

82
Q

hypoglycemia

A

HYPOglycemia= LOW sugar
70>
low brain function=rapid brain death
HYPOGLY the brain will DIE

83
Q

hypoglycemia symptoms

A

HI WASH
Headache
Irritable
Weakness
Anxious
Sweaty
Hunger

84
Q

hypoglycemia causes

A

exercise
insulin peak times
ETOH

85
Q

hyperglycemia

A

HYPERglycemia=HIGH sugar
115< A1c 6.5+
blood is thick as MUD

86
Q

hyperglycemia symptoms

A

3 P’s
Polyuria
Polydypsia
Polyphagia

87
Q

hyperglycemia causes

A

4 s’s
Sepsis (#1 cause)
Stress
Skip insulin
Steroids

88
Q

Dawn phenomenon

A

blood sugar rises with the sun

89
Q

Somogyi effect

A

hypoglycemia jumps to hyperglycemia

90
Q

Glucagon

A

no sugar=liver releases glucagon
GLUcagon=GLUcose GONE from liver into blood

91
Q

insulin type

A

rapid acting
short acting (regular)
intermediate
long acting

92
Q

rapid acting example

A

lispro

93
Q

rapid acting
onset
peak
duration

A

O: 15min
P: 1-2hr
D: 3-5hr

94
Q

What to know about rapid acting

A

meal tray in room
units
27-29G

95
Q

short acting example

A

Regular
humilin R
novolin R

96
Q

short acting
onset
peak
duration

A

O: 30-60min
P: 2-4 hr
D: 4-6hr

97
Q

what to know about short acting

A

the only insulin given IV

98
Q

Intermediate examples

A

NPH

99
Q

intermediate
Onset
peak
duration

A

O: 2-4hr
P: 6-12ht
D:<24hr

100
Q

what to know about intermediate

A

cloudy

101
Q

long acting example

A

Detemir (last a year)
gLARgine (LARge lasting)

102
Q

long acting
onset
peak
duration

A

O: 2hr
P: continuous
D: 24he

103
Q

what to know about long acting

A

cannot nix with anything

104
Q

how to mix insulin

A

Regular first than Intermediate

105
Q

Injection site

A

abd.
thing
underarm

106
Q

deadly hypoglycemia

A

Awake=Ask to eat
Sleep=Stab D50
shake, clammy give candy

107
Q

meds for diabetes to increase insulin sensitivity

A

sulfonylureas
biguanides
meglitinide analogs

108
Q

sulfonylureas example

A

glipizIDE (the heart can DIE)
ONLY TYPE 2

109
Q

when do you give sulfonlureas

A

30 min before meals

110
Q

side effects of sulfonylureas

A

hypoglycemia

111
Q

biguanides example

A

metformin
HOLD FOR CT SCAN WITH CONTRAST

112
Q

when do you give biguanides

A

with meals

113
Q

side effects of biguanides

A

Mini chance og hypoglycemia
Massive wt. gain
Major liver/kidney toxic

114
Q

meglitinide analogs example

A

prandin
starlix
RAPID ONSET SHORT DURATION
NO IF NPO OR FLUID RESTRICTION

115
Q

when do you give meglitinide analogs

A

just before meals

116
Q

side effects of meglitinide analogs

A

hypoglycemia

NSG 121 (4 decks)

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