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Liver > Liver > Flashcards

Liver Flashcards

1
Q

The injection of substances into or around esophagogastric varices to cause constriction, thickening & hardening of the vessel & to stop bleeding.

A

Sclerotherapy

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2
Q

CNS dysfunction frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness & coma.

A

Hepatic Encephalopathy

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3
Q

Involuntary flapping movements of the hands

A

Asterixis

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4
Q

Asterixis is a sign of what?

A

Hepatic Encephalopathy

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5
Q

The liver uses amino acids from protein for gluconeogenesis, which results in what byproduct?

A

Ammonia

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6
Q

The liver converts ammonia into what?

A

Urea

Ammonia produced by bacteria in the intestines is also removed from portal blood for urea synthesis. The liver converts ammonia, a potential toxin, into urea, a compound that is excreted in urine.

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7
Q

Plasma protein that is synthesized by the liver

A

Albumin

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8
Q

Breakdown of fatty acids (by the liver) into this, occurs primarily when the availability of glucose for metabolism is limited; as in starvation & uncontrolled diabetes

A

Ketone bodies

Ketone bodies provide a source of energy for muscles & other tissues.

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9
Q

What substances does the liver store?

(6)

A
  • Vitamin A
  • Vitamin B
  • Vitamin D
  • B-Complex vitamins
  • Copper
  • Iron
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10
Q

Substance composed mainly of water & electrolytes (sodium, potassium, calcium, chloride, bicarbonate, lecithin, fatty acids, cholesterol, bilirubin, and salts

A

Bile

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11
Q

Age-Related Changes of the Hepatobiliary System

A
  • Decrease in size/weight of liver (especially in women)
  • Decrease in blood flow
  • Decrease in replacement/repair of liver cells after injury
  • Reduced drug metabolism
  • Slow clearance of hep B surface antigen
  • Increased prevalence of gall stones due to increase in cholesterol secretion in bile
  • Decreased gall bladder contraction after meals
  • Atypical clinical presentation of biliary diseases
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12
Q

Symptoms that may have their origin in liver disease but are not specific to hepatic dysfunction:

A
  • Jaundice
  • Malaise/fatigue
  • Weakness
  • Pruritis
  • Abdominal pain
  • Fever
  • Anorexia
  • Weight gain
  • Edema
  • Increasing abdominal girth
  • Melena
  • Bloody stools
  • Easy bruising
  • Decreased libido in men
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13
Q

Normal total bilirubin

A

0.1 - 1 mg/dL

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14
Q

Normal plasma Ammonia level

A

15 - 45 mcg/dL

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15
Q

This lab value in liver function tests increases primarily in liver disorders and may be used to monitor the course of hepatitis or cirrhosis, or the effects of treatments that may be toxic to the liver

A

ALT

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16
Q

How does liver dysfunction affect coagulation factors/labs?

A
  • PT/PTT/INR increased
  • Bilirubin increased
  • LDL over 100
  • HDL under 40
  • Albumin decreased (3.4-5.4)
  • Total Cholesterol over 200
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17
Q

How is Cirrhosis fixed?

A

Liver Transplant

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18
Q

Jaundice becomes clinically evident when serum bilirubin level exceeds:

A

2.5 mg/dL

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19
Q

Functions of the liver:

(8)

A

Metabolism of

   1- Glucose

   2- Proteins

   3- Fats

   4- Drugs

5- Bile formation

6- Storage

   - Vitamin A, B, D & B-Complex

7- Ammonia conversion (to urea)

8- Excretion of bilirubin

20
Q
A
21
Q

Clinical Manifestations of Ascites

A
  • Increased abdominal girth
  • Rapid weight gain
  • SOB
  • Striae
  • Distended veins over abdominal wall
  • Umbilical hernias
  • Fluid & electrolyte imbalances are common
22
Q

Treatment of Ascites

A
  • Sodium restriction
  • Bed rest
  • Diuretics (Spironolactone or Lasix)
  • Paracentesis
  • TIPS (Transjugular Intrahepatic Protosystemic Shunt)
23
Q

What kind of IV fluid will be given with Lasix therapy?

A

Lactated Ringers

24
Q

Esophageal Varices are almost always caused by

A

Portal Hypertension

25
Q

Clinical manifestations of bleeding Esophageal Varices

A
  • Hematemesis
  • Melena
  • Deterioration in mental/physical status
  • Shock: cool, clammy skin, hypotension, tachycardia
  • Usually Hx of alcohol abuse
26
Q

Patients with esophageal varices should be screened (endoscopy) how often?

A

Every 1-2 years

27
Q

Pharmacological treatment for bleeding esophageal varices includes:

A
  • OCTREOTIDE (sandostatin)
             Vasoconstrictor. Continuous drip.To decrease bleeding
  • Vasopressin
  • Beta Blockers (propanolol/nadolol) used to prevent first bleed/prevent re-bleeding.
  • Nitrates can be used in combination with beta blockers to lower portal pressure.
28
Q

Balloon Tamponade is used to temporarily control hemorrhage/stabilize a patient with massive bleeding prior to other definitive management. What type of tube is used?

A

Blakemore

29
Q

Treatment of bleeding esophageal varices:

A
  • Octreotide (vasoconstrictor)
  • Balloon Tamponade (Blakemore tube)
  • Endoscopic Sclerotherapy
  • Endoscopic Variceal Ligation (banding)
  • Transjugular Intrahepatic Portosystemic Shunt (TIPS)
  • Surgical bypass
  • Devascularization & transection
30
Q

The neuropsychiatric manifestation of hepatic failure associated with portal hypertension & shunting of blood from the portal venous system into systemic circulation

A

Hepatic Encephalopathy

31
Q

Pharmacological management of Hepatic Encephalopathy

A
  • LACTULOSE: Reduces serum ammonia levels by trapping/expelling ammonia via feces
  • Neomycin: Antibiotic given to reduce levels of ammonia-forming bacteria in the colon
32
Q

Positioning for liver biopsy

A
  • Supine with arm above head
  • Left side-lying
33
Q

When taking care of a patient who has a balloon tamponade, always have what available, in case the patient starts to have respiratory issues?

A

Scissors

34
Q

Chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver

A

Hepatic Cirrhosis

35
Q

Manifestations of Compensated Cirrhosis

(Liver is still functional… Liver Disease)

A
  • Vascular spiders
  • Palmar erythema (reddened palms)
  • Ankle edema
  • Unexplained epitaxis
  • Firm, enlarged liver with abdominal pain
  • Splenomegaly (enlarged spleen)
  • Intermittant mild fever
  • Vague morning indigestion
36
Q

Manifestations of DecompensatedCirrhosis

(Liver is not functional… Liver Failure)

A
  • Ascites
  • Jaundice
  • Weakness
  • Muscle wasting
  • Coninuous mild fever
  • Clubbing of fingers
  • Purpura (due to decreased platelets
  • Spontaneous bruising
  • Epistaxis
  • White nails
  • Gonadal atrophy
37
Q

Medical management of Cirrhosis

A
  • H2receptors/antacids
  • Vitamins/nutritional supplements to aid in healing of damaged liver cells
  • Spironolactone to treat ascites
38
Q

Manifestations of Liver Cancer

A
  • Continuous dull RUQ pain, epigastic or back
  • Weight loss
  • Loss of strength
  • Anorexia
  • Anemia
  • Ascites if nodules obstruct the portal veins
39
Q

What type of meds are given to liver transplant patients?

A

Immunosuppressants:

  • cyclosporine
  • tacrolimus
  • corticosteroids
  • azathioprine
  • mycophenolate mofetil
  • daclizumab
40
Q

Risk factors for Hep B

A
  • IV drug users
  • Baby born to infected mother
  • Unprotected sex
41
Q

How is Hep A Virus transmitted?

A

Fecal-oral route:

  • Contaminated food/water
  • Poor sanitation
42
Q

How is Hep C transmitted?

A

Blood

43
Q

What is given to provide passive immunity for a person exposed to Hep B that hasn’t been vaccinated?

A

Hep B immune globulin (HBIG)

44
Q

What is the most promising treatment for Hep B?

A

alpha-interferon

  • 5 million units daily or 10 million units 3x weekly
  • for 16-24 weeks
  • Must be administered by injection
45
Q

Side effects of interferon

A
  • Fever/chills
  • Anorexia
  • Nausea
  • Myalgias
  • Fatigue
46
Q

Delayed side effects of interferon

A
  • Bone marrow suppression
  • Thyroid dysfunction
  • Alopecia
  • Bacterial infections

Liver (1 decks)

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