Liver Alterations Flashcards by Brandy Wilson

What are some functions of the liver?

Stores iron and other vitamins
Breaks down toxins and ammonia
Controls blood glucose and cholesterol
Makes albumin, bile, enzymes, clotting factors
Metabolizes fat, proteins, carbs

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Info on Hep A

Oral/fecal route
Common in poor santitation
Day cares/nursing homes
Outbreaks from infected food handler

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Info on Hep B

Blood borne or other body fluids
Vaccine (3 doses given by 18 months)
HBIG is given when exposure happens
Some adults will not have had vaccine

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Info on Hep C

Most damaging but 95% curable if treated
Blood borne/body fluids
High risk are drug users/MSM
Many are co-infected with HIV
No vaccine
Important to screen high risk patients

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What are S/Sx of acute hepatitis?

Anorexia, N/V, No taste/smell
Clay colored stools (bili NOT in stool)
Dark urine (bilirubin in urine)
Jaundice
Low grade fever
Joint/muscle pain
Pruritus
RUQ tenderness
Flu like symptoms
Hepatomegaly, splenomegaly (enlarged)

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S/Sx of chronic hepatitis?

Elevated AST/ALT
Ascites/edema in legs
Asterixis (liver flap)(Hands tremor when flexed back)
Increased bili/jaundice
Joint/muscle pain
Bleeding problems/spider angiomas
Encephalopathy
Palmar erythema

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What is difference in acute and chronic hepatitis?

Acute hepatitis can turn into chronic if patient doesn’t recover. Many times people don’t know they have hepatitis or don’t seek treatment.
Many times chronic HBV is acquired at young age and is asymptomatic until damage becomes obvious.

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What is hepatic encephalopathy?

Proteins the liver would normally breakdown stay in blood. Ammonia levels high»cross BB Barrier»encephalopathy.
Also: astrocytes swell, inflammatory cytokines in brain invade, neurotransmitters are abnormal
Life threatening
Neuro
Psych
Motor

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What is cause of ascites?

Liver is not producing albumin.
Albumin keeps solutes and fluid in blood.
Low albumin means solutes leave blood and water follows.
Also:
Portal hypertension pushes fluids into lymph system, where lymph vessels can’t deal with it and they leak.
Hyperaldosteronism»Na+ retention
Increased ADH»water retention

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How is hepatitis diagnosed?

Labs will look for specific antigens or antibodies to certain viruses.
If there are antibodies that means there was a previous infection or immunization.
If there are antigens, usually sign they are highly infective.

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What are some liver function tests?

ALP (Increased in liver dysfunction)
AST (Increased in liver injury)
ALT (Increased in liver injury)
GGT (increased in liver injury)
Albumin (decreased in chronic liver problems)
Bilirubin (Increased in liver injury)
Prothrombin time will be prolonged (decreased PPT production in liver)

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What is tx for acute viral hepatitis?

Nutrition (small frequent meals)
REST (decreased metabolism allows liver rest)
Avoiding alcohol and meds

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What is tx focused on for chronic HBV and HCV?

Focus on decreasing viral load and liver enzymes with meds. (another slide)
No special diet but nutritious

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Which meds will lower viral load of HBV?

Nucleoside/Nucleotide analogs:
adefoVIR
entecaVIR
tenofoVIR
lamiVUDINE
telbiVUDINE

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What is interferon?
How is it used to treat HBV?

A naturally occurring immune protein made by body to fight infection.
Pegylated interferon is used to decrease viral load in HBV.
Rarely used because it has terrible side effects.

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Which meds are used to treat HCV?

It’s called DAA therapy. (direct acting antiviral) Twelve week course. Most that finish are cured.
glecaPREVIR
grazoPREVIR
voxilaPREVIR

elbASVIR
ledipASVIR
pibrentASVIR
velpatASVIR

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What is best teaching for prevention of HAV infection?

Hand hygiene
Good sanitation
Isolation not needed
Vaccination is best protection against
Vaccine can prevent infection
IG (immune globulin) after stop after exposure

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What is best teaching for prevention of HBV and HCV infection?

Don’t share needles
Condoms
Hand washing
Don’t share toothbrushes, razors
HBIG after exposure (for HBV only
Vaccine before exposure (for HBV only)
No vax for HCV

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What are the two most common drugs that cause chemical hepatotoxicity?

Acetaminophen
Antibiotics, especially amoxicillin-clavulanate

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What disease is associated with Kayser-Fleischer rings? And what are these rings?

Wilson disease-a genetic disorder that makes copper accumulate in liver.
These rings appear on the cornea as a red/brown discoloration around the outer edge of cornea.

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What is hemochromatosis?
Hemo-chro-ma-tosis

Excess iron in blood/liver
Can damage liver

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What is cholangitis?

Inflammation of the bile duct system

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What is nonalcoholic fatty liver disease?

Broad term
Can range from mild to severe
Mild=build up of fat in liver leads to inflammation, fibrosis
Severe=cirrhosis, liver cancer
Associated with metabolic syndrome

What is the first sign of nonalcoholic fatty liver disease?

Elevated liver enzymes

What is steatosis?

Fatty liver

Most common causes cirrhosis.

Chronic HCV Alcoholism Fatty liver disease

What happens to liver in cirrhosis?

Damage to hepatocytes>>Scar tissue (fibrosis)>>Nodules Abnormal blood and bile flow from dysfunctional reconstruction Liver becomes starved for blood or engorged

What are early signs of cirrhosis?

Fatigue Hepatomegaly

What are late signs of cirrhosis?

Jaundice Edema/ascites Skin lesions/palmar erythema Neuropathy Blood disorders Spider angiomas Hormone problems

What are some neuro signs of cirrhosis?

Peripheral neuropathy Asterixis (liver flap) Hepatic encephalopathy

What are some GI signs of cirrhosis?

N/V/Anorexia Dull RUQ pain Fetor hepaticus (fruity musty breath) Esophageal/gastric/hemorrhoidal varices

What are some reproductive signs of cirrhosis?

Amenorrhea Testicular atrophy Gynecomastia Impotence

What are some skin signs of cirrhosis?

Jaundice Spider angioma Palmar erythema

What are some hematologic signs of cirrhosis?

Anemia Thrombocytopenia Leukopenia Coagulation disorders Splenomegaly

What are some metabolic problems in cirrhosis?

Hypokalemia Hyponatremia Hypoalbuminemia

What are some CV problems in cirrhosis?

Fluid retention/ascites Peripheral edema Portal hypertension

What is treatment of choice for reducing portal hypertension and esophageal varices?

Propranolol

What is most dangerous complication of cirrhosis?

Esophageal varices

What is portal hypertension?

Increased pressure in liver's circulatory system from the obstruction of blood in and out of liver. Causes large collateral veins to form. Ascites and esophageal and gastric varices. Splenomegaly

What can be some complications of ascites?

Dehydration>HYPOvolemia Peritonitis in ascitic fluid HYPOkalemia (from hyperaldosterone)

What is treatment for ascites?

Spironalactone Furosemide Sodium restriction (<2 g daily) Fluid removal through paracentesis Albumin replacement therapy

What are some important nursing interventions in ascites?

Daily weights Measure ab girth I/O's Sodium restriction (<2 g daily) High Fowlers

What are some important things to avoid in pts with esophageal or gastric varices?

Anything that thins blood (aspirin, heparin, lovenox) NSAIDS Alcohol

What meds are used to treat BLEEDING varices?

Sandostatin Vasopressin Both reduce portal HTN, constrict vessels of liver and spleen

What 2 meds are used to treat hepatic encephalopathy?

1. Lactulose Binds ammonia to poop and laxative effect Given PO, NG or enema Reduces ammonia in blood stream Makes poop acidic so keep skin protected 2. Rifaximin This is a broad spectrum antibiotic used to treat infections of gut. It is not absorbed systemically so only works inside the gut. It works by killing bacteria in gut thus reducing ammonia production.

What type of diet should a pt with cirrhosis need?

High calorie=3K daily Lots of carbs, moderate to low fat If alcoholic cirrhosis will typically be malnourished and will need lots of protein

What are some things that could increase risk of hepatic encephalopathy?

Cerebral depressants GI bleeding Fluid/electrolyte imbalance Infection Paracentesis Constipation/Diarrhea

What is usually first sign of acute liver failure? Why? What is usual cause? Liver failure usually causes what complication?

Change in LOC Because usually have hepatic encephalopathy Medication (usually Tylenol) Renal failure

What is normal PTT? Normal PT?

20----45 Seconds High (which means takes them longer than normal to clot) in Liver disease PT=11----12.5 seconds

What are normal albumin levels?

3.5-----5 g/dL

What are normal AST levels?

0-----35 U/L

What are normal ALT levels?

4------36 U/L

What are normal ALP levels?

30----120 U/L

What are normal ammonia levels?

10------80 mcg/dL

What are normal bilirubin levels?

Direct: 0.1----0.3 mg/dL

What is normal LDH-5 levels?

100------200 High means liver damage