Liver And Gallbladder Flashcards
Where is the liver and gallbladder located in the abdomen?
RUQ
What are the fxns of the liver?
Metabolism and energy storage
Detox of drugs, alcohol, and toxins
Converts ammonia from protein metabolism to urea
Produces bile to digest fats in the small intestine
Helps excrete bilirubin and cholesterol
Stores vitamins and minerals (fat soluble)
Contributes to immune fxn, clotting, and hormone regulation
How do we palpate the liver? What should we feel?
Pt in supine, come across on a diagonal from the L ASIS up to the R rib cage
Find the location under the ribs and have the to take a deep breath and feel the liver come into your hands with the dorsal of you fingers in contact with the underside of the ribs
Should feel the soft area become hard the hard area of the liver
Check for pain
What are the hepatic s/s?
Jaundice/bruising; yellow sclera
CTS (carpal tunnel syndrome)
Intermittent pruritis (itching)
Weakness and fatigue
Dark urine/clay colored stools
Brain fog
Chronic fatigue
RUQ pain
Referred pain to thoracic spine
Weight change
Ascites/LE edema
White fingernails
Cold hands/feet
What is asterixis?
Liver flap of wrist or hip in pts with hepatic encephalopathy
How does asterixis occur in the wrist?
In sitting, when attempting to extend the wrist, the hand tremors like a bird flapping its wings
How does asterixis occur in the hips?
In supine, passively fox and abduct the hips with the feet on the mat
The asterixis seems to be provoked by the involuntary contraction of hip abductors against gravity
What causes asterixis in hepatic encephalopathy?
Ammonia toxicity
What are some interventions for managing hepatic diseases?
Put the pt in Fowler’s position with head 18-20” above the knees bc they likely won’t tolerate lying flat bc it makes them feel like they’re drowning
Limit fluid intake to 1.5 mL/day
Limit Na intake to <2g/day
Diuretics to remove additional fluid
Paracentesis for further fluid removal
Breathing exercises
Monitor for falls, fever, chills, pain, and fatigue
What is the goal of interventions with hepatic diseases?
To not let s/s get out of control
What are the two options for liver donation?
Live donor or deceased donor
How does a living donor liver transplant work?
The pt will get part of the living person’s liver and it grows to a normal size
How does a deceased donor liver transplant work?
The pt can either receive an entire liver or a part of the liver split bw two people
What is the survival rate for deceased donor liver transplant at 1 year?
86%
What is the survival rate of a deceased donor liver transplant at 3 years?
78%
What is the survival rate of a deceased donor liver transplant at 5 years?
72%
What is the survival rate of a deceased donor liver transplant at 20 years?
53%
What types of hepatitis can result from contaminated water or food?
Hepatitis A and E
What types of hepatitis are more blood related?
Hepatitis B, C, and D
What types of hepatitis have vaccines in the US?
Hepatitis A, B, and D
What is the most common cause of acute liver failure?
Drugs (OTC or prescription)
What percent of heavy drinkers develop alcohol-related liver disease?
10-35%
What has to be done for alcohol-related liver disease?
The pt must change their behaviors
The pt must eat healthy foods
What are some foods to cleanse the liver?
Carrots, beets, olive oil, lemon juice, green tea, turmeric, garlic, spinach, leafy greens, avocado, and grapefruit
What are the symptoms of hepatitis?
Dark urine
Stomach/abdominal pain
Jaundice
Pale or clay colored stool
Fever
Loss of appetite
Fatigue
Nausea/vomiting
Aching jts
How do we get omega 3?
Fish oil
How much fish oil should we get?
EPA 250-500mg
DHA 250-500mg
ALA 1600 (male) 1100 (female)
What is the fxn of the gallbladder?
Important in processing and absorbing food (bile fxns)
Storage of bile
Release of bile
Regulating bile flow
Bile pH regulation
Absorption of certain vitamins in our body
How do we palpate the gallbladder?
Place your fingers to the R of the rectus just below the rib cage and ask the to to take a deep breath
What is a red flag with gallbladder palpation?
Sudden pain and abdominal muscle testing that ceases on inspiration is suggestive of gallbladder pathology
What motion may cause pain with gallbladder pathology?
FB
What is Murphy’s sign (of the gallbladder)?
Hook fingers under the costal margin and have the pt inhale
Causes sharp pain or the pt is unable to complete inspiration
What are the risk factors for gallbladder pathology?
Fat
Forty
Female
Fatty foods
Fertile
Family hx
Flatulent
Fair skin
What are gallstones make of?
Cholesterol and pigment
How do we ID gallstones?
US
T/f: when gallstones get to a certain size, even some meds will take a long time to work
True
When do gallstones form?
When there is excess cholesterol and the pH of the bile is too low
What are gallstones meds good for?
Only good for small stones and people who aren’t good with surgical risks
What does the gallstone med UDCA do?
It can dissolve cholesterol stones
What does the gallstone med CDCA do?
Works to decrease cholesterol saturation in bile
What are the guidelines for diet after gallbladder removal?
Limit fat intake
Eat smaller, more frequent meals
Gradually increase more fiber
Limit caffeine, alcohol, and spicy foods
Stay hydrated
T/f: after getting the gallbladder removed, you have to ease back into a normal diet
True
