liver and pancreas Flashcards
Stages of liver damage:
Health liver Fatty liver (increase liver due to fat deposits) Fibrosis liver (formation of scar tissue) Cirrhosis liver (liver cell destruction)
What is total bilirubin
The direct and indirect bilirubin (total is combined direct and indirect)
– waist product from breakdown of blood cells
Total bili range
0.3-1.0
ALT
helps metabolize proteins
8-40
AST
Helps metabolize protein and ALT
10-40
GGT
0-30
LDH (lactic acid dehydrogenase)
shows erythrocyte damage
100-225
Alk phos
Breaks down proteins and elevares in bone cancer or problems
30-120
Amylase
23-85
pancreatic enzyme - elevates with not working well
lipase
0-160
elevates with not working well
Jaundice: patho
impairment of bodies ability to metabolize and secrete bilirubin
serum bilirubin levels > 3
Jaudice: cause –> hepatocellular
Hepatitis, hepatotoxins
Jaundice: cause –> obstructive process
Cholelithiasis
Cancer
pancreatitis
Hemolytic jaundice
Increased production of bilirubin due to hemolysis
Multiple transfusions
Hereditary hyperbilirubinemia
Impaired bilirubin metabolism
May require transplant
portal HTN
Increased resistance to blood flow through the liver and increased blood flow due to vasodilation in the splanchnic circulation
Portal HTN: complications
Ascites
Gastroesophageal varices
Esophageal varices: endoscopic therapies
Esophageal banding
Sclerotherapy
Balloon tamponade
Esophageal varices: sclerotherpy
used for acute bleed to promote thrombosis
Ascites
Loss of fluid into the peritoneal space causes further sodium and water retention by the kidneys
Ascites: dietary modification
decrease Na
Ascites: diuretics
Spironolactone and furosemide Daily weight (may have weight loss daily limit)
Ascites: paracentesis
temporary removal
Ascites: TIPS
Diverts blood flow from high pressure hepatic bed to low pressure vascular bed
Increases risk of hepatic encephalopathy
Ascites: complications
Fluid overload
E coli
peritonitis – spontaneous from all the pressure changes
Long term antibiotic therapy after diagnostic paracentesis
Cirrhosis: patho
normal liver tissue is replaced by fibrotic tissue in response to damage to liver cells
more prone to ulcers
Focused assessment changes
Hepatic encephalopathy: assessment
Anorexia NV muscle waisting urine for presence of bilirubin stool tan or gray with jaundice resp. status itching hepatorenal encephalopathy
Hepatic encephalopathy: labs/diagnostics
EGD Liver Biopsy liver labs increased bili low albumin
Hepatic encephalopathy: interventions
Oral hygiene - promote intake and high calories Manange skin integrity I&O and daily weight BP (hypotension from varices) HR IV fluids Balloon tamponade for varices
Hepatic encephalopathy: complications
Ascites jaundice hepatorenal syndrome Bleeding varices coagulation defects Encephalopathy
Hepatic encephalopathy: albumin
Get it if they’re exceedingly low or if we are trying to minimize effect of its loss after paracentesis
Hepatic encephalopathy: education
- skin care
- medications
- no ETOH
- bowel maintenance
- Na restriction and food selections
- nutritional supplements
- NSAID acetaminophen safety
- follow ups
- check with provider pharmacist for OTC
- ascites
- weigh and log
- support groups
What is alcoholic liver disease
Excessive consumption of alcohol
AST/ALT > 2
How do we ID someone of having alcoholic liver disease?
CAGE questions
Supportive groups
Hepatitis A B and C
Inflammation of the liver from a viral source