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Med-Surg > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

metabolic liver functions

A
  • fat, carb, and protein metabolism
  • vitamin absorption and iron storage
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2
Q

homeostatic liver functions

A

alter circulating blood volume

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3
Q

filtering liver functions

A

purifies blood of bacteria

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4
Q

clotting liver functions

A

produces clotting factors

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5
Q

drug and chemical liver functions

A

drug and chemical detoxification and metabolization

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6
Q

what do we look at when assessing liver function

A
  • liver enzymes
  • bilirubin
  • clotting measures
  • ammonia and proteins
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7
Q

enzymes are the

A

clear portion of the blood

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8
Q

you will see enzymes rise when an

A

organ is damaged

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9
Q

____ is specific to liver damage

A

ALT

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10
Q

_____ could be from cardiac more than liver

A

AST

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11
Q

_____ shows biliary tract obstruction

A

ALK phospahte

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12
Q

when the liver is not working well you will see ______ and increase in _______

A

proteins and increase in albumin

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13
Q

ALT

A

alanine aminotransferase

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14
Q

normal ALT

A

5-35 units / L

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15
Q

AST

A

aspartate aminotransferase

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16
Q

normal AST

A

0-35 units / L

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17
Q

ALK phosphate

A

alkaline phosphate

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18
Q

ALK phospate normal

A

20-90 units / L

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19
Q

LDH5 and its normal

A

lactate dehydrogenase isoenzyme5 6-16%

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20
Q

ALP1

A

alkaline phosphate isoenzyme1 42-136

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21
Q

5’N

A

5’Nucleotidase less than 17 U/L

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22
Q

GGT

A

gamma glutamyl transferase

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23
Q

normal GGT

A

males 9-69 U/L
females 4-33 U/L

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24
Q

bilirubin

A

end product of hemoglobin degradation

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25
Q

fat soluble bilirubin is also known as

A

unconjugated

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26
Q

unconjugated means

A

it has not gone to the liver yet to get conjugated and become water soluble

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27
Q

water soluble bilirubin is also known as

A

conjugated

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28
Q

conjugated means

A

it reaches the liver and combines glucoronic acid and becomes conjugated

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29
Q

jaundice is

A

problem with body breaking down rbc

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30
Q

total bilirubin normal

A

0.1 - 1.2 mg/dL

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31
Q

indirect (unconjugated) normal

A

0.1-1.0 mg/dL

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32
Q

direct (conjugated) normal

A

0.1-0.3 mg/dL

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33
Q

urobilinogen normal

A

negative in freshly voided urine

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34
Q

liver produces which clotting factors

A

prothrombin, vitamin K, and other clotting factors that help us clot

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35
Q

if any of the clotting factors are elevated it means

A

that clotting factors are not being produced

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36
Q

normal prothrombin time (PT)

A

11.0-12.5 seconds

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37
Q

INR

A

internationalized normalized ratio 0.81-1.2

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38
Q

partial thromboplastin time (PTT)

A

60-90 seconds

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39
Q

aPTT

A

activated partial prothromboplastin time

40
Q

normal aPTT

A

23-32 seconds

41
Q

serum ammonia causes

A

mental status changes

42
Q

serum albumin is important

A

protein in the body

43
Q

stigma to liver disease is often related to

A

alcoholism

44
Q

hepatic failure

A

the inability of the liver to perform its normal functions

45
Q

causes of hepatic failure

A
  • acute viral hepatitis
  • autoimmune liver disease
  • drug induced liver disease
  • chronic liver disease (cirrhosis)
  • multiple organ failure (sepsis)
46
Q

stages of hepatic failure

A

fatty liver -> liver fibrosis -> liver cirrhosis

47
Q

fatty liver

A

deposits of fat causes liver enlargement

48
Q

liver fibrosis

A

scar tissue forms

49
Q

liver cirrhosis

A

growth of connective tissue destroys liver cells

50
Q

acute hepatic failure

A

includes evidence of abnormal coagulation and INR >1.5, altered mental state, encephalopathy, and illness <26 weeks

51
Q

acute hepatic failure results from

A
  • a primary disease process in the absence of pre-existing disease
  • as a complication of chronic liver disease, cirrhosis
  • multiple organ failure in critically ill
52
Q

fulminant hepatic failure

A

acute hepatic failure in a patient with no pre-existing history that develops rapidly (<8 weeks) with encephalopathy

53
Q

fulminant hepatic failure is a severe form of

A

acute hepatic failure

54
Q

fulminant hepatic failure results from

A
  • viral infections (hep A and hep B)
  • hepatotoxins (acetaminophen)
55
Q

Hep A is transmitted by

A

fecal - oral route

56
Q

Hep B is transmitted by

A

blood or body fluids

57
Q

Hep C is transmitted by

58
Q

Hep D is transmitted by

59
Q

Hep E is transmitted by

A

fecal - oral route

60
Q

cirrhosis of the liver

A

chronic disease is which liver tissue is replaced with fibrous tissue and functional liver cells are lost

61
Q

cirrhosis of the liver is the ____th leading cause of death in Canada

62
Q

during cirrhosis of the liver

A
  • cell necrosis occurs
  • inability to conjugate bilirubin
  • inability to detoxify bilirubin
  • inability to produce clotting factors and albumin
  • inability to convert ammonia to urea
  • inability to regulate glucose
  • inability to purify blood
  • inability to regulate blood volume
63
Q

complications of cirrhosis

A
  • portal htn
  • esophageal varices
  • ascites and albumin
  • hepatorenal syndrome
  • infections
  • hepatic encephalopathy
64
Q

portal hypertension

A

results from increased resistance within the portal venous system

65
Q

portal htn is caused by

A

cirrhosis disrupting normal structure of liver creating resistance to blood flow through the liver

66
Q

overtime a system of collateral circulation develops to relieve the pressure =

67
Q

esophageal varices

A

an increase in pressure (coughing, vomiting, straining) can cause the varices to rupture

68
Q

damage to liver tissues increases _______ resistance

69
Q

venous flow becomes blocked in the liver, causing portal vein tension to ________

70
Q

blood backs up through the splenic vein into the spleen and ________ circulation

A

collateral

71
Q

ascites

A

accumulation of serous fluid in the peritoneal or abdominal cavity

72
Q

ascites is usually seen in

A

advanced liver failure

73
Q

ascites is caused by

A

decrease colloid osmotic and portal hypertension

74
Q

hepatorenal syndrome (HRS)

A

renal failure in absence of underlying kidney pathology

75
Q

hepatorenal syndrome occurs in _____ stage of liver disease

76
Q

clinical manifestations of hepatorenal syndrome

A
  • oliguria
  • low urinary sodium
  • hyponatremia
77
Q

bacterial peritonitis

A

ascites fluid becomes infected

78
Q

hepatic encephalopathy is considered a _______ complication of liver disease

79
Q

hepatic encephalopathy is caused by

A

toxic levels of circulating ammonia which cross the blood-brain barrier

80
Q

usually the liver converts ammonia to ____ for excretion in urine

81
Q

when the liver is unable to convert ammonia to urea

A

toxicity develops

82
Q

precipitating factors of hepatic encephalopathy

A
  • infection
  • elevated protein intake
  • worsening hepatic function
  • constipation
  • increased BUN and creatinine
  • GI bleeding
  • hypovolemia
83
Q

goal of hepatic encephalopathy is to

A

reduce ammonia formation

84
Q

number of stages in hepatic encephalopathy

85
Q

neurologic effects of hepatic failure

A

grade I to IV encephalopathy

86
Q

cardiovascular effects of hepatic failure

A

pulmonary edema, hypotension

87
Q

GI effects of hepatic failure

A

n+v, constipation or diarrhea, anorexia, ascites, abdominal pain, hypoalbumnemia, hypoglycemia

88
Q

pulmonary effects of hepatic failure

A

tacypnea, crackles

89
Q

integumentary effects of hepatic failure

A

spider angioma, jaundice, edema

90
Q

laboratory evaluation for liver diseases

A
  • liver enzymes
  • bilirubin
  • albumin
  • ammonia
  • coagulation studies
  • CBC
  • glucose
91
Q

management of hepatic encephalopathy

A
  • limit protein intake
  • administer enema or laxatives
  • administer anti-infective
92
Q

management of ascites

A
  • administer diuretics
  • paracentesis
  • sodium restriction
93
Q

management of metabolic abnormalities

A
  • monitor electrolytes
  • correct electrolyte imbalances
94
Q

management of spontaneous bacterial peritonitis

A
  • administer antibiotic therapy
95
Q

management of all liver diseases

A

high carb, low fat diet
no alcohol

96
Q

management of esophageal varices

A

control bleeding
- vasopressin
constrict bleeding varices
- shunts
preventive therapy
- beta blockers
- elective shunts
- endoscopic sclerotherapy

Med-Surg (15 decks)

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