Liver disease Flashcards
1
Q
what is the digestive function of the liver?
A
- bile secretion for fat digestion
- processing and storage of carbs, proteins, vitamins (K & D) and minerals
2
Q
what is the endocrine function of the liver?
A
- regulation of carbs, fat & protein metabolism
- first step of activating vit D
3
Q
define hematological function of the liver
A
- temp storage of blood
- removal of bilirubin from blood steam
- synthesis of blood clotting factor
4
Q
define excretory function of the liver?
A
- excretion of bile pigment and cholesterol
- urea synthesis
- detox of drugs & other foreign substances (alch)
5
Q
what are the two main diseases that come from liver disease?
A
- hepatocellular failure
- (cirrhotic) portal hypertension
6
Q
what causes hepatocellular failure?
A
- jaundice, decreased clotting factors, hypoalbuminemia, decreased vitamins D
and K
7
Q
cirrhotic portal hypertension and the possible causes?
A
- GI congestion, development of esophageal or gastric varices, hemorrhoids, splenomegaly, ascites, hepatorenal syndrome, acute kidney injury, viral hepatitis, liver ischemia (cardiogenic shock)
8
Q
define varices?
A
- swollen BV in an organ that can burst and cause major bleeding
9
Q
define cirrhosis
A
- when liver is severely scarred & permanently damaged
10
Q
define portal hypertension
A
- elevated pressure in the portal vein due to scarring in the liver
11
Q
what are the CM of hepatocellular failure?
A
- Jaundice (in babies may lead to infant kernicterus)
- Ascites
- Muscle wasting
- dyslipidemia pr hypertriglyceremia due to altered lipoprotein processing
- bad protein metabolism = decreased production of clotting factors (no clotting)
- hypoalbuminemia (edema)
- bad storage and release of glucose = Hyperglycemia, Hypoglycemia
12
Q
what is the pathogenesis?
A
- Damaged RBCs release Hgb → Heme and globin separate
- Bilirubin (unconjugated, lipid soluble) released into plasma →transported to liver by albumin
- Bilirubin is bound (conjugated) in the liver → yields water-soluble bilirubin—excreted into bile duct
- Broken down in colon to urobilinogen → passed in feces
- Jaundice results from dysfunction anywhere along pathway
13
Q
what are the 3 reasons for portal hypertension?
A
- definition: increased pressure/resistance to portal circulation
- Hepatic fibrosis: causing increased resistance to portal circulation
- Sluggish blood flow: resulting in increased pressure in portal circulation
- Congested venous drainage of the GI tract
14
Q
what are the CM for portal hypertension?
A
- varices = esophageal, gastric, hemorrhoidal can rupture causing uncontrolled bleeding(!)
- Anorexia
- splenomegaly or ascites
15
Q
define is gastroesophageal varices
A
- Complex venous network surrounds the proximal part of stomach and esophagus
▪ Can rupture with critically high portal pressure
▪ Rupture leads to massive, life-threatening upper GI bleed
16
Q
how does gastroesophageal varices happen?
A
- bc portal hypertension
- alcoholic or post hepatic cirrhosis
- infection from liver fluke
17
Q
CM of gastroesophageal varices?
A
- Hematemesis (vomit blood), melena, bright red rectal bleeding, anemia, shock (massive blood loss)
18
Q
define hepatic encephalopathy & what happens
A
- Complex neuropsychiatric syndrome from too much ammonia
- Associated with hepatic failure or severe chronic liver disease NOT the cause (!)
- unknown cause
- Damaged liver cannot process proteins and leads to increase ammonia causing toxins to build up in the brain
19
Q
CM of hepatic encephalopathy?
A
- dementia
- Psychotic symptoms
- Asterixis “liver flap” (classic sign)
▪ Spastic jerking of hands held in forced hand
20
Q
what are the treatments of hepatic encephalopathy?
A
- Correcting any identifiable precipitating factors
- Restricting dietary protein (60 g or less) (to get rid of ammonia)
- High fiber diet
- Medications
20
Q
how is ascites diagnosed
A
- Fluid examination from abdominal paracentesis
21
Q
define ascites?
A
- Pathologic accumulation of fluid in peritoneal cavity
- Occurs with portal hypertension and
hypoalbuminemia ( & other diseases)
22
Q
define acute hepatitis? & what are the 5 types?
A
- Infection and Inflammation of the liver parenchyma
- caused by viruses (Cytomegalovirus, Epstein-Barr)
- viral hepatitis types: categized by infections of the liver
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D (Delta)
- Hepatitis E
22
Q
what is TX for ascites?
A
- Dietary sodium restriction to 88 mEq/day
- Diuretics: 0.5 kg of body weight/day
- Paracentesis, Shunt
- Liver transplant
22
what are the CM of ascites?
- Increased abdominal girth
- Rapid weight gain
- Shortness of breath due to pressure
23
what are the 4 phases of acute symptomatic viral hepatitis?
1. incubation period:
2. prodromal:
3. icteric phase:
4. convalescence:
24
what does the incubation period mean?
- Time from exposure to virus to onset of symptoms
25
what does the prodromal period mean? what happens in it?
- Manifesting non-specific signs and symptoms develop: malaise, fatigue,
nausea, anorexia, low-grade fever, muscle aching, headache; person is
infectious in the initial portion of this phase
26
what does the icteric phase mean? what happens in it?
- Jaundice appears, (!!) characterized by conjugated and unconjugated hyperbilirubinemia; dark urine, light-colored stools, pruritis due to retained bile salts; (!!) many of the nonspecific symptoms tend to resolve when jaundice appears; some individuals do not have an icteric phase, depending on the type of virus.
27
what does the convalescence mean? what happens in it?
- Gradual return of energy and recovery
of liver function.
28
how is hep A (HAV) spread & incubation period & prevention?
- RNA virus spread by fecal oral route
- incubation period: 2 - 7 weeks
- prevention:
- Careful hand washing
- Segregation (of clean and dirty things)
- Cleaning of laundry and personal items
- Immunization and γ-globulin
29
how is hep B (HBV) spread & incubation period & risk factors?
- Spread by contact with infected blood or sexual contact (contaminated needles)
- risk factors: Perinatal, health care settings (3%); transfusions and dialysis (1%); acupuncture, tattooing, extended overseas
travel, residence in an institution
- incubation period = 2 to 6 months
30
what is the prevention & Tx for hepatitis B?
- immunizations (HBV) (!!!!)
- doses given 0, 1, & 6 months
- 95% response rate
- Administration of HBIG post inoculation
- contains high levels of hepatitis B surface antibody (7 days of exposure)
- indications:
- Neonates born to HBsAg-positive mothers
- Prophylaxis after needlestick or sexual exposure in nonimmune persons
- After liver transplantation in patients who are HBsAg+ prior to transplantation
30
how does hepatitis D (delta) transmit, work, and prevented?
- works: Defective RNA virus that requires the helper function of HBV to replicate
- transmitted: parenteral and intimate contact
- Hep B and can lead to Hep D
- prevention:
- safe sex practices
- avoidance of IV drug use
- vaccination of susceptible person with HBV
30
how is hep c (HCV) spread & incubation period & risk factors?
- Spread through IV drug use or blood (transfusions prior to 1990)
- acute HCV infection
- usually asymptomatic
- course is erratic wide fluctuations on liver enzymes
- chronic HCV infection
- Usually asymptomatic until advanced liver disease intervenes
- Most common cause of end-stage liver disease with cirrhosis
30
what is hep C (HCV) Tx? for acute infections?
- supportive & expectant
- early treatment not recommended
- 20% to 40% of acute seropositive patients will convert to seronegativity and undetectable viral load during 1st 6 months
after infection
- immune globulin is not helpful in preventing infection
31
what is hep C (HCV) Tx? for chronic infections?
- Assessed by a viral load and viral genotype
- Liver biopsy to stage disease activity
32
how does hepatitis E (HEV) transmit, work, and prevented?
- RNA virus spread via fecal-oral route
- contaminated H2O (!!!!) so it's most common in developing countries or recent travel
- high mortality rate in preg women
- prevention:
- Careful hand washing
- Avoidance of undercooked foods
- Drinking safe H2O and beverages (ice included)
33
what are the 5 stages of Cirrhosis?
1. Severe acute hepatitis
2. chronic hepatitis
3. toxic hepatitis
4. Metal storage diseases
5. Alcoholism
- Results in permanent alteration in hepatic blood flow and liver function
34
what's the function of the gallbladder?
- regulating bile - storage and release during high fat meal
- bile pH regulation = too acidic can cause formation of gallstones
- absorption of fat soluble vitamins (A & K)
35
what's the function of the pancreas ?
- Exocrine function – produce enzymes to help digest food
- Endocrine – produce insulin and glucagon to regulate blood sugar
- 40% of Pancratius from gallstones
36
what are cholelithiasis (gallstones)
- Gallstones don’t always show symptoms
Biliary colic when stones block biliary
duct.
37
what are the causes of gallstones?
- female
- 40's YO
- fair skin
- over weight
- stress
- rapid weight loss
38
C.M of gallstone pain?
- Severe pain and crampy waves
-Periodic pain with gap of weeks to years increased pain with fatty food
-Nausea and vomiting.
39
what can gallstones lead to?
- Pancreatitis
* Cholecystitis
* Inflammation of the gallbladder
40
what are pancreatitis causes?
- 40% causes by gallstones
* 25% caused by alcohol and
smoking
* Many other causes:
medications, hereditary,
obesity, abdominal injury
