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N 4300 Exam 2 > Liver Failure and GI Bleed > Flashcards

Liver Failure and GI Bleed Flashcards

1
Q

T/F the liver sinusoids are lined with Kupffer’s cells and the liver has a rich blood supply.

A

True

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2
Q

What are some vascular functions of the liver?

A

blood storage: shunts blood into circulation when vol. is low. Blood filtration: kupffer’s cells eat bacteria.

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3
Q

If a pts liver is shunting blood what s/s may they have?

A

tachycardia followed by bradycardia; htn followed by hypotension

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4
Q

What are some secretory functions of the liver?

A

Bile production: bile salts emulsify fats. Bilirubin metabolism: unconjugated: indirect, toxic to cells, conjugated : direct, excreted.

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5
Q

What does excess bilirubin cause?

A

Jaundice

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6
Q

What are some metabolic functions of the liver?

A

Carbs: serum glucose levels, fats: primary site of metabolism(triglycerides), Protein: Ammonia(increase = altered MS), Plasma proteins: albumin, globulins(cellular metabolism), fibrinogen(clotting), clotting factors: synthesis and removal, detox: conversion of fat soluble to water soluble then excreted, vit. & mineral storage and synthesis: A,D, B12

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7
Q

What does albumin do?

A

pulls liquid back into vascular system.

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8
Q

What are some lab values to watch in liver function?

A

albumin, ammonia, total bilirubin, direct bilirubin, cholesterol, PT, PTT, APT, AST, ALT

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9
Q

What are some examples of CLD?

A

Cirrhosis: alcohol causes a lot of times, FLD (fatty): diet issues, alcohol, Inflammation (hepatitis)

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10
Q

ESLD (Fulminant liver) is movement from __________ to ___________?

A

compensated to uncompensated state

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11
Q

What is hepatitis?

A

acute inflammation of hepatocytes accompanied by edema; restriction of blood supply to cells leads to necrosis.

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12
Q

What kinds of symptoms will a hepatitis patient have before diagnosed?

A

flu like, low grade fever, jaundice

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13
Q

Hepatitis progresses to what? s/s?

A

Fulminant liver. Pt gets pruritus, insomnia, irritable, convulsions, N/V, chills, jaundice, fever

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14
Q

What do liver failure patients look like?

A

ascites, hard to breathe, hard stomach, decreased appetite.

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15
Q

What is the result of increases in both resistance to portal flow and in portal venous inflow?

A

portal htn

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16
Q

In portal htn hyperdynamic circulation (aka: high output failure) occurs resulting in what things?

A

shunting blood: Increased CO, vasodilation: decreased organ perfusion, s/s of HF: JVD, crackles, Initially high BP then hypotension, bounding pulses.

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17
Q

In portal htn pt may get esophageal or gastric varices resulting in?

A

increase in portal venous pressure, splenomegaly.

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18
Q

What is cirrhosis?

A

alteration in structure and function of hepatocytes

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19
Q

What are some things that occur with cirrhosis?

A

local or diffuse inflammation or necrosis, fat deposits, increased resistance to blood flow thru liver, fibrous tissue (irreversible)

20
Q

What is fatty liver often related to?

A

alcohol, obesity, DM, hepatic resection, starvation, TPN

21
Q

What are some causes of liver failure?

A

hepatotoxic drugs, FLD, DM, excessive alcohol.

22
Q

What are some initial signs of liver failure?

A

weakness, fatigue, weight loss, abdominal discomfort, n/v

23
Q

What are some signs of liver failure overtime?

A

portal htn, impaired metabolic processes, impaired bile formation and flow

24
Q

what are some impaired carbs metabolic processes?

A

impaired glucose, malnutrition, decreased stress response

25
Q

what are some impaired fat metabolic processes?

A

fatty liver, fatigue, altered skin integrity

26
Q

what are some impaired proteins metabolic processes?

A

decreased serum albumin leads to low vol. in vascular space, ascites, decreased clotting factors leads to more bruising and bleeding

27
Q

What could happen during liver failure if clotting factors aren’t removed from circulation?

A

clots, PE

28
Q

The liver normally converts ammonia to?

A

Urea

29
Q

What could elevated ammonia levels cause?

A

perceptual changes, tremors (asterixis: flap hands), slurred speech, confusion, coma

30
Q

What is given to get rid of ammonia?

A

Lactulose

31
Q

In liver failure aldosterone and antidiuretic hormone imbalances leads to?

A

sodium and water retention

32
Q

Bilirubin stains when level is greater than?

A

3 mg/dl

33
Q

What are some complications of liver failure?

A

hemodynamically unstable, decreased perfusion, infection, bleeding, ascites, encephalopathy

34
Q

What are some tx options for liver failure?

A

paracentesis (don’t take off too much fluid will bottom out BP), fluid & vasoconstrictive drugs, O2, TIPS, transplant, SAFETY r/t bleeding

35
Q

What does the GI system do?

A

digests food turns it into nutrients and helps in elimination.

36
Q

What are some causes of upper GI bleed

A

duodenal or gastric ulcer, esophageal or gastric varices, Mallory-weiss tear (arterial hemorrhage)

37
Q

What are some causes of lower GI bleed?

A

polyps or diverticulitis, inflammatory disease, cancer, vascular ectasis (dilation of vessel), hemorrhoids

38
Q

What does vomiting of upper GI look like? Stool?

A

coffee grounds, bright red; black, tary

39
Q

What are some diagnostic tests for GI bleed?

A

GAS test for occult blood, GAE test for blood in emesis, gastric acid stimulation

40
Q

How often to you assess GI bleed vitals?

A

Q 15 min

41
Q

What are some tx options for acute UGI bleed?

A

gastric lavage (rinse out), meds to decrease acid, antibiotics, meds to help slow or stop bleed: somatostatin, or octreotide; vasopressin, endoscopy

42
Q

Patient with GI bleed maybe given Colloids which are plasma expanders give examples of these and what they do?

A

albumin, hetastarch, dextran: increase osmotic pressure

43
Q

Patient with GI bleed maybe given Crystalloids which are plasma expanders give examples of these and what they do?

A

solution pf mineral salts or other water soluble molecule cheaper than colloids.

44
Q

Besides plasma expanders what other blood products might a GI bleed patient get?

A

whole blood, RBC’s, plasma, clotting factors, FFP, platelets, cryoprecipitate, albumin

45
Q

How do you estimate blood loss in GI bleed?

A

systolic less than 100 posture change greater than 110 or HR greater than 120 estimates 1,000 ml blood loss

N 4300 Exam 2 (6 decks)

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