Liver Failure and GI Bleed

Question 1

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

Answer 1

True

Question 2

What are some vascular functions of the liver?

Answer 2

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

Question 3

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

Answer 3

tachycardia followed by bradycardia; htn followed by hypotension

Question 4

What are some secretory functions of the liver?

Answer 4

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

Question 5

What does excess bilirubin cause?

Answer 5

Jaundice

Question 6

What are some metabolic functions of the liver?

Answer 6

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

Question 7

What does albumin do?

Answer 7

pulls liquid back into vascular system.

Question 8

What are some lab values to watch in liver function?

Answer 8

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

Question 9

What are some examples of CLD?

Answer 9

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

Question 10

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

Answer 10

compensated to uncompensated state

Question 11

What is hepatitis?

Answer 11

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

Question 12

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

Answer 12

flu like, low grade fever, jaundice

Question 13

Hepatitis progresses to what? s/s?

Answer 13

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

Question 14

What do liver failure patients look like?

Answer 14

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

Question 15

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

Answer 15

portal htn

Question 16

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

Answer 16

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

Question 17

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

Answer 17

increase in portal venous pressure, splenomegaly.

Question 18

What is cirrhosis?

Answer 18

alteration in structure and function of hepatocytes

Question 19

What are some things that occur with cirrhosis?

Answer 19

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

Question 20

What is fatty liver often related to?

Answer 20

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

Question 21

What are some causes of liver failure?

Answer 21

hepatotoxic drugs, FLD, DM, excessive alcohol.

Question 22

What are some initial signs of liver failure?

Answer 22

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

Question 23

What are some signs of liver failure overtime?

Answer 23

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

Question 24

what are some impaired carbs metabolic processes?

Answer 24

impaired glucose, malnutrition, decreased stress response

Question 25

what are some impaired fat metabolic processes?

Answer 25

fatty liver, fatigue, altered skin integrity

Question 26

what are some impaired proteins metabolic processes?

Answer 26

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

Question 27

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

Answer 27

clots, PE

Question 28

The liver normally converts ammonia to?

Answer 28

Urea

Question 29

What could elevated ammonia levels cause?

Answer 29

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

Question 30

What is given to get rid of ammonia?

Answer 30

Lactulose

Question 31

In liver failure aldosterone and antidiuretic hormone imbalances leads to?

Answer 31

sodium and water retention

Question 32

Bilirubin stains when level is greater than?

Answer 32

3 mg/dl

Question 33

What are some complications of liver failure?

Answer 33

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

Question 34

What are some tx options for liver failure?

Answer 34

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

Question 35

What does the GI system do?

Answer 35

digests food turns it into nutrients and helps in elimination.

Question 36

What are some causes of upper GI bleed

Answer 36

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

Question 37

What are some causes of lower GI bleed?

Answer 37

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

Question 38

What does vomiting of upper GI look like? Stool?

Answer 38

coffee grounds, bright red; black, tary

Question 39

What are some diagnostic tests for GI bleed?

Answer 39

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

Question 40

How often to you assess GI bleed vitals?

Answer 40

Q 15 min

Question 41

What are some tx options for acute UGI bleed?

Answer 41

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

Question 42

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

Answer 42

albumin, hetastarch, dextran: increase osmotic pressure

Question 43

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

Answer 43

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

Question 44

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

Answer 44

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

Question 45

How do you estimate blood loss in GI bleed?

Answer 45

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