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Pathpharm 2 > liver flashcards > Flashcards

liver flashcards

1
Q

What are 3 digestive functions of the liver?

A

bile salt secretion and help make bile, process & store of proteins, fat, carbs,vitamins and minerals

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2
Q

Metabolism (break down) of glucocorticoids, mineralcorticoids, and sex hormones & regulation of metabolism of fats, proteins, and carbs are an example of which fxn of the liver?

A

Endocrine

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3
Q

True or False, if aldosterone is out of balance, secondary characteristics will not be affected

A

FALSE, voices may changes, abnormal chin hair growth, testicular atrophy, loss of body, and growth of breast tissue

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4
Q

Hematologic fxn of liver include: synthesis of _____ from _____ products, temporary blood storage of ____ ml, _____poiesis, synthesis of blood ____ factors.

A

synthesis of billirubin from blood products, temporary blood storage of 400ml, hematopoiesis, and synthesis of blood cloting factors

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5
Q

True or False if you are bleeding, the liver can release blood contents into the blood stream as sort of a back up

A

TRUE

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6
Q

Excretion function of liver include:

A

cholesterol in bile, bile pigment, urea synthesis, and detoxification of drugs, toxins, and chemicals

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7
Q

What are kuffer cells?

A

fixed tissue macrophages

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8
Q

How many hepatitis viruses are there?

A
  1. A -G
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9
Q

How many hepatotoxic drugs are there?

A

1000

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10
Q

True or False, if the drug is metabolized or excreted by the liver, it is not hepatoxic

A

FALSE, voices may changes, abnormal chin hair growth, testicular atroph, loss of body, and growth of breast tissue

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11
Q

What does fulminant mean?

A

full-blown, complete liver failure in a short amount of time

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12
Q

What infections can cause hepatitis?

A

Tb,malaria, mumps, measles, CMV (cytomegalvirus)

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13
Q

True or False, a primary infection of Hepatitis is caused by 1 of 5 viruses (A-E), blood-borne transmission, and water-digestive

A

TRUE

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14
Q

Who has a high risk of developing hepatitis docs, nurses, resp. therapy

A

nurses

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15
Q

What is the incubation to seroconversion for Hep C?

A

6-7 weeks to 6 months

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16
Q

True or False, people with chronic HCV are typically asymptomatic or have mild clinical illness

A

FALSE, persons with acute infection typically are either asymptomatic or have mild clinical illness

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17
Q

How do you get hepatitis?

A

illegal injection drug use, blood transfusion or solid organ transplant before 1992, receipt of clotting factor conc. Produced before 1987, and long term hemodialysis

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18
Q

What is the difference between having a pos HCV antibody test and a positive HCV RNA test?

A

pos HCV antibody test = person was infected at some point in time, if pos HCV RNA test = person has a current infection

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19
Q

What are the 2 categories for drugs to treat chronic Hepatitis?

A

Antiviral drugs and Immunomodulators

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20
Q

What are 2 types of Immunodulators?

A

Interferon and Ribavirin

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21
Q

Fatigue, headache, muscle and joint aches, nausea, loss of appetite, weight loss, fever, depression, thyroid problems, hair loss, skin rash, low levels of RBC, WBC, & platelets are all side effects of which drugs?

A

Pos HCV antibody test = person was infected at some point in time, if pos HCV RNA test = person has a current infection

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22
Q

Cirrhosis _________ structure and replaces with __________ and fatty _____

A

Cirrhosis disrupts structure and replaces with collagen and fatty infiltration

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23
Q

What are the 4 types of Cirrhosis?

A

Alcoholic (Laennec’s), Biliary, Post necrotic, and metabolic

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24
Q

Ischemia from inflammation of the liver for too long leads to necrosis. These patients did not get the blood supply they needed to soon enough. This describes which type of Cirrhosis?

A

Post necrotic

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25
Q

True or False, if the liver is shrunken in since it is caused by something inflammatory, and if the liver is enlarged and tender, it is failing

A

False. Enlarged & tender = inflammatory. Shrunken = failing

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26
Q

True or False, problems with Cirrhosis is electrolyte and fluid based

A

TRUE

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27
Q

What are proteins useful for?

A

healing/drugs, oncotic pressure, and tissue repair

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28
Q

Most hepatic disorders cause either: __________ changes or alterations in _______ blood flow

A

Hepatocellular changes or alteration in portal blood flow

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29
Q

What are the 2 pathological mechanisms related to Cirrhosis?

A

Inflammation and obstruction of ducts

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30
Q

What are the 2 components of inflammation in cirrhosis?

A

leads to malabsorption & maldigestion) and edema (hepatomegaly) and increase permeability

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31
Q

Obstruction of ducts can lead to what?

A

gallstones and tumors

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32
Q

Portal HTN is a pathological mechanism of what disease?

A

cirrhosis

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33
Q

What are 4 causes of portal HTN?

A

thrombi, inflammation, fibrosis (scarring), cardiac (RVF)

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34
Q

What happens when the portal blood is not able to move to the liver?

A

back flow pressure, forces collateral veins to open and bypass, which creates increase in splenic pressure

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35
Q

Jaundice, fever, malaise, anorexia, n & v, aversion to smell and tastes, rashes and joint pain are clinical manifestations to which disease?

A

cirrhosis

36
Q

True or False, hypoalbuminemia is a s/s to cirrhosis

A

TRUE

37
Q

Carol is admitted for hypoalbuminemia, peripheral edema, ascities, and electrolyte shift, what could be causing this?

A

cirrhosis

38
Q

Define ascites

A

excess fluid in the space between the membranes lining the abdomen and abdominal organs

39
Q

What are varices?

A

abnormally dilated vessels

40
Q

Ascities, varices, and hepatic encephalopathy are clinical manifestations of ____ HTN

A

Portal HTN

41
Q

True or False, Cerebral edema is the 1st sign of hepatic encephalopathy?

A

False, personality changes are 1st signs. (e.g. cranky and mean, irritability)

42
Q

Coagulopathies, inability to synthesize factors such as Vit K, can cause:

A

GI bleeding, petechial bleeding, increased workload to absorb blood from intestine, and DIC

43
Q

What is DIC?

A

Disseminated Intravascular coagulation, platelets will clump together and clog small blood vessels throughout the body. Causing excessive bleeding

44
Q

What is the tx for DIC?

A

heparin b/c it shuts down the cascade of event that make the body overuse its blood clotting factors

45
Q

True or False, arterial vasoconstriction + peripheral vasodilatation = Decreased renal perfusion

A

TRUE

46
Q

Christy comes to the ER with a SBP over under 100, urine + for BUN (azotemia), and peripheral edema. What could her dx be?

A

Acute Renal Failure

47
Q

When the liver can no longer maintain function and has 80-90% of fxnl capacity is lost, what is it called?

A

Hepatic Failure

48
Q

What is kernicterus and who does it primarily affect?

A

excessive bilirubin moves into brain cells causing irreversible damage. Affects premies.

49
Q

What is biliary atresia?

A

blocking of the bile duct, bile cant get out

50
Q

True or False, acute viral infections, biliary atresia, portal HTN, and Wilson’s disease are chronic liver diseases that effect the pediatric population

A

TRUE

51
Q

Which diuretics would you give a pt. with a chronic liver disease?

A

k sparing, loop

52
Q

True or False, you would want to keep patients on depressant drugs and drugs excreted via the liver in patients with chronic liver diseases

A

FALSE. D/C them

53
Q

What type of treatments for infections would you expect implemented if a patient has chronic liver disease?

A

prevention/vaccines, hygiene, ABX (antibiotics)

54
Q

What is a normal INR?

A

1

55
Q

What is a normal PT?

A

12-15 seconds

56
Q

You are caring for a patient that has liver disease, what things could you discuss with him about the mgmt. of his disease?

A

No alcohol intake, rest after you eat (easier for blood flow to move if you are laying down), drugs excreted by the liver, and nutritional supplements (folic acid, Vit b12)

57
Q

What are 2 types of shunts that can be used to manage liver disease?

A

portacaval, TIPS

58
Q

What does TIPS stand for and what is it?

A

Transjugular Intrahepatic Portosystemic Shunt. A channel of blood flow across jugular vein, through the liver, from the portal vein to the general circulation.

59
Q

What are some less invasive, “conservative” management options for patients with chronic liver disease?

A

low protein diet, lactulose mgmt. of toxins, vitamin replacement, volume expanders (Albumin)

60
Q

Jessica has fulminat liver failure with encephalopathy, she wants a transplant. What criteria must she meet in order to qualify for a liver transplant?

A

PT > 10 seconds above baseline, bilirubin >15

61
Q

What are the indications for transplant in a patient with Chronic liver disease?

A

Bilirubin > 15, intractable encephalopathy and ascites, serum albumin < 2.5 mg/dl, PT > 20sec, hepatorenal syndrome

62
Q

Can an AIDS patient with an end stage cardiopulmonary disease and a hx of psychiatric issues qualify for a liver transplant?

A

No, other patients that do not qualify include: pts. With active sepsis, and metastic cancer

63
Q

What is MELD? How will it be used?

A

Model for End Stage Liver Disease- a numerical scale used for candidates.

64
Q

Which patient will get a transplant first, a patient with a MELD score of 6 or a patient with a MELD score of 40

A
  1. Range is: 6 (less ill) - 40 (gravely ill)
65
Q

What are the four MELD levels?

A

> 24, 24-19, 18-11, < 11

66
Q

Carl just came back for the OR for a liver transplant, as a nurse you know that he is at risk for what post-op complications?

A

Acute rejection, infection, bilary anastamosis, chronic rejection, hemorrhage, hepatic artery thrombosis, and acute renal failure

67
Q

What are s/s of rejection of a liver transplant?

A

pain/swelling over the organ, Temp 101 or greater, increased WBC count, and change in liver enzymes

68
Q

Prograf, Neoral, and Prednisone are all examples of what types of drugs?

A

Antirejection transplant drugs

69
Q

True or False, prednisone leads to a decrease in blood sugar

A

False, you can get steroid induced diabetes d/t a rise in blood sugar induced by prednisone

70
Q

Give 5 examples of adverse effects of antirejection drugs

A

nightmares, nephrotoxicity, depression, constipation, diarrhea, n & v, anxiety, headache, insomnia, skin rash, general weakness

71
Q

Give 3 examples of antiviral/infective drugs that are given after a liver transplant

A

Bactrim septra, acyclovir, ganicyclovir

72
Q

Mycostatin falls under which category of liver transplant drugs

A

Antifungal

73
Q

Which proton pump inhibitors are given post liver transplant?

A

Rantidine, pepcid

74
Q

True or False, production of insulin in Islets of Langherans cells is the exocrine fxn of the pancreas

A

False, it is the endocrine fxn

75
Q

True or False, production of enzymes for digestion and metabolism is the exocrine fxn of the pancreas

A

TRUE

76
Q

What are the 2 types of non-bacterial inflammatory disorder of the pancreas?

A

Interstitial (edematous) or hemorrhagic

77
Q

True or False, in non-bacterial inflammatory disorder of the pancreas, enzymes are deactivated and liberated

A

False, enzymes are activated and liberated.

78
Q

Lipolysis, proteolysis, necrosis of blood vessels, and inflammation are all pathological mechanisms of which disease?

A

Acute pancreatitis

80
Q

True or False, acute inflammation (pancreatitis) and obstruction leads to scarring and fibrosis

A

False, Chronic Inflammation leads to scarring and fibrosis

81
Q

Abdominal pain, malabsorption, and diabetes mellitus are effects of acute OR chronic pancreatitis

A

Chronic

82
Q

Timmy comes in to the ER complaining of severe ULQ and epigastric pain. You test his urine and his specific gravity shows that he is dehydrated. In your assessment you note no bowel sounds, bruising in the umbilicus region, and a mild yellow tinge in his face. While assessing him he throws up in his hands. What might he dx be?

A

Chronic pancreatitis

83
Q

True or False, a high fever is the most serious complication of pancreatitis?

A

False, pancreatic abscess. It is always fatal if untreated

84
Q

True or False, antibiotic treatment alone will resolve the pancreatic abscess

A

False, you will need drainage via the percutaneous method or laparoscopy plus antibiotics

85
Q

In a patient with pancreatitis, what might the doctor order to manage the disease?

A

pain management, NPO, IV fluid replacement, CA & Mg replacement, surgery to remove stones and dilate sphincter

86
Q

True or False, all narcotics increase the SO (sphincter of Oddi) phasic wave frequency and interfere with SO peristalsis

A

TRUE

Pathpharm 2 (8 decks)

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