liver issues Flashcards
what are the 4 major functions of the liver
Metabolism &/or storage of:
Fat, CHO, PRO, vitamins and minerals
Blood volume reservoir
Distends/compresses to alter circulating blood volume
Blood filter
Helps purify blood
Blood clotting factors
Including prothrombin & fibrinogen
Drug metabolism and detoxification
what is jaundice
caused by increased level of bilirubin in the bloodstream
usually when total bilirubin is greater than 2-2.5 mg/dl
3 classes of jaundice
Hemolytic increased breakdown of RBCs
Hepatocellular liver unable to take up bilirubin from blood or unable to conjugate it
Obstructive decreased or obstructed flow of bile
what is bilirubin
By product of heme breakdown mainly hemoglobin
Elevations of INDIRECT bilirubin =
bilirubin overproduction OR impaired liver functioning
Elevations of DIRECT bilirubin =
liver working, but can’t get the bilirubin out
clinical manifestations of jaundice
Urine darker
Liver enzymes = elevated
Stools = Normal or clay colored
Pruritis
what can cause hepatitis other than the infection
alcohol abuse
drugs
chemicals
bacteria
Viral hepatitis patho
Viral infection
Immune response: inflammatory mediators
Lysis of infected cells
Edema and swelling of tissue
Tissue hypoxia
Hepatocyte
death!
T/F Many cases of ALL types of hepatitis are asymptomatic
TRUE
prodromal hepatitits
2 weeks after exposure
Fatigue, anorexia, malaise, nausea, vomiting, HA hyperalgesia, cough, low-grade fever
HIGHLY transmissible
Iceteric hepatitis
Begins with jaundice
Jaundice, dark urine, clay-colored stools
Liver enlarged and may be painful to palpation
Fatigue abdominal pain persists or increases in severity
Recovery hepatitis
Resolution of jaundice
6-8 weeks after exposure, symptoms diminish
Liver remains enlarged/tender
Complications of viral hepatitis
Chronic hepatitis
Liver cirrhosis (next section)
Liver cancer
Fulminant viral hepatitis – acute liver failure
transmission of Hep A
fectal-oral, parental, sexual
Hep A characteristics
Acute onset with fever Usually mild severity Does NOT lead to chronic hepatitis Usually affects children and adult Hand hygiene, Hep A vaccine
hep b transmission
parental, sexual
hep b characteristics
Insidious onset
Severe disease, may be prolonged course or develop into chronic
Any age group affected
HBV vaccine and safe sex and hygiene
hep c transmission and characteristics
Transmission parental, sexual
Insidious onset
Mild to severe symptoms
Can develop into chronic hepatitis (80%)
Any age is affected
Screening blood, hygiene; NO vaccine
Leads to hepatocellular carcinoma, liver transplant
New treatment is developing and becoming more widely available
Hep A Series
2 doses 6 months apart
Recommendations
All children beginning at age 12 months
Special “high risk” populations
Hep B Series
3 doses at least 4 months apart
Recommendation: All infants beginning as newborns
Hep C =
No vaccine
Two classes of drugs are used for chronic HBV:
Interferons
Nucleoside analogs
What is high risk from treatment with HBV
↑ AST levels
Hepatic inflammation
Advanced fibrosis
disadvantages of HBV treatment
Prolonged therapy
Costs and adverse effects
High relapse
how is HCV treated
direct-acting antiviral therapy and interferon-based regiments
Some require treatment along with a nucleoside analogue medication as well
what is cirrhosis
Irreversible, inflammatory, fibrotic liver disease
Structural changes from injury (alcohol/viruses) and fibrosis
Chaotic fibrosis leads to obstructive biliary channels and blood flow jaundice and portal hypertension
Regeneration is disrupted by hypoxia, necrosis, atrophy, and liver failure
Common causes of cirrhosis
Hepatitis B&C
Excessive alcohol intake
Idiopathic
Non-alcoholic fatty liver disease [NASH, NAFLD]
stages of alcoholic liver disease
most common type
Alcoholic fatty liver
Mildest, asymptomatic
Alcoholic steatohepatitis
Precursor to cirrhosis
Inflammation, degeneration of hepatocytes
Alcoholic cirrhosis
Fibrosis and scarring alter liver structure
cirrhosis patho
Liver cells destroyed Cells try to regenerate Disorganized process Abnormal growth Poor blood flow and scar tissue Hypoxia Liver failure
early manifests of cirrhosis
GI disturbances N/V Anorexia Flatulence Change in bowel habits Fever, weight loss Palpable liver
late manifests of cirrhosis
Jaundice Peripheral edema Decreased albumin & PT Ascites Skin lesions Hematologic problems (anemia, bleeding) Endocrine problems Esophageal & anorectal varices Encephalopathy
what is portal hypertension
Resistant portal blood flow leads to varices & ascites
cause of portal hypertension
systemic hypotension,
vascular underfilling,
stimulation of vasoactive (RAAS system) systems,
plasma volume expansion,
increased cardiac output -> ascites
T/F Can’t do anything for the portal hypertension except liver transplant
True
what is the primary driver of diagnosis in hepatic encephalopathy
LOC
Grades of hepatic encephalopathy
Grade I: Changes in behavior, mild confusion, slurred speech, disordered sleep
Grade II: Lethargy, moderate confusion
Grade III: Marked confusion (stupor), incoherent speech, sleeping but arousable
Grade IV: Coma, unresponsive to pain
what is the primary chemical driver in LOC changes
ammonia
most common cause of acute liver failure
Acetaminophen overdose
patho of acute liver failure
Patho: edematous hepatocytes and patchy areas of necrosis and inflammatory cell infiltrates and disrupts the liver tissue
Can occur 6-8 weeks after a viral hepatitis or metabolic liver disease
5 days to 8 weeks after an acetaminophen overdose
Signs are similar to cirrhosis symptoms
Treatment: not much, liver transplant
Class of lactulose
hyperosmotic laxative
indication of lactulose
reduction of ammonia absorption in hepatic encephalopathy
MOA of lactulose
reduces blood ammonia levels by converting ammonia to ammonium
route of lactulose
po, enema.rectal
contraindication of lactulose
hypokalemic
rifaximin MOA
inhibits bacterial RNA synthesis by binding to bacterial DNA (initially used as an antibiotic for GI infections)
S/E of rifaximin
peripheral edema, nausea, ascites, dizziness, fatigue, pruritis, skin rash, abdominal pain, anemia
Has been associated with an increased risk of C diff
