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NUR 326-Pathopharm > Liver Problems > Flashcards

Liver Problems Flashcards

1
Q

Major Functions of Liver

A

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

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2
Q

Portal Circulation

A
  • The portal circulatory system brings blood to the liver from the stomach, intestines, spleen, and pancreas
  • The blood enters the liver through the
    portal vein
  • The absorbed products of digestion come directly to the liver, and are sent to the lobules
  • This is the “first pass effect”
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3
Q

Components of the Liver funtion tests (LFT)

A

Liver enzymes
-ALT, AST, Alk Phos

Bilirubin
-conjugated (direct), unconjugated (indirect)

Serum Ammonia
Serum Protein
Serum Albumin
Prothrombin time (PT)

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4
Q

Jaundice (Icterus) caused by:

A
  • Caused by increased level of bilirubin in the bloodstream
  • Usually causes problems and is noticeable with total bilirubin is greater than 2-2.5mg/dl
  • Look at conjugated versus unconjugated to determine possible cause
  • Yellowish discoloration of skin and deep tissues
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5
Q

3 classifications of Jaundice

A
  • 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
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6
Q

What is Bilirubin?

A

By product of heme breakdown (mainly hemoglobin)

DIRECT: Conjugated INDIRECT:unconjugated

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7
Q

Elevations of INDIRECT bilirubin:

A

Bilirubin overproduction OR impaired liver functioning

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8
Q

Elevations of DIRECT bilirubin:

A

Liver working, but can’t get the bilirubin out
* Bile duct obstruction, gall stones

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9
Q

Jaundice: Clinical Manifestations

A
  • Urine is darker
  • Liver enzymes = elevated
  • Stools = Normal or clay colored
  • Pruritis
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10
Q

What is Viral Hepatitis?

A

Systemic virus that mainly affects the livers
* Inflammation of the liver
Various strains cause the different types of hepatitis
* HAV, HBV, HCV
* Other viruses that can cause hepatitis (Epstein-Barr, cytomegalovirus)

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11
Q

T/F: Hepatitis is always from a viral infection

A

FALSE: can occur from other causes
* Alcohol abuse, drugs, chemicals, and bacteria

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12
Q

Viral Hepatitis: Pathogenesis

A
  1. Viral infection
  2. Immune response: imflammatory mediators
  3. Lysis of infected cells
  4. Edema and swelling of tissue
  5. Tissue hypoxia
  6. Hepatocyte death
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13
Q

Clinical Manifestations of Viral Hepatitis

A
  • Similar between all types
  • Many cases of ALL types of hepatitis are asymptomatic
  • But can range from none, mild, to liver failure
  • Causes abnormal elevated LFTs– but NOT consistent with cellular damage within the liver
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14
Q

Hepatitis: Prodromal

A
  • 2 weeks after exposure
  • Fatigue, anorexia, malaise, nausea, vomiting, HA hyperalgesia, cough, low- grade fever
  • HIGHLY transmissible
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15
Q

Hepatitis: Icteric

A
  • 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
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16
Q

Hepatitis: Recovery

A
  • Resolution of jaundice
  • 6-8 weeks after exposure, symptoms diminish
  • Liver remains enlarged/tender
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17
Q

Viral Hepatitis: Complications

A
  • Chronic hepatitis
  • Liver cirrhosis
  • Liver cancer
  • Fulminant viral hepatitis – acute liver failure

Most patients with acute viral hepatitis recover completely with no complications

Overall mortality rate is less than 1%
* Higher mortality in elderly and comorbidities

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18
Q

Hepatitis A
-transmission, progression, population, prevention

A
  • Transmission: fecal-oral, parental, sexual
  • Acute onset with fever
  • Usually mild severity
  • Does NOT lead to chronic hepatitis
  • Usually affects children and adult
  • Hand hygiene, Hep A vaccine
19
Q

Hepatitis B
-transmission, progression, population, prevention

A
  • Transmission: parental, sexual
  • Insidious onset
  • Severe disease, may be prolonged course or develop into chronic
  • Any age group affected
  • HBV vaccine and safe sex and hygiene
20
Q

Hepatitis C
-transmission, progression, population, prevention

A
  • 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
21
Q

Prevention of Hepatitis: Vaccines
Hep A Series

A
  • 2 doses 6 months apart
    Recommendations
  • All children beginning at age 12 months
  • Special “high risk” populations
22
Q

Prevention of Hepatitis: Vaccines
Hep B Series

A
  • 3 doses at least 4 months apart
  • Recommendation: All infants beginning as newborns
23
Q

Prevention of Hepatitis: Vaccines
Hep C

A

NO vaccine

24
Q

Two classes of drugs are used for chronic HBV:

A
  • Interferons
  • Nucleoside analogs
25
Q

HBV treatment is only for high-risk patients who have:

A
  • ↑ AST levels
  • Hepatic inflammation
  • Advanced fibrosis
26
Q

Disadvantages of HBV treatment:

A
  • Prolonged therapy
  • Costs and adverse effects
  • High relapse
27
Q

How is HCV treated

A
  • Treated with direct-acting antiviral therapy and interferon-based regiments
  • Some require treatment along with a nucleoside
    analogue medication as well
  • Now easily treatable and eliminated in most all patients

Can take tylenol although must be <2,000 mg

28
Q

What is Cirrhosis?

A
  • Irreversible, inflammatory, fibrotic liver disease
  • Structural changes from injury (alcohol/viruses) and fibrosis
  • Regeneration is disrupted by hypoxia, necrosis, atrophy, and liver failure
29
Q

Chaotic fibrosis leads to:

A

Obstructive biliary channels and blood flow
which lead to jaundice and portal hypertension

30
Q

Cirrhosis Common Causes

A

-Hepatitis B&C
-Excessive alcohol intake
-Idiopathic
-Non-alcoholic fatty liver disease [NASH, NAFLD]

31
Q

Stages of alcoholic liver disease

A
  1. Alcoholic fatty liver
    -Mildest, asymptomatic
  2. Alcohol steatohepatitis
    -precusor to cirrhosis
    -Inflammation, degeneration of hepatocytes
  3. Alcohol cirrhosis
    -Fibrosis and scarring alter liver structure
32
Q

Cirrhosis: Pathogenesis

A

-Liver cells destroyed
-Cells try to regenerate
-Disorganized process
-Abnormal growth
-Poor blood flow and scar tissue
-Hypoxia
-Liver failure

33
Q

Cirrhosis: Early Manifestations

A

GI disturbances
* N/V
* Anorexia
* Flatulence
* Change in bowel habits

Fever, weight loss

Palpable liver

34
Q

Cirrhosis: Late Manifestations

A

Jaundice
Peripheral edema
Decreased albumin & PT
Ascites
Skin lesions
Hematologic problems (anemia, bleeding)
Endocrine problems
Esophageal & anorectal varices
Encephalopathy

35
Q

What is Portal Hypertension?

A

Resistant portal blood flow  leads to varices & ascites

36
Q

Portal hypertension causes

A

Causes: systemic hypotension, vascular underfilling, stimulation of vasoactive (RAAS system) systems, plasma volume expansion, increased cardiac output leads to ascites

37
Q

Portal hypertension symptoms

A

Asymptomatic until complications
* Variceal hemorrhage, ascites, peritonitis, hepatorenal syndrome, cardiomyopathy

38
Q

Portal hypertension prevention/treatment

A

Can’t do anything for the portal hypertension except liver transplant

39
Q

How is hepatic encephalopathy diagnosed?

A

LOC is the primary driver of diagnosis
* Graded by severity

  • Correlate with liver labs, mainly ammonia which is primary chemical driver of LOC changes
40
Q

What are the grades of hepatic encephalopathy?

A
  • Minimal: Abnormal results on psychometric or neurophysiological testing without clinical manifestations (see ‘Psychometric tests’ below)
  • 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
41
Q

Acute liver failure (fulminant liver failure)
-Common cause

A

Most common cause: acetaminophen overdose
* Can be treated with acetylcysteine

42
Q

T/F Acute liver failure caused by cirrhosis

A

False, acute liver failure is a separate liver failure NOT caused by cirrhosis or other type of liver disease

43
Q

Acute liver failure: Patho

A

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

44
Q

Acute liver failure
-S/S and treatment

A
  • Signs are similar to cirrhosis symptoms
  • Treatment: not much, liver transplant

NUR 326-Pathopharm (24 decks)

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