Medical Flashcards
Liver functions
1) Metabolism of CHO, Proteins and Fats (stores glucose as glycogen)
2) Detoxifying blood, metabolizes ETOH & drugs
3) Converting ammonia (metabolite from protein metabolism) to urea for excretion
4) Bile production
5) Plasma proteins (fibrinogen & prothrombin)
6) Albumin production
7) Stores Vit A, Vit D, B12, Fe+
8) Excretes bilirubin from breakdown of hemoglobin > heme > Fe+ UCB => bile
9) Regenerates itself by repairing or replacing injured tissue
10) Regulates/Removes some hormones > estrogen
Liver assessment
1) Health hx: occupational, recreational & travel hx- exposure to infections, substance use, herbal remedies, dietary supplements & etoh use, lifestyle
2) Physical assessment by palpation (when swollen or enlarged is really painful)
3) Abdomen assessment
4) Abdomen circumference
5) Bowel sounds
6) Tenderness
7) Percuss
enlargement of liver is ALWAYS an abnormal finding!
Cirrhosis
Diffuse scarring of the liver - follows hepatocellular necrosis of hepatitis
Inflammation that heals with fibrosis
Loss of normal architecture & function
Common end result of many chronic liver disorders
Hepatitis: Non-Viral
Inflammation of the liver that usually results from exposure to certain chemicals or drugs.
eg: hepatotoxic chemicals & drugs (acetaminophen), & poisonous mushrooms.
Tx aims to remove causative agents: lavage (stomach), catharsis (laxatives) or hyperventilation.
Hepatitis: Viral
Viral form of hepatitis - acute inflammation of the liver marked by liver cell destruction, necrosis and autolysis.
Complicated by age and underlying disorders (cardiac, diabetes, CVA)
Prognosis is poor in the presence of edema and hepatic encephalopathy.
S+S of Hepatitis
GI: anorexia, malnourishment, indigestion, nausea and vomiting, constipation or diarrhea, dull abdominal ache, GI bleed, clay coloured stools
Resp: pleural effusion, limited expansion , dyspnea, hypoxia
Endocrine: testicular atrophy, ammenorrhea, gyecomastia, loss of chest and axillary hair
Hema: bleeding tendencies, anemia, DIC, thrombocytopenia, low WBC, electrolyte imbalances (hypo K, Hypo Ca, hypo/hyper Na, hypo Mg)
Hepatic: jaundice, hepatomegaly, ascites, edema of legs
Miscellaneous: hepaticus fetor, ..
Viral Hepatitis Tx
Rest in the early stages of the illness
Small meals high in calories and protein
Chronic Hep B: interferon & lamivudine
Monitor blood work and liver fx
Hep C: tx with interferon & ribavirin
Hepatitis A
Caused by eating food or water infected with HAV
Anal-oral contact during sex
Full recovery, does not lead to chronic
Hepatitis B
STD caused by unprotected sexual intercourse - HBV
Vaccination available
Infected needles or punctured skin - tattoo, IV drug users, needlestick, toothbrush, razors.
The liver swells and pt suffers liver damage d/t infection resulting in CA
Hepatitis C
Spread by direct contact with HCV infected blood
Liver swells and becomes damaged
Leads to cirrhosis
Feces is NEVER a route of transmission
Hepatitis s+s
GI: anorexia, malnourishment, indigestion, nausea and vomiting, constipation or diarrhea, dull abdominal ache, GI bleed, clay coloured stools
Respiratory: pleural effusion, dyspnea, limited thoracic
Hematological: bleeding, anemia, DIC, thrombocytopenia, hypo/hypernatremia, hypomagnesemia
Endocrine: testicular atrophy, menstrual irregularities, gynecomastia, loss of chest and axillary hair.
Hepatic: Jaundice, hepatomegaly, ascites, edema of the legs.
Fetor hepaticus, splenomegaly, bleeding from esophageal varices, portal HTN.
Hepatic disorder: Patient Teaching
Regular medical checks for at least 1 year
Abstain from alcohol
Proper use of drugs and handling cleaning agents and solvents
How to prevent exchange of body fluids during sexual intercourse
Avoid contact sports
Hepatitis: Treatment
REST! small meals high in calories and protein Monitor blood work to monitor liver fx Interferon, lamivudine - to decrease viral load of Hep B Interferon & Ribavirin - Hep C
Alcoholic Liver Injury
Ethyl alcohol: common cause of acute/chronic liver disease Fatty change chronic hepatitis Chronic hepatitis with portal fibrosis Chronic liver failure All reversible except cirrhosis stage
CAGE questions for alcohol use
Cut down
Annoyed you by criticizing your drinking
Guilty about drinking
Eye-opener - Drink first thing in the morning
Glucagon mechanism on DKA & HHS
Glucagon secretion is inhibited by increasing glucose levels ONLY when insulin is present.
DKA & HHS occur in an environment of absolute or relative lack of insulin so that glucagon cannot be turned off thereby increasing the blood glucose further.
DKA (absolute or relative) insulin lack?
Absolute- No insulin, therefore gluconeogenesis and lipolysis
Production of ketone bodies (acetone breath) and ketoacidosis
HHS (absolute or relative) insulin lack?
Insulin still is present therefore gluconeogenesis and lipolysis mainly inhibited.
Ketones mild/absent and pH normal/mild.
DKA: s+s
Onset 4-10 hr Tachycardia Hypotension d/t fluid depletion Metabolic acidosis Kussmaul Resps Hyperglycemia Hyperkalemia Polyuria Polidipsia Polyphagia Mental status changes
Low Bicarb levels
Accumulation of ketones (in blood and urine)
Elevated Creatinine and BUN d/t poor hydration
HHS: s+s
Occurs predominantly in type II diabetes (some cases of type I)
Develops more slowly and gradually than DKA > more insidious
Blood glucose > 33.3 mmol/L
Older people with no hx of diabetes or mild T2DM.
s+s: Hypotension Profound dehydration Tachycardia varying neurological signs Mortality rate ranges 10%-40% No Ketones present
DKA management
Teaching/raising awareness
Fluid resuscitation: rapid fluid resuscitation - prevent cerebral edema!!!
NS at a rapid rate for 2 to 3 hours. 6-10L of fluid.
NS (0.45%) may be used for HTN or hypernatremia.
Electrolyte management: K+ shifts, Na+ levels
Major concern is potassium > as levels drops as insulin is given> K enters the cells and depletes serum levels > KCL may be given in conjunction with NS and insulin
Insulin IV
Ketosis & acidosis - intubation & ventilation
Infection > C&S, ABx
