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chronic > Patho Regulatory Lecture Test #4 > Flashcards

Patho Regulatory Lecture Test #4 Flashcards

1
Q

What tests can be done to check liver function? (blood tests)

A

GAAALS

(GGT)- acc with homeostasis 
(AST)- raise could be an issue with heart liver or kidney 
(ALT)- specific raise to liver disease 
Lactic dehydrogenase
Serum enzymes
other tests: Albumin 
                    Biliribin
                     Ammonia
                     clotting factors 
                     Lipids
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2
Q

What tests can be done to check liver function? (not blood tests)

A

Liver Biopsy

Ultrasound
CT
MRI
radioisotope liver scan

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3
Q

What are some reasons why someone could be diagnosed with hepatic dysfunction?

A
  • A virus (hepatitis, mono)
  • obesity
  • nutritional deficiences
  • tumors
  • Alc or other toxic substances
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4
Q

what is end-stage liver disease? (name)

A

Cirrhosis

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5
Q

what are some common manifestations of liver disease?

A
  • Hepatomegaly (abnormally enlarged liver)
  • Jaundice
  • edema
  • indigestion
  • Vague URQ pain
  • nutritional deficiencies due to the liver not being able to metabolize certain vitamins (fat-soluble)
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6
Q

What are some fat-soluble vitamins? (these are the vitamins that are impaired when the liver is damaged)

A

A, D, E and K

also what is impaired with liver is folic acid

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7
Q

If the liver cannot make vitamin k it is not able to make what?

A

prothrombin

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8
Q

What are the three kinds of jaundice and why do they occur?

A

Hemolytic: red blood cells destroyed too fast and liver cannot keep up with it
Hepatocellular- more associated with liver disease, liver not able to clear normal amount of bilirubin
Obstructive Jaundice- gall stone

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9
Q

If someone is dark-skinned where should they look for jaundice?

A

eyes and hard pallet of mouth

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10
Q

When someone has jaundice what other manifestations would we see?

A
  • yellow skin of sclera
  • pruritus (itching)
  • lack of appitie, nausea, weight loss
  • Malaise, fatigue and weakness
  • Elevated AST and ALT
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11
Q

the liver synthesizes albumin, what is albumins job?

A

So the fluid doesn’t leak outside the tissue

this leads to decreased colloidal pressure

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12
Q

The job of the liver to convert Ammonia to uria.

when there is a build-up of Ammonia it can lead to _______.

A

Hepatic encephalopathy, ammonia build up that crosses the blood-brain barrier manifested by sleep disturbance, lethargy and come as well as fetor hepaticus ( musty sweer odor breath)

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13
Q

What causes cirrhosis

A

Genetic disease- wilson, hemochromaosis, hlycogen storage disease

  • chronic viral hepatitis
  • chronic obstruction of bile ducts
  • alc most common
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14
Q

Early manifestations of Cirrohis

A
  • Dull acy upper R quadrant pain
  • weight loss
  • N/V
  • Flatulence
  • Anorexia
  • Dyspepsia
  • Change in bowel habits
  • Weakness
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15
Q

What are the endocrine issues associated with cirrhosis?

A

Hyperaldosteronism - retaining too much sodium and water and too much potassium

males: gynecomastia 
           lose hair on pubic hair                 
           testicular atrophy 
           impotence
Females: sterility 
                 abnormal bleeding in 
                post menopausal 
              women
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16
Q

Complications of cirrhosis

if the person has these complications they have uncompensated cirrhosis

A
  • portal hypertension
  • esophageal/gastric varices
  • peripheral edema
  • ascites
  • hepatic encephalopathy
  • hepatorenal syndrome
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17
Q

Ascities, esophageal and gastric varices

are all related to what disease?

A

Cirrhosis

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18
Q

Third spacing

A

fluid accumulates in abnormal places, unusable
ascites
Pleural effusion
Peritonitis

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19
Q

What are the classifications of edema?

A

Localized - edema is in one area (from injury)
Generalized - uniformly distributed
Dependent - found in different parts of the body like lower extremities or bedridden people in button

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20
Q

What is the job of ADH and RAAS system

A

ADH- is from the hypotalamus telling it to conserve water

RAAS System: rennin and angiotensin that responds to BP and causes vasoconstriction

-Aldosterone holds onto sodium and water

21
Q

how do older adults process thirst?

A

the have a LESS acute of thirst

22
Q

what are normal sodium levels and what is their role?

A

135 - 145
Maintains Blood pressure
Maintains blood volume
Maintains pH balance

23
Q

what will we see with someone who has hypernatremia?

A 
145<
(high big and bloated)
High big and bloated 
big swollen tongue
looks like Santa clause 
high muscle tone 
excessive water loss 
low-grade fever
24
Q

what will we see with someone who has hyponatremia?

A

Low and depressed

seizures and coma, tachycardia and weak thready pulse, respiratory arrest

25
Q

what is the normal range for potassium?

A

3.5-5

role to maintain heart and muscle contraction

26
Q

what does hypokalemia look like

A

can show ECG changes, GI: low and slow
biggest danger is paralytic ileus stopped GI track very dangerous
Musculoskeletal: low and slow check for deep tendeon reflexes, cramping confusion and weakness

27
Q

what does hyperkalemia look like?

A

high tight and contracted,
could be from decreased renal elimination, medications

S/S hyper-heart, GI, and neuromuscular
confusion and weakness

28
Q

what medications can cause hyperkalemia?

A

potassium supplements

ARBS and Ace inhibitors

29
Q

what medications can cause hypokalemia?

A

loop diuretics and all other diuretics other than potassium sparing

30
Q

what is calciums values and what is its role?

A

adds strengths to bones and teeth

  • cofactor in blood-clotting
  • essential in muscle contraction
31
Q

Hypocalcemia:

same as hyperphosphoria

A

(postive *chvosteks sign and trousseau sign blood pressure cuff leave inflated for 3 min , will have spasm if positive)

  • circumoral tingling (tingling around the mouth
  • risk for bleeding
  • cardiac dysrhythmias
32
Q

Hypercalcemia:

same as Hypophosphatia

A
  • bone pain
  • constipatin
  • severe muscle weakness
  • decreased DTR’s (deep tendon)
  • Kidney stones
33
Q

what is the role and ideal level for phosphorus?

A

Roles:

  • bone and teeth formation
  • helps regulate calcium
  • red blood cell function

2.4-4.5 mg dl

34
Q

Hypophosphatemia

A

can be caused by refeeding syndrome, high intake of Mg, hypothyroidism

35
Q

what electrolytes help regulate each other?

A

Phosphorus and calcium

ones high the other is low vice versa

36
Q

Low phosphorus has the same effects as hypercalcemia

A

low calcemia has the same effects as hypercalcemia

37
Q

What is magnesium role and ideal levels

A

1.8- 3.0
Muscle relaxation in the heart, uterus, and deep tenon reflexes

required for calcium and vitamin D absorption

38
Q

Hypomagnesium: ( low wild party)

A

causes: insufficient intake, bowel resection, Inflammatory bowl disease, chronic alcoholism/withdrawal

S/S : torsades de points, Vfib, tachycardia, DTR hyperreflexia
Eyes: nystagmus
GI confusion

39
Q

Hypermagnesium: (calm and quiet)

A

causes: renal failure, diabetes mellitus, DKA, ALL and AML

S/S: heart block, bradycardia, hypotension, DTR:hypo,
hypoactive bowel sounds, confusion

40
Q

Albumin role and level?

A

maintain osmotic forces and keeps fluid where it needs to be

3.4-5.4

41
Q

Hypoalbumin

A

under 3.4
causes: liver disease, malnutrition, congestive heart failure, leukemia and lupus

S/S: peripheral edema, third spacing

42
Q

Hyperalbumin

A

above 5.4

Causes: dehydration, multiple myeloma, sarcoidosis, respiratory distress

S/S: extreme thirst, poor skin turgor, tachycardia and increased respirations

43
Q

hypovolemia FVD

A

decrease intravascular fluid and blood volume

  • electrolyte concentration remains unchanged*
    causes: decreased fluid intake, fever, burns, renal disease, blood loss,
44
Q

Manifestations of Hypovolemia

A

decreased skin turgor,
sunken eyeballs, oliguria, concentrated urine, long cap refill, dizziness cool clammy pale skin, hypotension

Lab findings:
raised hemoglobin & hematocrit, BUN and creatinine

raised serum and urine osmolality and specific gravity

decreased urine sodium

45
Q

Manifestations of Hypervolemia

A

all the opposites of hypo

46
Q

measures in ABGs’

A

PH (7.35-7.45)

PaCO2 (normal 35-45 mmHg)
<35 alkaline and 45< acidic

HCO3 ( normal 21-28 mEq/L )
<21 acidic 28< alk

Pao2 (normal 80-100 mmHg and 60-70 in newborns)

47
Q

T/F

respiratory acid-base regulation is faster but does not last as long

A

True

respiration does Co2

48
Q

Renal regulation

A

regulates bicarbonate by
conserving it
secreting it into urine to process new bicarbonate

excretion oh H+ buffered bu ammonia

49
Q

what acid-base issue is common for people with renal disease

A

metabolic acidosis

chronic (7 decks)

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