Patho Regulatory Lecture Test #4 Flashcards
What tests can be done to check liver function? (blood tests)
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
What tests can be done to check liver function? (not blood tests)
Liver Biopsy
Ultrasound
CT
MRI
radioisotope liver scan
What are some reasons why someone could be diagnosed with hepatic dysfunction?
- A virus (hepatitis, mono)
- obesity
- nutritional deficiences
- tumors
- Alc or other toxic substances
what is end-stage liver disease? (name)
Cirrhosis
what are some common manifestations of liver disease?
- 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)
What are some fat-soluble vitamins? (these are the vitamins that are impaired when the liver is damaged)
A, D, E and K
also what is impaired with liver is folic acid
If the liver cannot make vitamin k it is not able to make what?
prothrombin
What are the three kinds of jaundice and why do they occur?
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
If someone is dark-skinned where should they look for jaundice?
eyes and hard pallet of mouth
When someone has jaundice what other manifestations would we see?
- yellow skin of sclera
- pruritus (itching)
- lack of appitie, nausea, weight loss
- Malaise, fatigue and weakness
- Elevated AST and ALT
the liver synthesizes albumin, what is albumins job?
So the fluid doesn’t leak outside the tissue
this leads to decreased colloidal pressure
The job of the liver to convert Ammonia to uria.
when there is a build-up of Ammonia it can lead to _______.
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)
What causes cirrhosis
Genetic disease- wilson, hemochromaosis, hlycogen storage disease
- chronic viral hepatitis
- chronic obstruction of bile ducts
- alc most common
Early manifestations of Cirrohis
- Dull acy upper R quadrant pain
- weight loss
- N/V
- Flatulence
- Anorexia
- Dyspepsia
- Change in bowel habits
- Weakness
What are the endocrine issues associated with cirrhosis?
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
Complications of cirrhosis
if the person has these complications they have uncompensated cirrhosis
- portal hypertension
- esophageal/gastric varices
- peripheral edema
- ascites
- hepatic encephalopathy
- hepatorenal syndrome
Ascities, esophageal and gastric varices
are all related to what disease?
Cirrhosis
Third spacing
fluid accumulates in abnormal places, unusable
ascites
Pleural effusion
Peritonitis
What are the classifications of edema?
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
What is the job of ADH and RAAS system
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
how do older adults process thirst?
the have a LESS acute of thirst
what are normal sodium levels and what is their role?
135 - 145
Maintains Blood pressure
Maintains blood volume
Maintains pH balance
what will we see with someone who has hypernatremia?
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
what will we see with someone who has hyponatremia?
Low and depressed
seizures and coma, tachycardia and weak thready pulse, respiratory arrest
what is the normal range for potassium?
3.5-5
role to maintain heart and muscle contraction
what does hypokalemia look like
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
what does hyperkalemia look like?
high tight and contracted,
could be from decreased renal elimination, medications
S/S hyper-heart, GI, and neuromuscular
confusion and weakness
what medications can cause hyperkalemia?
potassium supplements
ARBS and Ace inhibitors
what medications can cause hypokalemia?
loop diuretics and all other diuretics other than potassium sparing
what is calciums values and what is its role?
adds strengths to bones and teeth
- cofactor in blood-clotting
- essential in muscle contraction
Hypocalcemia:
same as hyperphosphoria
(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
Hypercalcemia:
same as Hypophosphatia
- bone pain
- constipatin
- severe muscle weakness
- decreased DTR’s (deep tendon)
- Kidney stones
what is the role and ideal level for phosphorus?
Roles:
- bone and teeth formation
- helps regulate calcium
- red blood cell function
2.4-4.5 mg dl
Hypophosphatemia
can be caused by refeeding syndrome, high intake of Mg, hypothyroidism
what electrolytes help regulate each other?
Phosphorus and calcium
ones high the other is low vice versa
Low phosphorus has the same effects as hypercalcemia
low calcemia has the same effects as hypercalcemia
What is magnesium role and ideal levels
1.8- 3.0
Muscle relaxation in the heart, uterus, and deep tenon reflexes
required for calcium and vitamin D absorption
Hypomagnesium: ( low wild party)
causes: insufficient intake, bowel resection, Inflammatory bowl disease, chronic alcoholism/withdrawal
S/S : torsades de points, Vfib, tachycardia, DTR hyperreflexia
Eyes: nystagmus
GI confusion
Hypermagnesium: (calm and quiet)
causes: renal failure, diabetes mellitus, DKA, ALL and AML
S/S: heart block, bradycardia, hypotension, DTR:hypo,
hypoactive bowel sounds, confusion
Albumin role and level?
maintain osmotic forces and keeps fluid where it needs to be
3.4-5.4
Hypoalbumin
under 3.4
causes: liver disease, malnutrition, congestive heart failure, leukemia and lupus
S/S: peripheral edema, third spacing
Hyperalbumin
above 5.4
Causes: dehydration, multiple myeloma, sarcoidosis, respiratory distress
S/S: extreme thirst, poor skin turgor, tachycardia and increased respirations
hypovolemia FVD
decrease intravascular fluid and blood volume
- electrolyte concentration remains unchanged*
causes: decreased fluid intake, fever, burns, renal disease, blood loss,
Manifestations of Hypovolemia
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
Manifestations of Hypervolemia
all the opposites of hypo
measures in ABGs’
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)
T/F
respiratory acid-base regulation is faster but does not last as long
True
respiration does Co2
Renal regulation
regulates bicarbonate by
conserving it
secreting it into urine to process new bicarbonate
excretion oh H+ buffered bu ammonia
what acid-base issue is common for people with renal disease
metabolic acidosis
