Quiz 10 Flashcards
Apraxia
Asterixis
Ataxia
(how to remember last 3)
What do the 3 above have anything to do with the liver?
Cavernous hemangioma
Peritonitis
Spider Angioma
Uremia
____
Hepatic osteodystrophy
LIVER DISEASE:
Bilirubin:
Jaundice
Icterus:
(how to remember)
Cirrhosis
(how to remember)
Portal hypertension
Hepatic encephalopathy
STAGES:
Ascites
Hepatorenal syndrome
HEPATIC SYSTEM:
Hepatitis
Chronic hepatitis Fulminant hepatitis Viral hepatitis (distinguish between HAV, HBV, HCV, HDV, HEV, HGV ... or Hepatisis A, B, C, D, E) Hepatitis A, B, C, D, E Autoimmune hepatitis Alcoholic Hepatisis
Primary biliary cirrhosis
Liver abscess
Liver adenomas
Primary hepatocellular carcinoma
PANCREATIC SYSTEM: Diabetes mellitus (we already did this in unit 5) Pancreatitis – acute vs. chronic Pancreatic cancer Cystic Fibrosis
BILIARY (Gallbladder) SYSTEM:
Bile
Gallstones
Chole:
Cholelithiasis (Choledocholithiasis)
Cholecystitis
Cholestatsis
Primary schlerosing cholangitis
Cholang
Cholangitis
Cholangiography
Cholecyst
Cholecystectomy
Cholecystography
Cholecystostomy
Choledocho:
Choledochostomy
Apraxia: is a motor SPEECH DISORDER that makes it hard to speak. Result of brain damage from liver not removing all toxins (and the toxins get into brain).
Asterixis: is a TREMOR of the HAND when the WRIST is extended, sometimes said to resemble a bird flapping its wings. “Flapping tremor” (one will get it as same reason noted above)
Ataxia: the loss of FULL control of BODILY MOVEMENTS. (one will get it as same reason noted above)
(P = sPeech, S = wriSt or st for wrist tremor, T = Total)
Hepatic encephalopathy: The LOSS of BRAIN FUNCTION when a DAMAGED LIVER DOESN’T REMOVE TOXINS from the blood and those toxins pass through blood-brain barrier and effect the brain.
Cavernous hemangioma: a type of blood vessel malformation or hemangioma, where a collection of dilated BLOOD VESSELS form a benign TUMOR.
Peritonitis: INFLAMMATION of the PERITONEUM, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ.
Spider Angioma: SPIDER VEINS. … A spider nevus is a collection of small, DILATED arterioles (blood vessels) clustered very close to the SUFACE of the SKIN. … Spider nevi (plural) can be caused by injuries, sun exposure, hormonal changes, or LIVER DISEASE, but often the cause is unknown.
Uremia: From last lecture, but it is a condition involving abnormally HIGH LEVELS of WASTE products in the BLOOD.
____
Hepatic Osteodystrophy (HO): is a generic definition for the metabolic BONE DISEASE that may occur in individuals with chronic LIVER DISEASE. Hepatic Osteodystrophy is an important but frequently overlooked complication, seen in chronic liver disease patients.
Bilirubin: an orange-YELLOW PIGMENT formed in the liver by the BREAKDOWN of HEMOGLOBIN, and excreted in BILE. High levels of bilirubin results in jaundice.
Jaundice: A LIVER condition that causes YELLOWING of a NEWBORN baby’s skin and eyes. An IMMATURE LIVER of a baby will result in high levels of BILIRUBIN (hyperbilirubinemia) from immature liver, liver disease, obstruction of bile duct, or excessive breakdown of RBC’s. About 15-20% of newborns have it.
Icterus: technical term for Jaundice
(ic u = NICU)
Cirrhosis: is the name for the condition when the LIVER CELLS become so DAMAGED that they are replaced by SCAR tissue. This scar tissue AFFECTS BLOOD FLOW and the flow of other fluids THROUGH THE LIVER, interfering with its ability to rid the body of TOXINS.
(remember: scarring in Liver, H = hepatic)
Portal hypertension: Portal hypertension is an increase in the blood pressure within the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver.
Hepatic encephalopathy: LIVER DOES NOT DETOXIFY … so toxins pass blood-BRAIN barrier and get into brain. The LOSS of BRAIN FUNCTION when a DAMAGED LIVER DOESN’T REMOVE TOXINS from the blood.
Stage I- flapping tremor, numbness/tingling, memory
lapses, impaired concentration
Stage II – motor apraxia
Stage III – arousable
Stage IV – comatose
Ascites: the accumulation of FLUID in the PERITONEAL cavity, causing abdominal swelling. Caused by LIVER DISEASE.
Hepatorenal syndrome: life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or liver failure. KIDNEY FAILS AS A RESULT OF LIVER FAILURE?
Hepatitis: INFLAMMATION of the LIVER
Chronic Hepatitis: A SERIOUS liver infection caused by the HEPATITIS B VIRUS that’s easily preventable by a VACCINE.
Fulminant hepatitis: is a RARE syndrome of MASSIVE NECROSIS of LIVER parenchyma and a DECREASE in LIVER SIZE (acute yellow atrophy) that usually occurs after infection with certain hepatitis viruses, exposure to toxic agents, or drug-induced injury.
Viral Hepatisis (or Hep A, B, C, D, E, G)
A: from contaminated FOOD or WATER or FECES.
VACCINE AVAILABLE
B: exposure to infected BLOOD, SEMUN, bodily
FLUIDS.
Spread from SEXUAL contact, from mother to baby,
drug NEEDLES, etc. VACCINE AVAILABLE
C: From needles from drungs, hemodyalisis. VACCINE
NOT AVAILABLE
D: Only occurs with Hep B
E: Typically in DEVELOPING COUNTRIES due to
contaminated water and food, and feces.
- A, B, C are most common. Vaccine available for Hep A and B (and D), but not C. A and E obtained through fecal-oral route. B, C, and D through promiscuous activity (drugs, sex) or blood contact.
Autoimmune Hepatitis: Inflammation in the liver that occurs when the immune system attacks the liver.
Alcoholic Hepatitis: Liver inflammation caused by drinking too much alcohol.
Primary biliary cirrhosis: An autoimmune disease that causes progressive destruction of the bile ducts. The bile ducts develop inflammation and eventually collapse. This causes liver damage and may eventually lead to cirrhosis.
Liver abscess: A liver abscess is a PUS-FILLED MASS inside the liver. Common causes are abdominal conditions such as appendicitis or diverticulitis due to hamatogenous spread through the portal vein.
Liver adenomas: benign liver tumors
Primary hepatocellular carcinoma: Most COMMON form of liver cancer
Pancreatitis: Inflammation of the pancreas
Pancreatic cancer: Cancer in pancreas :)
Cystic Fibrosis: Usually seen in CHILDREN, but can effect LUNGS or DIGESTIVE system. Cystic fibrosis AFFECTS THE EXOCRINE CELLS THAT PRODUCE MUCOUS, sweat and digestive juices. These secreted fluids are normally thin and slippery. But in people with cystic fibrosis, a DEFECTIVE GENE causes the SECRETIONS TO BECOME STICKY AND THICK. Instead of acting as a lubricant, the secretions PLUGS THE TUBES, ducts and passageways, especially in the lungs and pancreas.
Bile: a bitter greenish-brown alkaline fluid that aids DIGESTION and is created/secreted by the LIVER and STORED in the GALLBLADDER.
Gallstones: HARDENED DEPOSITS of BILE that can form in your gallbladder and pass through bile duct. Causes great pain in upper right quadrant of abdomen (and referred pain to back) as they pass.
Chole: Meaning BILE or gall
Cholelithiasis: formation of GALLSTONES (see above)
Cholecystitis: Inflammation of the GALLBLADDER
Cholestatsis: where bile from liver STOPS or slows
Primary schlerosing cholangitis: is a LONG-TERM progressive disease of the liver and gallbladder characterized by inflammation and scarring of the BILE DUCTS which normally allow bile to drain from the gallbladder.
Cholang: Bile duct
Cholangitis: Infection of the BILE DUCT
Cholangiograpahy: X-ray examination of the BILE DUCTS, used to locate and identify an obstruction.
Cholecyst: Gall bladder
Cholecystectomy: Surgical removal of gallbladder
Cholecystography: X-ray examination of the gallbladder, especially used to detect the presence of gallstones.
Cholecystostomy: a procedure where a STOMA is created in the gallbladder, which can help DRAIN the GALLBLADDER when not working properly.
Choledocho: Common bile duct
Choledochostomy: A fistula in common bile duct
1) What are the major functions of the liver?
2) What are the major functions of the pancreas?
3) What are the major functions of the gall bladder?
1) Liver:
- Produces bile (and excretes it to gallbladder)
- Metabolizes fats, proteins, carbs
- Stores glycogen, vitamens, and minerals
- Blood detoxification and purification … ridding the body of toxins and harmful substances (ie. alcohol) ***
- Blood sugar regulation
2) Pancreas:
- Produces insulin and glucogon to regulate blood sugar levels
- Makes and secretes enzymes to help with digesting fats, proteins, carbs.
3) GallBladder:
- Store and concentrate BILE (that comes from the liver) and released to duodenum to metabolize and break down food during digestion.
Describe the signs and symptoms of liver disease.
*** NEVER forget she may try and trick us about the difference between SIGN and SYMPTOM. What is the difference:
Symptoms vary but may include:
- yellow eyes and skin (jaundice)
- nausea, vommitting, fever
- abdominal pain and swelling (ascites)
- swelling of the legs
- spider veins
- Tender enlarged liver
- Dark urine, pale stools
- Hepatic osteodystrophy
- Portal hypertension
- Renal failure
- Asterixis (muscle tremmors)
Sign = something a Dr. can see or measure Symptom = Something a Dr. can't see or measure, just what the patient reports.
What changes occur in the hepatic system as a person ages?
T or F: With age, the pancreas must lose 90% of its function before observable dysfunction occurs
T or F: With age, the gallbladder releases less bile?
- Liver decreases in size, and thus blood flow decreases
- Inability to eliminate drugs and toxins
- Metabolism slows down
- Production and flow of bile decreases
- Substances that are toxic (alcohol) do MORE damage
- Repair of damaged liver cells takes longer
TRUE
TRUE
1) Describe the healing process in the hepatic system.
2) One of the most common causes of liver damage/disease is:
3) How does Alcohol damage your liver:
4) What is Alcoholic Hepatitis:
5) What is Nonalcoholic Fatty Liver Disease
2) Alcoholism
3) The LIVER GETS RID OF TOXINS and harmful substances in your body. When alcohol is introduced to the liver, it produces acetaldehyde, which is a TOXIC ENZYME that can DAMAGE LIVER CELLS and cause scarring. Additionally, alcohol DEHYDRATES the body, and the liver requires water to function correctly. When the body lacks in water, the liver is forced to pull in water from other sources. It can lead to: a fatty liver (fat build up from drinking more than the liver can handle), alcoholic hepatitis, and cirrhosis of the liver.
4) Alcoholic hepatitis: Liver inflammation caused by drinking too much alcohol. With this condition, the liver becomes swollen and tender. This interferes with the liver’s ability to perform essential functions (get rid of toxins), and with time may develop into a more serious condition known as CIRRHOSIS of the liver.
5) The accumulation of liver fat in people who drink little or no alcohol.
1) Hepatic System =
2) Renal System =
3) Pancreatic System =
4) Biliary System =
1) Liver
2) Kidney (learned about it’s function in previous lectures … review those)
3) Pancreas (learned about it’s function in previous lectures … review those)
4) Gallbladder. The gallbladder holds a DIGESTIVE FLUID called BILE (that it gets from the liver) that’s released into your small intestine. The biliary system is the organs and ducts that create and store bile and release it into the duodenum (the small intestine). The biliary system includes the gallbladder and bile ducts inside and outside the liver. It is also known as the biliary, or bile, tract.
Implications for the PT for each of these systems:
Hepatic System =
Renal System =
Pancreatic System =
Biliary System =
EDUCATION, referrals
- LIVER: Help the patient STOP drinking alcohol
- PANCREAS: Be aware of ALL the diabetes issues we discussed in previous lecture
What is a TIPS procedure:
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that may be used to reduce portal hypertension and its complications, especially variceal bleeding. A TIPS procedure may be done by a radiologist, who places a small wire-mesh coil (stent) into a liver vein.
Reroute blood from vein to vein
Review the functions of the pancreas:
Exocrine secretion of digestive enzymes and pancreatic juices, transported through the pancreatic duct to the duodenum where proteins, carbohydrates, and fats are broken down
Endocrine function involves the secretion of glucagon and insulin for the regulation of carbohydrate metabolism
Review the functions of the gallbladder:
Bile – a thick fluid secreted by the liver. About 50% is stored and concentrated in the gallbladder (between meals). The function of bile in digestion is the emulsification of FATS which facilitates their digestion in the small intestine. It also stimulates peristalsis. It is normally ejected only during duodenal digestion.
Cystic duct and the common hepatic duct form the common bile duct
Review terminology:
1) Chole-
2) Cholang-
3) Cholecyst-
4) Choledocho-
5) Cholelith-
6) Cholangitis –
7) Cholecystitis –
8) Cholecystectomy –
9) Cholescintigraphy –
1) Bile
2) Bile ducts
3) Gall bladder
4) Common bile duct
5) Gallstones
6) Inflammation of the bile duct
7) Inflammation of the gall bladder
8) Removal of the gall bladder
9) Radionuclide imaging of biliary system
From Dr. Black’s Lecture on the Case Study:
1) What would mild dementia have to do with liver failure?
2) Can you get rid of cirrhosis?
3) What is OASIS?
1) If liver doesn’t work, more toxins go through blood to brain, which causes memory loss and brain dysfunction.
2) NO
3) A initial intake form that a Nurse will do in a home health setting to do a comprehensive overview of the patient’s health and condition. It includes a multi-discipline view to know what type of care they need to know what insurance reimbursement they will get.
REVIEW of the different Hepatitis’
Hep A:
Hep B:
Hep C:
Hep D:
Hep E:
Big differences between Hep A and E:
Hep A:
- The virus is transmitted via the fecal-oral route, primarily via contaminated water, undercooked meat, feces.
- Typically happens in underdeveloped countries
- VACCINE available
Hep B:
Hep C:
Hep D:
Hep E:
- The virus is transmitted via the fecal-oral route, primarily via contaminated water, undercooked meat, feces.
- Typically happens in underdeveloped countries
- NO VACCINE available
- Usually the infection is self-limiting and resolves within 2–6 weeks.
- Does NOT develop into cancer
Hep A and E: Vaccine is available for Hep A, but NOT Hep E, even though they both are transmitted in a same way (food, water, feces, etc.)
What is more contagious … HIV or Hepatitis?
Hepatitis
JEAPORDY ?’s and ANSWERS:
- What term would you use to describe an infants yellow skin color when born?
- Types of acute viral hepatitis that may progress to chronic hepatitis?
- A well-documented cause of hepatic encephalopathy; a toxin created by bacteria in the colon from the metabolism of protein and urea
- Children in daycare centers are at highest risk for which type of hepatitis
- The best treatment for liver cirrhosis caused by Hep B (HBV) is:
- Which Hepatitis’ can lead to cancer?
- Can you get liver cancer from Hep A or E
- Which of the following is NOT a clinical manifestation (or s/s) of cirrhosis of the liver
- Hpyerbilirubinemia
- Light-colored stools
- Hyperglycemia
- Ascites - How would you describe the symptom of liver disease where the hands are red
- What term would you use to describe small red streaks in a circular area
- The two conditions most commonly associated with acute pancreatitis
- Surgical procedure to remove gallbladder
- Vaccine is available for use in primary prevention of these types of viral hepatitis
- A proceedure used to treat portal hypertension by creating an artificial channel from the portal vein to a hepatic vein
- *** A ? on final exam will be on TIPS proceedure from the last ?
- Post-exposure immunoglobulin is available as a prophylaxis against these hepatitis viruses (meaning you are exposed and worried you might get the disease)
- Term for cancer of the bile ducts
- Jaundice
- Hep B, C, D
- Ammonia (byproduct of bacteria in the colon which the liver is supposed to detoxify)
- Hep A (because fecal-oral route)
- Liver Transplant
- Hep B, C, D
- NO
- Hyperglycemia
- Palmer Arrythemia
- Spider Angioma
- Alcohol abuse, gallstones
- Cholecystectomy
- Hep A, B (and thus D)
- TIPS proceedure (transjugular intrahepatic portosystemic shunt)
- Ok
- Hep A (and maybe E)
- Cholangiocarcinoma
Chole
Cholang
Cholecyst
Choledocho
Cholelith
graphy =
itis =
ectomy =
ostomy =
lithiasis =
stasis =
carcinoma =
Bile
Bile Duct
Gallbladder
Common Bile duct
Gallstones
graphy = radiographic study of
itis = inflammation
ectomy = removal
ostomy = incision of (bag)
lithiasis = formation of
stasis = stoppage
carcinoma = cancer
