Reviewer #5 Flashcards
A chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver cells.
Cirrhosis
The development of cirrhosis is
An insidious, prolonged course, usually after decades of chronic liver disease.
LIVER CIRRHOSIS is twice as common in
Men
The most common causes of cirrhosis are
Chronic hepatitis C infection and alcohol induced liver disease.
A common problem in people who abuse alcohol is
Protein malnutrition
Chronic inflammation and cell necrosis result in
Fibrosis and ultimately Cirrhosis
Chronic hepatitis combined with alcohol ingestion is synergistic in accelerating liver damage. Biliary causes of cirrhosis include
Primary Biliary Cirrhosis (PBC) and Primary Sclerosing Cholangitis (PSC)
Includes a spectrum of hepatic derangements that result from longstanding, severe, right-sided heart failure.
Cardiac Cirrhosis
Patients with normal liver function is known as
Compensated Cirrhosis
Symptoms may be severe and result from
Liver failure and Portal hypertension
In the advanced stages, the liver becomes
Small and nodular
Results from the functional derangement of liver cells and compression of bile ducts overgrowth.
Jaundice
Are small, dilated blood vessels with a bright red center point and spiderlikebranches.
SPIDER ANGIOMAS (telangiectasia or spider nevi)
A red area that branches with pressure and is located on the palms of the hands.
PALMAR ERYTHEMA
Are probably caused by the splenomegaly that results from the backup of blood from the portal vein into the spleen (portal hypertension).
Thrombocytopenia, Leukopenia, and Anemia
Is also due to inadequate RBC production and survival, poor diet, poor absorption of folic acid, and bleeding from varices.
Anemia
Results from the liver’s inability to produce prothrombin and other factors essential for blood clotting. It is manifested by hemorrhage or bleeding tendencies, such as epistaxis, purpura, petechiae, easy bruising, gingival bleeding, and heavy menstrual bleeding.
Coagulation problems
The liver fails to metabolize aldosterone adequately, resulting in
hyperaldosteronism with subsequent sodium retention and potassium loss.
A common finding in alcoholic cirrhosis and is probably due to a dietary deficiency of thiamine, folic acid, and cobalamin.
Peripheral Neuropathy
It usually results in mixed nervous system symptoms, but
Sensory symptoms may predominate
Those who have one or more complications of their liver disease have
Decompensated Cirrhosis
Ring of varices around the umbilicus
CAPUT MEDUSAE
Characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric esophageal varices.
Portal Hypertension
A complex of tortuous veins at the lower end of the esophagus, which are enlarged and swollen because of portal hypertension.
Esophageal varices
Are in the upper portion (cardia, fundus) of the stomach. These varices contain little elastic tissue and are fragile.
Gastric Varices
Are the most life-threatening complication of cirrhosis. The patient may have melena or hematemesis.
Bleeding Esophageal Varices
Sometimes precedes ascites, but in some patients, its development coincides with or occurs after ascites.
Peripheral Edema
Results from decreased colloidal oncotic pressure from synthesis of albumin portacaval hypertension.
Edema
Ascites is manifested by
Abdominal distention with weight gain.
If the ascites is severe, the umbilicus may be
Everted
Common and is due to an excessive loss of potassium caused by hyperaldosteronism. Low potassium levels can also result from diuretic therapy used to treat the ascites
Hypokalemia
A neuropsychiatric manifestation of liver disease
Hepatic Encephalopathy
A characteristic manifestation of hepatic encephalopathy is
Asterixis
Musty, sweet odor of the patient’s breath
Fetor hepaticus
Can occur in patients with decompensated cirrhosis.
Hepatorenal Syndrome
An elevation of blood urea nitrogen
Azotemia
Is an effective diuretic, even in patients with severe sodium retention. A potassium sparing diuretic
Spironolactone (Aldactone)
May be performed to remove ascitic fluid or to test the fluid for infection (spontaneous bacterial peritonitis).
Paracentesis
The main therapeutic goal for esophageal and gastric varices is to
Prevent bleeding and hemorrhage
When variceal bleeding occurs, the first step is to
Stabilize the patient and manage the airway.
May be used in patient with acute esophageal or gastric variceal hemorrhage that cannot be controlled on initial endoscopy.
Balloon tamponade
Ammonia formation in the intestines is reduced with
Lactulose (Duphalac)
A drug that traps ammonia in the gut. It can be given orally, as an enema, or through a nasogastric (NG) tube. The laxative effect of the drug expels the ammonia from the colon.
Lactulose
May also be given, particularly in patients who do not respond to lactulose.
Antibiotics such as Rifaximin
The most common disorder of the biliary system.
Cholelithiasis
Colelithiasis develops when the balance that keeps cholesterol, bile salts, and calcium in solution is
Altered
Conditions that upset the balance includes
Infection and disturbance in the metabolism of cholesterol.
Stones may be lodged in the
Neck of the gallbladder or in the cystic duct
The cause of gallstones is
Unknown
The inability to construct simple figures
Apraxia
Develops to reduce high portal pressure and the increased plasma volume and lymphatic flow.
Collateral Circulation
May develop in areas where the collateral and systemic circulations communicate, resulting in esophageal and gastric varices, caput medusae, and hemorrhoids
Varicosities
The accumulation of serous fluid in the peritoneal or abdominal cavity. It is a common manifestation of cirrhosis.
Ascites
Hormonal factors during pregnancy may cause delayed emptying of the gallbladder, resulting in
Stasis of Bile
The stones may remain in the gallbladder or migrate to the
Cystic duct or the common bile duc
Inflammation of the gallbladder
Cholecystitis
Cholecystitis may be
Acute or Chronic
Cholecystitis in the absence of obstruction
Acalculous Cholecystitis
Common causative bacteria for cholecystitis
E. coli, streptococci, and salmonella
The major pathophysiologic condition and may be confined to the mucous lining or involve the entire wall of the gallbladder.
Inflammation
During an acute attack of cholecystitis, the gallbladder is
Edematous and hyperemic, and it may be distended with bile or pus.
Manifestations of inflammation includes
Leukocytosis and Fever
Physical findings include
Right upper quadrant tenderness and abdominal rigidity.
Manifestations of chronic cholecystitis include
History of fat intolerance, dyspepsia, heartburn, and flatulence.
Stone in the common bile duct
Choledocholithiasis
Commonly used to diagnose gallstones.
Ultrasonography
Allows for visualization of the gallbladder, the cystic duct, the common hepatic duct, and the common bile duct.
ERCP
The direct insertion of a needle directly into the gallbladder duct followed by injection of contrast materials.
Percutaneous transhepatic cholangiography
Dissolves the solid cholesterol in gallstones, provides alternatives for patients who are poor surgical risks or who refuse surgery.
URSODIOL (Actigall) and CHENODIOL (Chenix)
Inflammation of the pancreas is characterized by the release of pancreatic tissue into the tissue of the pancreas itself, leading to hemorrhage and necrosis.
Pancreatitis
More common in middle adult. Its incidence is higher in men than in women. Usually associated with gallstones in women and alcoholism in men.
Acute pancreatitis
Characterized by gradual destruction of functional pancreatic tissue.
Chronic pancreatitis
Treatment for pancreatitis
Nutrition, Surgery, and Complement Therapy
Bile secreted by the liver is supersaturated with cholesterol
Lithogenic bile
When the lymphatic system is unable to carry off the excess proteins and water, they leak through the
Liver capsule into the peritoneal cavity
