Test 1 Flashcards
Hemolytic Liver Jaundice
increase breakdown of RBCs leads to increase amount of unconjugated bilirubin
Causes: blood transfusion reaction, sickle cell crisis, hemolytic anemia
Hepatocellular Liver Jaundice
result of liver’s inability to take bilirubin from blood, to conjugate it, or to excrete it
Causes: hepatitis, cirrhosis, hepatocellular carcinoma
Obstructive Liver Jaundice
result of decreased or obstructed flow of bile
Causes: intrahepatic swelling or fibrosis of liver caniliculi & bile ducts
Hepatitis A (HAV) vaccine? route of transmission? Prevention measures?
Vaccine? Yes
Transmission route? fecal-oral, contaminated water, shellfish from contaminated water
Prevention Measures: hand washing
Hepatitis A (HAV) Symptoms? Potential Complications?
Symptoms: can last 4-8 weeks, similar to typical viral syndrome
Complications: Not usually life threatening
Hepatitis B (HBV) vaccine? Route of transmission? Prevention measures?
Vaccine: Yes
Route of transmission: unprotected sex, sharing needles, blood transfusions, semen & saliva
Prevention: condoms
Hepatitis B (HBV) symptoms? Potential Complications?
Symptoms: anorexia, N/V, fever, fatigue, RUQ pain, dark urine, light stool, joint pain & jaundice
Complications: cirrhosis, liver cancer, chronic hepatitis, death
Hepatitis C (HCV) vaccine? Route of transmission? Prevention Measures?
Vaccine: No
Route of transmission: blood transfusions before 1992, sharing needles, high risk sexual behavior
Hepatitis C (HCV) symptoms? Potential Complications?
Symptoms: anorexia, N/V, fever, fatigue, RUQ pain, dark urine, light stool, joint pain, jaundice
Complications: liver cancer or chronic live disease
*Accounts for 30% of all liver transplants
Hepatitis D (HDV) vaccine? Route of transmission? Prevention Measures?
This virus requires Hep B to replicate
Vaccine: Hep B vaccine reduces risk
Route of Transmission: similar to Hep B; needles
*High mortality rate
Hepatitis E (HEV) vaccine? Route of transmission? Prevention Measures
Vaccine: ?
Route of transmission: occurs primarily in developing countries; oral fecal; drinking contaminated water (Resembles Hep A)
Cirrhosis and causes
extensive scarring of the liver
Causes: alcohol (mc), viral hepatitis, autoimmune hepatitis…
Cirrhosis clinical manifestations (early)
fatigue, slight weight loss, anorexia, flatulence, N/V, abd pain and liver tenderness, diarrhea or constipation, pruritus, enlarged liver & spleen
Cirrhosis clinical manifestations (late)
jaundice, skin lesions (spider angiomas, palmar erythema), hematologic problems (thrombocytopenia, leukopenia, anemia, splenomegaly, epitaxis, purpura, petechiae), endocrine problems (gynocomastia, loss of axillary & pubic hair, testicular atrophy, amenorrhea, hyperaldosteronism, water retention & potassium loss), peripheral neuropathy
Complications of cirrhosis
portal hypertension, bleeding esophageal & gastric varices, peripheral edema & ascites, coagulation defects, spontaneous bacterial peritonitis, hepatic encephalopathy
Esophageal varices
caused by portal hypertension, mc of death from cirrhosis
treatment of esophageal varices
- sclerotherapy
* banding
Interventions for ascites & gynecomastia
- High fowlers to improve breathing
- Fluid restriction
- Low Na, K sparing diuretics
- Albumin
- Paracentesis
Diagnosis for cirrhosis
- Liver function tests - increased
- Prothrombin Time - increased (AKA Protime) (Clotting factors impaired)
- Total Protein & Albumin - decreased
- Bilirubin - increased
- Ultrasound
- CT
- MRI
- Biopsy
- Varices: UGI, esophagoscopy
Hepatic Encephalopathy
terminal complication of liver damage, protein is broken down by bacteria & forms ammonia. The liver converts ammonia into urea which is eliminated in urine. Liver is unable to convert ammonia to urea
Treatment of hepatic encephalopathy
Diet: high calorie, carb, protein depends on severity, multi-vitamins esp B complex & vit K; antacids to decrease GI distress & bleeding, avoid alcohol
Drug Therapy: Lactulose, neomycin sulfate, Flagyl
Manifestations of Hepatic Encephalopathy
- Neurologic changes (lethargy to coma)
- Asterixis (course tremor w flexion of wrists/fingers)
- Apraxia (inability to form simple figures
- Hyperventilation
- Hypothermia
- Grimacing
- fector hepaticus (musty sweet odor on breath)
Fulminant Hepatic Failure (AKA acute liver failure)
severe impairment of liver function associated with hepatic encephalopathy
*MC cause drugs (esp Tylenol & ETOH)
Clinical manifestations of liver failure
jaundice, coagulation abnormalities & encephalopathy, mentation changes, pts may worsen rapidly; liver transplant is treatment of choice
