Test #2 Flashcards

(38 cards)

1
Q

what are the functions of the liver

A
  • Bile synthesis and secretion
  • fat and protein metabolism- albumin and ammonia conversion to urea
  • CHO metabolism- glycogenesis
  • clotting factors i ii vi ix x pt
  • glycogenolysis, gluconeogenesis and lipolysis
  • first pass, drug metabolism
  • stores A D B12, iron copper angiotensinogen, immune role
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2
Q

what is wilsons disease

A

defect in biliary excretion which leads to accumualtion of copper in the liver causing liver injury and cirrhosis

copper then can leak into the plasma and go to other areas causing tissue damage, neurological damage and renal disease

hallmark sign = corneal Kayser Fleischer rings- brownish red rings in the cornea

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3
Q

what are risk factors for liver disease

A
alcohol abuse
medications- TYLENOL 
gastric bypass
hepatitis
hypercholesterolemia/triglyceridemia
excess iron
malnutrition
obesity (metabolic syndrome)
toxic/chemical exposure
rapid weight loss
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4
Q

signs of liver disease

A
  • anorexia
  • ascites
  • dark urine (d/t excess bilirubin)
  • hepatomegaly
  • hyperbilirubinemia
  • jaundice
  • RUQ pain
  • Splenomegaly
  • steatorrhea (can’t break down fat so its excreted in the stool
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5
Q

what types of labs would you draw for diagnostic studies for liver disease

A

clotting studies
CBC CMP
LFTs (ALT, AST, BIli, ammonia, albumin, ALP, GGT)
(ggt will be elevated in conjunction with alp in liver disease. alp will be elevated by itself in bone disease)

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6
Q

Side effects of viral hepatitis

A

Many are a symptomatic

Acute phase includes malaise fatigue myalgia arthralgia anorexia weight loss fatigue n&v HA fever jaundice

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7
Q

If a patient has dark urine and clay colored stool what is going on

A

Urine may darken d/t excess bilirubin

If conjugated bilirubin cannot fly w out of the liver the stool will be clay colored

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8
Q

What is a difference in sxs of acute and chronic hepatitis

A

In chronic hepatitis liver enzymes will be elevated

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9
Q

what does albumin do

A

it has oncotic pressure maintaining volume in vascular system
medications also bind with albumin deactivating them.

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10
Q

what diagnostic tests may be performed by someone with liver disease

A

Upper GI-can go into the common bile duct
US
CT scan
angiographic studies-checking liver perfusion
radioisotope liver scan
liver biopsy- can check for hepatocellular change

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11
Q

causes of hepatitis

A

viral
alcohol
toxins
autoimmune disease (body is attacking its own)
nonalcoholic fatty liver disease (fat accumulation in hepatocytes)
nonalcoholic steatosis (fat accumulation in the liver causing scarring)

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12
Q

risk factors for non alcoholic fatty liver disease

A
obesity
diabetes 
hyperlipidemia
 HTN
(increased fat in the diet)
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13
Q

how do you treat nonalcoholic fatty liver disease

A

no specific treatment

tx of the causes: tx of diabetes, hyperlipidemia, body weight

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14
Q

what is the acute phase of viral hepatitis

A

1-4months

a person is at maximum infectibility in acute phase

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15
Q

s/s of acute phase of viral hepatitis

A
anorexia
n/v
ruq pain
fever
malaise
weight loss
fatigue
dark urine
arthralgia
hepatomegaly
splenomegaly
jaundice
pruritus
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16
Q

how is Hep A transmitted

A

fecal oral route- primarily fecal contamination and oral ingestion

17
Q

how do you prohibit the transmission of Hep A

A

wash hands thoroughly
cooking kills Hepatitis A
vaccination can protect you from acquiring hep a

18
Q

what is the tx for Hep A

A

support
nutrition
NO etoh or tylenol

19
Q

how is Hep B transmitted

A

bodily fluids
blood to blood transmission
transmitted via birth

20
Q

how long can hep B last on surface

21
Q

how do interferons work

A

bind to receptors on host cell membranes blocking viral entry into cells.

blocks synthesis of viral proteins

blocks viral assembly and release

22
Q

how do nucleosides and nucleotide analogs work

A

they make the virus think they are normal building blocks confusing them thus making them unable to replicate

lowers the amount of virus in the body

23
Q

what do you do for a needle stick

A

obtain a blood test at 0, 3 and 6 months
the blood test at 0 is to test for any exsiting antibodies.
if it goes from neg to positive for antibodies, you will be treated prophylactically with interferon.

24
Q

what helps break down fat? and what does that mean for liver disease pt

A

bile

therefore if the pt has liver damage, less bile will be produced thus less fats will be broken down and pt should intake less fats

25
what is significant about Hep D
it needs Hep B to survive. | it quickly leads to liver failure
26
what type of things should a hepatitis pt be taught
if they have one strain of hepatitis they should get vaccinated for the other adequate hand hygiene blood and body fluid precautions- modes of transmission, safe sex adequate diet, no etoh, cautious use of medications (tylenol)
27
what is the goal of hepatitis treatment
to decrease the viral load decrease inflammation decrease fibrosis scarring
28
what are things nursing can do to help a pt with acute hepatitis
``` assess degree of jaundice assess color of urine comfort measures- tx for itching, HA arthralgia -make sure they have adequate nutrition prevent nausea adequate fluid intake promote rest ```
29
what is cirrhosis
a chronic progressive disease of the liver characterized by extensive degeneration and destruction of liver cells.
30
what causes cirhosis
any liver disease can lead to cirrhosis | from alcoholism to NAFLD
31
what is the most common cause of cirrhosis
Hepatitis C and alcohol induced liver disease
32
what are early clinical manifestations of cirrhosis
``` loss of appetite malaise weight loss jaundice steatorrhea itching (from excess bile salts) nausea easy bruising nosebleeds ```
33
what are the later clinical manifestations of cirrhosis
``` ascites peripheral edema hemataemesis black stools muscle wasting (decreased a) spider angiomas dilated blood vessels fever and chills hepatic encephalopaty hepatorenal syndrome ```
34
how does hepatic encephalopathy occur
the liver is unable to convert ammonia to urea thus an increase in ammonia in the body ammonia is able to cross the BBB and cause encephalopathy
35
how is jaundice caused
the liver has a decreased ability to conjugate and excrete bilirubin
36
why would a pt with cirrhosis cause ascites or peripheral edema
Blood flow can't flow through he liver and it backs up into the portal vein. all that pressure pushes the fluid out into the tissue spaces causing ascites there is less albumin so oncotic pressure is off thus fluid moving out into the tissues
37
why would a cirrhosis pt have muscle wasting
the body is breaking down protein for energy this also causes increased ammonia from protein breakdown and liver can't break down ammonia so that contributes to increased ammonia levels
38
what is hepatorenal syndrom
the blood flow to the liver is backing up into the portal vein because blood cannot easily flow through the liver. The blood flow backs up in the renal arteries causing decreased function in the kidneys.