Test #2 Flashcards
what are the functions of the liver
- 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
what is wilsons disease
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
what are risk factors for liver disease
alcohol abuse medications- TYLENOL gastric bypass hepatitis hypercholesterolemia/triglyceridemia excess iron malnutrition obesity (metabolic syndrome) toxic/chemical exposure rapid weight loss
signs of liver disease
- 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
what types of labs would you draw for diagnostic studies for liver disease
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)
Side effects of viral hepatitis
Many are a symptomatic
Acute phase includes malaise fatigue myalgia arthralgia anorexia weight loss fatigue n&v HA fever jaundice
If a patient has dark urine and clay colored stool what is going on
Urine may darken d/t excess bilirubin
If conjugated bilirubin cannot fly w out of the liver the stool will be clay colored
What is a difference in sxs of acute and chronic hepatitis
In chronic hepatitis liver enzymes will be elevated
what does albumin do
it has oncotic pressure maintaining volume in vascular system
medications also bind with albumin deactivating them.
what diagnostic tests may be performed by someone with liver disease
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
causes of hepatitis
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)
risk factors for non alcoholic fatty liver disease
obesity diabetes hyperlipidemia HTN (increased fat in the diet)
how do you treat nonalcoholic fatty liver disease
no specific treatment
tx of the causes: tx of diabetes, hyperlipidemia, body weight
what is the acute phase of viral hepatitis
1-4months
a person is at maximum infectibility in acute phase
s/s of acute phase of viral hepatitis
anorexia n/v ruq pain fever malaise weight loss fatigue dark urine arthralgia hepatomegaly splenomegaly jaundice pruritus
how is Hep A transmitted
fecal oral route- primarily fecal contamination and oral ingestion
how do you prohibit the transmission of Hep A
wash hands thoroughly
cooking kills Hepatitis A
vaccination can protect you from acquiring hep a
what is the tx for Hep A
support
nutrition
NO etoh or tylenol
how is Hep B transmitted
bodily fluids
blood to blood transmission
transmitted via birth
how long can hep B last on surface
7 days
how do interferons work
bind to receptors on host cell membranes blocking viral entry into cells.
blocks synthesis of viral proteins
blocks viral assembly and release
how do nucleosides and nucleotide analogs work
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
what do you do for a needle stick
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.
what helps break down fat? and what does that mean for liver disease pt
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
what is significant about Hep D
it needs Hep B to survive.
it quickly leads to liver failure
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)
what is the goal of hepatitis treatment
to decrease the viral load
decrease inflammation
decrease fibrosis scarring
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
what is cirrhosis
a chronic progressive disease of the liver characterized by extensive degeneration and destruction of liver cells.
what causes cirhosis
any liver disease can lead to cirrhosis
from alcoholism to NAFLD
what is the most common cause of cirrhosis
Hepatitis C and alcohol induced liver disease
what are early clinical manifestations of cirrhosis
loss of appetite malaise weight loss jaundice steatorrhea itching (from excess bile salts) nausea easy bruising nosebleeds
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
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
how is jaundice caused
the liver has a decreased ability to conjugate and excrete bilirubin
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
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
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.
