Test #2

Question 1

what are the functions of the liver

Answer 1

• 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

Question 2

what is wilsons disease

Answer 2

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

Question 3

what are risk factors for liver disease

Answer 3

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

Question 4

signs of liver disease

Answer 4

• 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

Question 5

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

Answer 5

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)

Question 6

Side effects of viral hepatitis

Answer 6

Many are a symptomatic

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

Question 7

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

Answer 7

Urine may darken d/t excess bilirubin

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

Question 8

What is a difference in sxs of acute and chronic hepatitis

Answer 8

In chronic hepatitis liver enzymes will be elevated

Question 9

what does albumin do

Answer 9

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

Question 10

what diagnostic tests may be performed by someone with liver disease

Answer 10

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

Question 11

causes of hepatitis

Answer 11

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)

Question 12

risk factors for non alcoholic fatty liver disease

Answer 12

obesity
diabetes 
hyperlipidemia
 HTN
(increased fat in the diet)

Question 13

how do you treat nonalcoholic fatty liver disease

Answer 13

no specific treatment

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

Question 14

what is the acute phase of viral hepatitis

Answer 14

1-4months

a person is at maximum infectibility in acute phase

Question 15

s/s of acute phase of viral hepatitis

Answer 15

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

Question 16

how is Hep A transmitted

Answer 16

fecal oral route- primarily fecal contamination and oral ingestion

Question 17

how do you prohibit the transmission of Hep A

Answer 17

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

Question 18

what is the tx for Hep A

Answer 18

support
nutrition
NO etoh or tylenol

Question 19

how is Hep B transmitted

Answer 19

bodily fluids
blood to blood transmission
transmitted via birth

Question 20

how long can hep B last on surface

Answer 20

7 days

Question 21

how do interferons work

Answer 21

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

blocks synthesis of viral proteins

blocks viral assembly and release

Question 22

how do nucleosides and nucleotide analogs work

Answer 22

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

Question 23

what do you do for a needle stick

Answer 23

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.

Question 24

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

Answer 24

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

Question 25

what is significant about Hep D

Answer 25

it needs Hep B to survive. | it quickly leads to liver failure

Question 26

what type of things should a hepatitis pt be taught

Answer 26

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)

Question 27

what is the goal of hepatitis treatment

Answer 27

to decrease the viral load decrease inflammation decrease fibrosis scarring

Question 28

what are things nursing can do to help a pt with acute hepatitis

Answer 28

``` 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 ```

Question 29

what is cirrhosis

Answer 29

a chronic progressive disease of the liver characterized by extensive degeneration and destruction of liver cells.

Question 30

what causes cirhosis

Answer 30

any liver disease can lead to cirrhosis | from alcoholism to NAFLD

Question 31

what is the most common cause of cirrhosis

Answer 31

Hepatitis C and alcohol induced liver disease

Question 32

what are early clinical manifestations of cirrhosis

Answer 32

``` loss of appetite malaise weight loss jaundice steatorrhea itching (from excess bile salts) nausea easy bruising nosebleeds ```

Question 33

what are the later clinical manifestations of cirrhosis

Answer 33

``` ascites peripheral edema hemataemesis black stools muscle wasting (decreased a) spider angiomas dilated blood vessels fever and chills hepatic encephalopaty hepatorenal syndrome ```

Question 34

how does hepatic encephalopathy occur

Answer 34

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

Question 35

how is jaundice caused

Answer 35

the liver has a decreased ability to conjugate and excrete bilirubin

Question 36

why would a pt with cirrhosis cause ascites or peripheral edema

Answer 36

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

Question 37

why would a cirrhosis pt have muscle wasting

Answer 37

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

Question 38

what is hepatorenal syndrom

Answer 38

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.