Test 5 Flashcards
What are causes of cirrhosis of the liver? (8)
- Alcoholic liver dz
- NAFLD (fatty liver)
- Autoimmune
- Hepatitis
- Primary biliary cirrhosis
- Drug induced
- Wilson’s Dz
- Chronic R sided HF
Which type of Hepatitis is closely associated with development of cancer?
Hep C
Name 6 complications of altered liver function:
- Low albumin
- Low protein
- Low potassium
- High bilirubin
- High ammonia
- Coagulopathies
- H2O retention
What is the most common cause of encephalopathy? (hepatic or otherwise)
High ammonia levels
What are 2 medications used to lower ammonia levels/Tx encephalopathy?
Lactulose
Neomycin
Asterixis is AKA _____ and is caused from _____
Liver flap; encepalopathy (high ammonia)
Liver failure patients are hypo or hypervolemic?
Hypovolemic despite being edematous–due to third spacing
What role do the kidneys play in liver failure?
Hypovolemia causes the kidneys to be under-perfused which can cause AKI.
Kidneys excrete bilirubin.
What blood products/Tx might a liver failure pt. receive?
- PRBCs
- FFP
- Plts
- Volume rep. w/ Colloids
- Vit K
What fluid/electrolyte imbalances would you see in LF patients?
- Hypokalemia
- Decreased UOP
- IV volume depletion
- Hypoalbuminemia
Explain the TIPS procedure:
Stent placed (acts as an artificial vessel) to bypass the portal system in liver
When chronic paracentesises are no longer tolerated, what intervention can be done?
A LeVeen shunt can be placed- shunt is placed under the skin that routes the ascitic fluid from the peritoneum (more permanent drainage system)
What causes abdominal compartment syndrome?
High pressures that result in decreased perfusion to the abdominal cavity (sustained intra abdominal pressure of >20 mmHg with new organ dysfunction or failure)
Sustained IAP = MAP-IAP
Define fulminant hepatic failure and what is the major cause?
Liver failure which occurs in less than 6 months; hepatotoxic meds (acetaminophen)
Which medications are contraindicated in fulminant LF but are indicated in normal LF?
Lactulose, neomycin
Name some non-candidate risk factors for liver transplant:
- Uncontrolled bacterial sepsis
- Major organ failure
- Portal vein thrombosis
- Current alcohol/drug use
- Extrahepatic malignancy
What role does bicarb play in the liver?
It provides pH balance for the acids that come from the stomach
What are two common clinical manifestations that result from pancreatitis?
ARDS and hypocalcemia
What entails “pancreatic rest”?
NPO, NG tube suctioning
What analgesic medication is contraindicated in pancreatitis?
Morphine which causes sphincter spasms which worsens the problem
Name and explain the three zones of injury in burns:
- Zone of coagulation- center (site of greatest damage)
- Zone of stasis- surrounding (impaired circulation)
- Zone of hyperemia- peripheral (vasodilation and increased blood flow)
Name and describe the burn classifications:
Minor: <15%
Moderate: 15-25% partial thickness, <10% full thickness
Severe: >25% partial, >10% full thickness
What might you watch for in a lightning strike pt.? Related to urine
Myoglobinuria
Define the phases of burn injuries:
Emergent- resuscitative phase (0-72 hours)
Acute (weeks/months UNTIL WOUND CLOSURE)
Rehabilitative (years–>lifetime)
What issues do you watch for during the emergent burn phase?
Airway management
Burn shock/fluids
Pain management
What issues do you watch for during the emergent burn phase? (3)
Airway management
Burn shock/fluids
Pain management
How will carbonmonoxide poisoning present?
Good O2 sats but hypoxic
What is the consensus formula for burn fluid calc and how fast is the fluid delivered?
2mL LR x weight in kg x TBSA = 24 hour post burn total
1/2 mL in first 8 hours
Remaining over the remaining 16 hours
What are the 6 P’s of compartment syndrome?
Pain Pallor Paresthesia Pulseless Paralysis Poikliothermia (temp unmanageable)
