The Hepatic, Biliary, and Pancreatic Systems Flashcards by Julie Kinard

What is the major functions of the liver?

production of bile
absorbs nutrients
storage
conversion of bilirubin and amonia

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What percentage of CO does the liver receive?

25%

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What vein provides 2/3rds of the blood supply? What artery provides the rest?

portal vein; hepatic artery

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Where does the portal vein drain blood from?

The GI tract
spleen
pancreas
gallbladder

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What is the functional unit of the liver?

The liver lobule

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The principal site of exchange between the blood and perisinusoidal space is the:

hepatic sinusoid

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What are the minor signs and symptoms of liver disease?

N and V
Diarrhea
constipation
edema/ascites
increase in bilirubin (dark urine)
light or clay colored stool

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What are the major signs and symptoms of liver disease?

R Upper Quadrant abdominal pain
neurologic involvement (confusion)
hepatic osteodystrophy
osteoporosis
jaundice

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Is jaundice a medical emergency? Is it a disease?

yes! no, not a disease.

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How do you treat jaundice?

have to deal with underlying disease
return to normal color suggests the resolution
activity can be resumed

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What does neurologic involvement of liver disease look like?

confusion
sleep disturbances
muscle tremors
hyper reactive reflexes

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liver disease limits the catabolism of __________, which will result in a decrease of __________.

ammonia
urea

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If ammonia cannot break down in the liver, will this cause an increase in ammonia in the blood stream or a decrease?

increase

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Physiologically, what leads to the range of neuropsychiatric and neurological symptoms associated with liver disease?

increase in ammonia levels

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What is a flapping tremor and how is it associated with liver disease?

flapping tremor is a clonus-like movement of the hands in response to wrist hyperextension. occurs due to the accumulation of ammonia in the blood.

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why is hepatic osteodystrophy an issue?

leads to abnormal development of bone in the individuals with chronic liver disease

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what will hepatic osteodystrophy eventually lead to?

osteopenia and osteoporosis.

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does healing of the liver occur slowly or quickly?

quickly

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what is cirrhosis?

a late stage of scarring of the liver caused by many forms of liver disease.

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What is the pathophysiology of liver cirrhosis?

progressive patterned loss of healthy tissue which is replaced with fibrotic tissue.

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What should we as a PT know about a pt with cirrhosis?

it can lead to:
- osteoporosis
- impaired posture
- impaired muscle performance/weakness
- loss of balance
- deconditioning
- blood loss

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what is recommended for a pt with cirrhosis in order to reduce metabolic demand on the heart?

rest

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for an individual with cirrhosis, a pt should make sure to plan for:

rest breaks and avoid unnecessary fatigue.

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the portal vein carries blood to the:

capillary beds in the liver

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Portal hypertension is defined as an increase in hepatic sinusoidal BP by greater than

6 mm

increased portal pressure causes a __________ flow of blood back into the stomach, spleen, small intestine, rectum and esophagus.

retrograde

Retrograde flow of the portal vein will result in:

varices or varicose veins

Retrograde flow of the portal vein will result in:

varices or varicose veins

Varicose veins may leak blood and can result in hepatic bleeding that leads to:

hypovolemia shock death

What are consequences of portal hypertension?

ascites splenomegaly hemorrhoids varices rupture and bleeding

What is the condition called where the epigastric veins are seen radiating from the umbilicus across the abdomen?

caput medusae

Hepatic encephalopathy is thought to be caused by:

elevated blood ammonia and altered neurotransmitter status in the brain

ammonia is created by:

bacteria in the colon from the metabolism of protein and urea

ammonia is absorbed into the portal blood system and transported to the: _______________. Then the ammonia is converted into _______.

liver; urea

When the liver is diseased, what happens to ammonia?

it cannot be metabolized so blood ammonia levels go up leading to impaired cognitive and motor function

Decorticate posture -

elbow flexion, wrist flexion extension of legs and plantar flexion

decerebrate posture -

elbow extension, pronation and wrist flexion extension and plantar flexion

Decorticate posture -

elbow flexion, wrist flexion extension of legs and plantar flexion

what are implications for the PT regarding hepatic encephalopathy?

patient safety impaired motor and sensory integrity impaired mobility impaired arousal increased risk of pressure ulcers

What is ascites?

abnormal accumulation of fluid in the abdomen.

Ascites is associated mostly with:

cirrhosis and portal hypertension

Why is it important to recognize ascites as a physical therapist?

along with it comes impaired cardiac and respiratory function lymphedema integumentary disorders malnutrition muscle degradation

Hepatitis is an __________________ condition of the liver.

inflammatory

Viral hepatitis can cause ___________ or _____________ inflammation of the liver.

acute or chronic

Most people who have hepatitis are:

asymptomatic

How do you diagnose viral hepatitis?

symptoms physical exam blood test

What are the symptoms of viral hepatitis?

N and V poor appetite and weight loss weakness jaundice (dark urine) pale or clay colored stool fatigue

what hepatitis is known as infecitous hepatitis?

hep a

which hepatitis can be described as "benign, self-limiting, most people can recover from it, highly contagious and preventable with a vaccine?

Hepatitis A

What hepatitis was known as serum hepatitis?

HEP B

How is Hep B spread?

Blood transfusions, needle sticks, sharing of needles, dialysis, sexual contact, exchange of body fluids.

HEP B is considered an:

STD

Healthcare workers who come into contact with blood are at risk of which Hep?

Hep B

What percentage of adults infected with Hep B develop chronic liver disease?

2 - 6%

There is a vaccine for all hepatitis except:

HEP C

______________ is the leading cause of chronic liver disease.

Hepatitis C

How is Hep C transmitted?

contact with blood of an infected person.

What percentage of individuals with Hep C develop cirrhosis?

5 - 20%

What is a major problem with detecting Hepatitis C?

IT is often asymptomatic.

What are other viral causes of hepatitis?

1. autoimmune hepatitis 2. cytomegalovirus CMV 3. Epstein - Barr (mono) 4. Yellow fever

What drug or toxin can cause liver disease?

acetaminophen tetracycline alcohol

How many Americans are alcoholics? What percentage of these individuals will develop cirrhosis?

10 million 10 - 15 %

How many Americans are alcoholics? What percentage of these individuals will develop cirrhosis?

10 million 10 - 15 %

what will excessive fat content lead to?

inflammation, which will cause the degeneration of hepatocytes