the liver Flashcards
is the liver highly vascular?
yep
is the liver heavy
yep about 3lbs
how many lobes does the liver have
4
describe the ducts of the liver
hepatic duct + cystic duct = common bile duct
what are some functions of the liver
- glucose metabolism
- ammonia metabolism
- protein metabolism
- vitamin and iron storage
- bile formation
- bilirubin excretion
- drug metabolism
in the older adult, the liver gets a little fucked, what can this lead to?
toxic buildup
whats ALT
- helps break down proteins
- process of turning food into energy
- in liver cells
- increased when damage to the liver happens
whats AST
found in many body tissues (mostly in liver muscles, heart, kidney, brain, and RBCs
whats serum bilirubin
- made when Hgb broken down
- turned into bile (conjugated)
- too much = jaundice
whats ammonia
- waste product of colon bacteria
- processed by liver into urea and glutamine
- without proper disposal, can cross blood brain barrier
- ammonia is TOXIC to the brain
whats albumin
- most abundant plasma protein
- holds fluid in the bloodstream (leads to thridspacing and ascites if low)
- carries hormones, vitamins, and enxymes
whats normal goal cholesterol
below 200
want more HDL and less LDL
whats alkaline phosphatase
- measure of billiary tract obstruction
- can indicate gallbladder issues
what are some causes of hepatitis A
Hepatitis A Virus (HAV)
Contaminated food / water
Close contact with person / infected object
FECAL ORAL
whats happening with hep A
Virus attacking liver cells (inflammation)
Often self-limiting, rarely chronic
how will the client with hep A present
Asymptomatic
Flu-Like sx
N/V, Anorexia
Fatigue
Low-grade fever
Abdominal pain (typically RUQ)
Clay-colored stools and or dark urine
Jaundice
Pruritis
what are some labs/diagnostics for hep A
LFTs (AST / ALT)
CT / Ultrasound
HAV antibodies
what are some acute interventions for hep A
rest and hydration
whats a complication of hep A
rarely acute liver failure
what meds can help with hep A
antiemetics (ondansetron)
describe nursing focus and education for hep A
Self-limiting
Rest, Hydration, Light diet w/ frequent meals (small)
Discuss transmission
Wash hands!
HAV vaccine
Havrix & Vaqta (need 2 doses)
Avoid alcohol
Watch OTC meds (Tylenol)
what are some causes of hep B
Hepatitis B Virus (HBV)
Transmission from blood / semen / bodily fluids
Can be Acute or Chronic
whats happening with hep B
virus attacks liver cells
how will a client with hep B present
2 weeks up to 1-4 months post transmission
Flu-Like sx
N/V, Anorexia
Fatigue, Weakness
Low-grade fever
Abdominal pain (typically RUQ)
Dark urine
Jaundice
Joint pain
what are some labs/diagnostics for hep B
LFTs (AST / ALT)
CT / Ultrasound
HBV antibodies
Liver Biopsy
what are some acute interventions for hep B
Rest
Nutrition / Fluids
Antivirals (chronic flare-up)
what are some complications of hep B
Cirrhosis
Liver Failure / Liver CA
Kidney / Vascular issues
Portal HTN -> esophageal varices
describe nursing focus and education for hep B
Vaccinate!
Can fully recover (>90%)
Discuss liver transplant options (chronic)
Keep liver happy = avoid alcohol and certain meds during flare-ups
Nurse = Wear gloves = ALWAYS
Discuss how to prevent transmission
Nurse safety
what are some causes of cirrhosis
- liver diseases (hep and alcoholism)
- chronic obesity
- certain meds (methotrexate and isoniazid)
whats happening with cirrhosis
Later stage of scarring of liver
Liver can only regenerate for so long
Scar tissues to portal areas
Biliary duct obstruction
Hepatocytes to fat to scarred
how will the client with cirrhosis present
Fatigue
Easily bleeding / ecchymosis
Nausea and anorexia
Edema to legs, feet, ankles, and abdomen (ascites)
Weight loss
Jaundice
Confusion, drowsiness, slurred speech
Late finding = GI varices and Caput Medusa
how can nurses help with cirrhosis
- Vitamin replacement (banana bags)
- Assess for esophageal varices
- Pain control
- Monitor for mental deterioration
- Educate on drinking cessation
- Complications of immobility
- Falls risk!
- Bleeding risk!
- Discuss how to protect against Hepatitis
- Liver transplant
what are some labs and diagnostics for cirrhosis
- LFT
- INR, BMP
- MRI, CT, US
- biopsy
what are some acute interventions for cirrhosis
- pain control
- nutrition replacement
- complication control (varices)
what are some complications of cirrhosis
- portal HTN
- bleeding
- splenomegaly
- edema
- malnutrition
- hepatic enchalopathy
what are some meds that can help with cirrhosis
- meds for hep B and C
- antibiotics for infection
- BP medication to control portal (really needs to be controlled)
- K sparing diuretics
- lactulose: binds to ammonia so you shit it out, can lead to falls, dehydration, and fatigue
- antifibrotic meds (colchicine, ACEs, statins, immunosuppressants): prevent scarring
