the liver

Question 1

is the liver highly vascular?

Answer 1

yep

Question 2

is the liver heavy

Answer 2

yep about 3lbs

Question 3

how many lobes does the liver have

Answer 3

4

Question 4

describe the ducts of the liver

Answer 4

hepatic duct + cystic duct = common bile duct

Question 5

what are some functions of the liver

Answer 5

• glucose metabolism
• ammonia metabolism
• protein metabolism
• vitamin and iron storage
• bile formation
• bilirubin excretion
• drug metabolism

Question 6

in the older adult, the liver gets a little fucked, what can this lead to?

Answer 6

toxic buildup

Question 7

whats ALT

Answer 7

• helps break down proteins
• process of turning food into energy
• in liver cells
• increased when damage to the liver happens

Question 8

whats AST

Answer 8

found in many body tissues (mostly in liver muscles, heart, kidney, brain, and RBCs

Question 9

whats serum bilirubin

Answer 9

• made when Hgb broken down
• turned into bile (conjugated)
• too much = jaundice

Question 10

whats ammonia

Answer 10

• 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

Question 11

whats albumin

Answer 11

• most abundant plasma protein
• holds fluid in the bloodstream (leads to thridspacing and ascites if low)
• carries hormones, vitamins, and enxymes

Question 12

whats normal goal cholesterol

Answer 12

below 200

want more HDL and less LDL

Question 13

whats alkaline phosphatase

Answer 13

• measure of billiary tract obstruction
• can indicate gallbladder issues

Question 14

what are some causes of hepatitis A

Answer 14

Hepatitis A Virus (HAV)
Contaminated food / water
Close contact with person / infected object

FECAL ORAL

Question 15

whats happening with hep A

Answer 15

Virus attacking liver cells (inflammation)
Often self-limiting, rarely chronic

Question 16

how will the client with hep A present

Answer 16

Asymptomatic
Flu-Like sx
N/V, Anorexia
Fatigue
Low-grade fever
Abdominal pain (typically RUQ)
Clay-colored stools and or dark urine
Jaundice
Pruritis

Question 17

what are some labs/diagnostics for hep A

Answer 17

LFTs (AST / ALT)
CT / Ultrasound
HAV antibodies

Question 18

what are some acute interventions for hep A

Answer 18

rest and hydration

Question 19

whats a complication of hep A

Answer 19

rarely acute liver failure

Question 20

what meds can help with hep A

Answer 20

antiemetics (ondansetron)

Question 21

describe nursing focus and education for hep A

Answer 21

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)

Question 22

what are some causes of hep B

Answer 22

Hepatitis B Virus (HBV)
Transmission from blood / semen / bodily fluids
Can be Acute or Chronic

Question 23

whats happening with hep B

Answer 23

virus attacks liver cells

Question 24

how will a client with hep B present

Answer 24

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

Question 25

what are some labs/diagnostics for hep B

Answer 25

LFTs (AST / ALT)
CT / Ultrasound
HBV antibodies
Liver Biopsy

Question 26

what are some acute interventions for hep B

Answer 26

Rest
Nutrition / Fluids
Antivirals (chronic flare-up)

Question 27

what are some complications of hep B

Answer 27

Cirrhosis
Liver Failure / Liver CA
Kidney / Vascular issues
Portal HTN -> esophageal varices

Question 28

describe nursing focus and education for hep B

Answer 28

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

Question 29

what are some causes of cirrhosis

Answer 29

• liver diseases (hep and alcoholism)
• chronic obesity
• certain meds (methotrexate and isoniazid)

Question 30

whats happening with cirrhosis

Answer 30

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

Question 31

how will the client with cirrhosis present

Answer 31

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

Question 32

how can nurses help with cirrhosis

Answer 32

• 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

Question 33

what are some labs and diagnostics for cirrhosis

Answer 33

• LFT
• INR, BMP
• MRI, CT, US
• biopsy

Question 34

what are some acute interventions for cirrhosis

Answer 34

• pain control
• nutrition replacement
• complication control (varices)

Question 35

what are some complications of cirrhosis

Answer 35

• portal HTN
• bleeding
• splenomegaly
• edema
• malnutrition
• hepatic enchalopathy

Question 36

what are some meds that can help with cirrhosis

Answer 36

• 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