Week 11- Hepatic, Pancreatic, and Biliary Systems 1 Flashcards
Versatile functions of the liver
-Digestive
-Endocrine
-Excretory
-Hematologic
-Immune
Examples of versatile functions for the liver
-Conversion and excretion of bilirubin
-Produce of clotting factors and storage of vitamins
-Metabolize drugs, chemicals and toxins
-Filters all of the blood from the gastrointestinal (GI) system
The liver is the sole source of _________
Albumin
The liver produces ______ ml of bile each day
600 (500-1500 ml)
True or false: The pancreas is only an exocrine gland
False
(exocrine AND endocrine gland
Pancreas as an exocrine gland
-Primary function in digestion is exocrine secretion of digestive enzymes and pancreatic juices
-Neutralize the acidic substances passed from the stomach to the duodenum
Pancreas as an endocrine gland
-Secretion of glucagon and insulin by islet of Langerhans cells for the regulation of carbohydrate metabolism
Reservoir for bile
Gallbladder
Function of gallbladder
Stores and concentrates the bile during fasting periods and then contracts to expel the bile into the duodenum in response to the arrival of food
Bile helps in… and plays a role in…
-Alkalinizing the intestinal contents
-Emulsification, absorption, and digestion of fat
Primary signs and symptoms of liver diseases
-Gastrointestinal (GI) symptoms
-Edema/ascites
-Dark urine
-Light-colored or clay-colored feces
-Right upper abdominal pain
True or false: Hepatic failure can be acute or chronic
True
This occurs during hepatic failure
-The mass of liver cells is sufficiently diminished
-The function is impaired as a result of cirrhosis, liver cancer, or infection and/or inflammation
Clinical syndrome for hepatic failure
-Hepatic encephalopathy (HE)
-Renal failure (hepatorenal syndrome [HRS])
-Endocrine changes
-Jaundice
SLIDE 10
Dark urine and light stools occurs in association with…
Jaundice
Serum bilirubin level increases from normal (0.1 to 1.0mg/dL) to a value of 2.0 or 3.0 mg/dL
Dark urine and light stools associated with jaundice
Why is the stool normally brown?
Bile converted from bilirubin causes brown coloration of the stool
What do light-colored (almost white) stools and urine the color of tea or cola indicate?
Inability of the liver or biliary system to excrete bilirubin properly
Skin changes associated with the hepatic system include…
-Jaundice
-Pallor
-Orange/green skin
Spider angiomas may be vascular manifestations of increased _________ levels
Estrogen
___________ is warm redness of the skin over the palms, also called liver palms
Palmar erythema
Neurologic symptoms of hepatic problems
-Confusion, sleep disturbances, muscle tremors, hyper-reactive reflexes, and asterixis
-Impair PNS function
-Hepaticencephalopathy (HE) or Portosystemic encephalopathy (PSE)
The inability to maintain wrist extension with forward flexion of the upper extremities
Asterixis
True or false: It is important to observe for quick, irregular extensions and flexions of the wrist when a patient has asterixis
True
True or false: Regarding asterixis, tremor is not absent of rest, increased by intentional movement, and maximal on unsustained posture; usually unilateral
False
Asterixis can be observed in…
-Uremia
-Respiratory failure
-Severe heart failure
Test for asterixis
Asking the client to extend the wrist and hand with the rest of the arm supported on a firm surface or with the arms held out in front of the body
MSK symptoms
-Thoracic pain between scapulae, right shoulder, right upper trapezius, right interscapular, or right subscapular areas
-Hepatic osteodystrophy
Abnormal development of bone, can occur in all forms of cholestasis (bile flow suppression) and hepatocellular disease
Hepatic osteodystrophy
Hepatic osteodystrophy is associated with…
Osteomalacia and osteoporosis
Pain may develop in the ____________ and ___________ as a nonspecific complication of chronic liver disease
-Wrist
-Ankles
True or false: Client presenting with undiagnosed or untreated jaundice must be referred to the physician
True
True or false: A patient can participate in active, intense exercise when the liver is compromised
False
How to educate individuals at risk for pressure ulcers
-Implement prevention strategies such as skin care, optimal nutrition, and hydration
-Teach the client and family pressure-reducing or -relieving positions and turning strategies
Increased risk of ___________ also occurs with liver disease
Coagulopathy
True or false: Easy bruising and bleeding under the skin or into the joints in response to the slightest trauma can occur with liver disease
True
True or false: Liver decreases in size (volume), weight (mass), and blood flow with advancing age
True
Affects of liver decreasing in size (volume), weight (mass), and blood flow with advancing age
-Require more time to process substances, medications, and alcohol
-Become less tolerant to damage and less able to repair and regenerate
Cellular changes in the hepatic system…
Contribute to the liver’s difficulty in responding to stress, inflammation, and injury
Modification of drug dosage may be required—__________ production decreases with age
Albumin
True or false: Drugs that are typically bound to albumin and rendered pharmacologically unavailable become more readily available
True
Medications that are _________ have an increased area of distribution in older people secondary to an increase in the proportion of fat mass and decrease of lean mass
Lipophilic
True or false: The liver does not contain a large number of immunologically active cells
False
(it does)
The liver is a major site of production of _________ that are associated with ______________ reactions
-Proteins
-Acute inflammatory
True or false: Age-related changes in sinusoids result in substantial alterations in many immunologic functions
True
Severe complications that occur when the liver has been damaged or is no longer functioning
-Jaundice (Icterus)
-Cirrhosis
-Portal Hypertension
-Hepatic Encephalopathy
-Ascites
-Hepatorenal Syndrome
Yellow discoloration of the skin, sclerae, and mucous membranes
> 2.0 mg/dL
Skin becomes a yellow color; urine turns a darker color, and stool is light in color
> 3.0 mg/dL
Four common causes of jaundice
-Diseases associated with overproduction of bilirubin
-Decreased uptake or conjugation in bilirubin metabolism
-Hepatocyte dysfunction
-Impaired bile flow
The final common pathway of chronic, progressive inflammation of the liver; usually not reversible
Cirrhosis
Cirrhosis when inflammation (from disease or toxin) causes…
Liver tissue damage and/or necrosis
Cirrhosis characterizes a progressive loss of normal tissue that is replaced with…
Fibrosis and nodular regeneration
True or false: Cirrhosis can be compensated or uncompensated
True
SLIDE 25-26
An elevated portal pressure gradient occurs when the pressure of the blood entering the liver (portal vein) is higher than the pressure of the blood in the inferior vena cava
Portal hypertension
Most cases of portal hypertension are related to _________
Cirrhosis
These combine to form mechanical barriers to blood flow and increase resistance
-Fibrosis
-Nodularity
-Abnormal liver architecture
Blood can back up in the… causing dilation and expansion
-Stomach
-Esophagus
-Umbilicus
-Rectum
A complex neuropsychiatric syndrome with symptoms ranging from subtle neuropsychiatric and motor disturbances to coma and death
Hepatic encephalopathy (HE)
HE occurs due to…
-Hepatic dysfunction
-Portosystemic shunting of blood
-Portal hypertension
Serious and common causes of HE include…
-GI bleeding
-Infection
-Hypovolemia
-Electrolyte abnormalities
True or false: Pathologic mechanisms of HE are well understood
False
(not well understood)
Pathologic mechanisms of HE may be related to…
-Ammonia
-Glutamate
-Neurotransmitters
True or false: Reversal of HE is typically successful when a source is identified, corrected, and treated appropriately
True
SLIDE 29
Abnormal accumulation of fluid within the peritoneal cavity
Ascites
Ascites is most often caused by…
-Decompensated liver cirrhosis (85% of cases)
-Heart failure
-Abdominal malignancies
-Nephrotic syndrome
-Infection
-Malnutrition
Dyspnea with increased respiratory rate occurs in Ascites when the fluid displaces the ____________
Diaphragm
Infection of ascitic fluid in the setting of portal hypertension
Spontaneous Bacterial Peritonitis (SBP)
