week 3 accessory GI Flashcards
What 5 lab values increase in liver disease and why
- bilirubin - b/c liver can’t conjugate effectively and some leaks out due to dead cells
- cholesterol - b/c liver can’t make bile effectively so fat can’t be broken down - so cholesterol stays in blood
- ALT, ALK, AST, GGT - liver enzymes b/c dead hepatocytes
- INR and PT - because liver can’t absorb vitamin K needed for clotting factors so high risk to bleed and longer bleeding time
- ammonia - b/c liver can’t convert ammonia to urea to be excreted in the kidney
What 4 lab values decrease in liver disease and why
- potassium - b/c over production of aldosterone that holds Na in
- Glucose - b/c glycogenesis and glycolysis can’t happen effectively = hypoglycemia
- pancytopenia - because portal hypertension leads to spleen issues so WBC, RBC, and platelets are stuck in there
- Albumin - liver can’t make it effectively
What are the 2 most common causes of acute pancreatitis?
- Alcohol
- Gall stones
What saying is for acute pancreatitis causes?
A Hare Had Gout Golfing Monday To Vriday
where is pain in acute pancreatitis?
upper left quadrent to the back
what lab values go up in pancreatitis?
amalayse and lipase- cells break open
potassium - cell death
blood sugar - can’t send out insulin
Why does hypocalcemia happen in pancreatitis?
because fatty acids bind to calcium
What organ does pancreatitis affect and why?
the lungs
pulmonary complications - ARDS b/c cytokynes cause inflammation in the lungs and alveoli
why does hypovolemia happen in pancreatitis?
because of increased permeability and vasodilation
What drugs are used for portal hypertension?
Propanolol (beta blocker)
Lactulose (osmotic laxative)
what drugs are used for edema and acities in liver disease?
albumin 25%
spironolactone
what is the order of liver degeneration?
normal- fatty- fibrous- cirrosis
What drugs are used to lower cholesterol with liver disease?
Atorvastatin- lipid lowering
bile-acid sequestrates - takes bile acid out so more cholesterol is absorbed to make more bile acids
what are the symptoms of hepatitis?
jaundice
RUQ pain
fatigue
muscle pain
joint pain
malaise
anorexia
fever
What are the symptoms of cirrhosis ?
Dependent Edema
Low blood pressure
High heart rate
High temp
Ascities
SOB
Jaundice – very yellow
What are the complications of liver cirrhosis?
- varacies
- portal hypertension
- splenomegaly- pancytopenia
- hepatic encephalopathy
- Ascities
- edema
- HRS* hepatorenal syndrome - cause of death
- Bleeding*
What meds damage the liver?
Tylenol
meds that have first pass effect
why are liver cirrhosis patients at risk for PN?
B/c their ascities - belly too big, can’t take deep breaths and alveoli start to shut down
Why do liver cirrhosis patients get red palms?
palmer erythema - too much estrogen
Spider angiomas are what?
think nose with red lines
Caput Medusae
varicies on the outside of the abdomen
what 2 things cause fluid retention in liver cirrhosis patients?
increased aldosterone - Na+ and fluid retention
low albumin - can’t balance it back into the blood stream
is glucose high or low in liver cirrhosis?
hypoglycemia
What diseases raises blood glucose?
Diabetes
Pancreatitis
High ICP
What colour is urine with Bilirubinuria?
tea colour - dark- bad
stercobelinigoin turns poop what colour?
brown. When lacking - it’s clay colour
what does portal hypertension lead to the development of?
varacies - bleeding
what leads to hemorrhagic shock in liver cirrhosis patients?
varacies that bleed b/c clotting is slow
spenomegaly = lack platelets
lack vitamin K for clotting factors
what is a common trigger for hepatic encephalopathy?
GI bleed
what does a positive murphy’s sign show?
cholecystitis
Steatorrhea
fatty stools
what 3 test are done for acute cholecystitis ?
- labs
- abdominal ultrasound
- ERCP
What additional 2 tests are done for acute pancreatitis?
- CT
- MRCP
plus labs, abdominal ultrasound, ercp like cholecystitis
where is cullen’s sign found?
around the belly button and to the left a bit
where is grey turner’s sign found?
sides - hemorrhagic pancreatitis
