week 4 content exam 2 Flashcards
- Various strains of ___________ – HAV, HBV, HCV, Epstein-barr, cytomegalovirus
Systemic virus that mainly affects the liver = cause viral hepatitis
causes of cirrhosis
SATA
- Hep B
- Hep C
- Excessive alcohol intake
- Idiopathic
- Non-alcoholic fatty liver disease
- genetics
which is most common
- Hep B
- Hep C
- Excessive alcohol intake - most common
- Idiopathic
- Non-alcoholic fatty liver disease
X- genetics
cirrhosis commonly causes portal HTN which causes varices and ascites
what is portal HTN?
what is varices?
what is ascites?
portal HTN = high blood pressure in the portal vein, which is the large blood vessel that carries blood to the liver.
Varices are abnormally enlarged blood vessels. ex: Varicose veins, Rectal varices/hemorrhoids, Esophageal varices
ascites is accumulation of excess fluid in the abdominal cavity.
viral hep
s/s
- jaundice
- dark urine
- clay colored stool
- liver enlargement
- liver painful to palpation RUQ
- fatigue
- abdominal pain persists or increases
prodromal, icteric, recovery?
icteric (active/actual phase of illness)
2 classes of drugs for chronic Hep____
- Interferons
- Nucleoside analogs
hep B
grey turners sign = (Ecchymoses) bruises or discolorations caused by bleeding pancreas, leaky vessels and blood pooling under the skin in what location?
cullens sign (Ecchymoses) bruises or discolorations caused by bleeding pancreas, leaky vessels and blood pooling under the skin in what location?
flank/sides of stomach = grey turners sign
periumbilical/belly button = cullens sign
T/F
cirrhosis is…
-Irreversible, inflammatory, fibrotic liver disease
-Structural changes from injury like alcohol, hep virus
-Structural changes from fibrosis
- structural changes leads to obstructive biliary channels and blood flow = jaundice and portal hypertension
-Regeneration is disrupted by hypoxia, necrosis, atrophy, and liver failure
-Fibrosis can reversed if treated soon enough
all true except
- Fibrosis can be halted, but not reversed
Cirrhosis patho
1. _______ cells destroyed
2. Cells try to regenerate
3. Disorganized process
4. __________ growth
5. Poor blood flow and ______ tissue
6. Hypoxia
7. Cell death and liver failure
Cirrhosis patho
1. Liver cells destroyed
2. Cells try to regenerate
3. Disorganized process
4. Abnormal growth
5. Poor blood flow and scar tissue
6. Hypoxia
7. Cell death and liver failure
Fulminant liver failure = chronic or acute liver failure?
Acute live failure
3 classifications of jaundice
___________ = increased RBC breakdown
____________ = liver is unable to take up bilirubin from blood, or unable to conjugate it
___________= decreased or obstructed flow of bile, bilirubin can’t get out of liver (r/t gallstones)
Hepatocellular, Obstructive, Hemolytic
3 classifications
- Hemolytic = increased RBC breakdown
- Hepatocellular = liver is unable to take up bilirubin from blood, or unable to conjugate it
- Obstructive = decreased or obstructed flow of bile, bilirubin can’t get out of liver (r/t gallstones)
which issue with the liver Manifests in this way?
- Dark urine
- High liver enzymes
- Normal or clay colored stool
- Pruritis
jaundice
-Ecchymoses - bruises or discolorations caused by bleeding _________, leaky vessels and blood pooling under the skin
o Location – flank/sides of stomach = grey turners sign
o Location – periumbilical/belly button = cullens sign
associated with what issue?
acute pancreatitis
Liver failure not caused by cirrhosis or any other type of liver disease =
Fulminant liver failure or acute liver failure
complications of acute pancreatitis -
_____________ complications
o pain = pt isn’t taking deep breaths
o pleural effusion
-
_____________- = shock
-
- tetany from ________calcemia = monitor electrolytes
- pulmonary complications
- hypotension
- hypocalcemia
LFT - liver function tests
1. check liver enzymes
increased =
2. check bilirubin
increased =
3. check ammonia (the liver breaks it down)
increased =
4. check protein and albumin (liver creates)
decreased =
5. check Prothrombin time (liver makes PT)
increased PTT =
decreased PT =
- Liver enzymes increased = liver dysfunction
- Bilirubin increased = liver dysfunction
- Ammonia (liver breaks down) increased = liver dysfunction
- Protein and albumin (liver creates) decreased = liver dysfunction
- Prothrombin time (liver makes PT) increased = liver dysfunction
PT decreased = PTTime increased = slower to clot, more likely to bleed
Types of Cholelithiasis or Nephrolithiasis
- Cholesterol
- Pigmented
- Mixed
Cholelithiasis
manifestations of _________
- severe epigastric pain - region of the abdomen above the navel and below the sternum.
oSudden onset
oPain may radiate to back
oTender
- n/v
- abdominal distention – fluid in peritoneal cavity
- hypoactive bowel sounds
- fever – r/t inflammatory process
- hypotension and tachycardia – r/t fluid loss
- jaundice – r/t blocked common bile duct
- Ecchymoses - bruises or discolorations caused by bleeding __________, leaky vessels and blood pooling under the skin
o Location – flank/sides of stomach = grey turners sign
o Location – periumbilical/belly button = cullens sign
acute pancreatitis
etiology of _______ HTN
o systemic hypotension
o vascular underfilling
o stimulation of vasoactive system (RAAS system)
o plasma volume expansion
o increased CO = ascites
portal
Patho of which liver issue?
- Edematous hepatocytes and patchy areas of necrosis and inflammatory cell infiltrates and disrupts liver tissue
Fulminant liver failure or acute liver failure
Acute pancreatitis =
- Usually mild, resolves spontaneously
- 20% becomes severe and needs hospitalization
pancreas inflammation
Cirrhosis pharm
2nd line
Moa
- Inhibitis bacterial RNA synthesis by binding to bacterial DNA – initially used as an abx for GI infections
- Sometimes used as preventative drug
Route – PO
s/e
- Peripheral edema
- Nausea
- Ascites
- Dizzy
- Fatigue
- Pruritis
- Skin rash
- Abdominal pain
- Anemia
Has been associated with increased risk of C diff – monitor
Rifaximin
does liver make it or break it down:
ammonia?
protein?
albumin?
prothrombin?
billirubin?
ammonia - break it down
protein - makes it
albumin - makes it
prothrombin - makes it
billirubin - makes it
_____________ – liver inflammation can occur from alcohol abuse, drugs, chemicals, bacteria
___________ – inflammation of liver from systemic viral infection
hepatitis
viral hepatitis
tylenol reccomendations?
Tylenol + hepatitis
______ grams/day
Tylenol + advanced liver disease
________ grams/day
Tylenol + hepatitis
< 2grams/day
Tylenol + advanced liver disease
AVOID Tylenol
normally = <4 grams/day
Cholelithiasis
“gallstones” – stones in the gallbladder
viral hep
s/s
- jaundice stops
- symptoms diminish
- liver enlarged and tender
- LFTs return to normal
prodromal, icteric, recovery?
recovery (6-8 weeks after exposure)
Cirrhosis
Liver scarring
acute pancreatitis labs
- glucose – _________ or _________
- amylase, lipase, WBC – __________ r/t damage to organs
labs
- glucose – can be increased or decreased
- amylase, lipase, WBC – increased r/t damage to organs
- manifestations of _________
o asymptomatic until complications occur
o variceal hemorrhage
o ascites
o peritonitis
o hepatorenal syndrome
o cardiomyopathy - treatment
o prevent and treat complications
o only way to treat _________ is liver transplant b/c it is irreversible
portal HTN
Etiology of acute pancreatitis
SATA
- Obstruction of the outflow of pancreatic enzymes, r/t pancreatic and bile duct obstruction (gallstones)
- alcohol
- drugs
- DM
- viral infection
- Obstruction of the outflow of pancreatic enzymes, r/t pancreatic and bile duct obstruction (gallstones)
- alcohol
- drugs
X- DM - viral infection
Manifestations of Cholecystitis
- Fever
- Leukocytosis
- Rebound tenderness
- guarding
- Pain similar to gallstones
- When stones get lodged – _______ and ________ location of pain
o Biliary colic – pain occurs 30 mins to several hours after eating ________ foods
Manifestations
- Fever
- Leukocytosis
- Rebound tenderness and guarding
- Pain similar to gallstones
- When stones get lodged – epigastric pain and RUQ pain
o Biliary colic – pain occurs 30 mins to several hours after eating fatty foods
cirrhosis causes __________ _________ which is a condition that occurs when the liver is unable to filter toxins from the blood. These toxins can build up in the brain and lead to a variety of symptoms, including confusion, disorientation, and altered mental status.
hepatic encephalopathy
which hep?
- Transmission – parenteral, sexual
- Onset – insidious
- Mild – severe
- Large chance can develop into chronic hep
- Any age group
- Prevention – screen blood, hygiene, NO vaccine
- Leads to liver cancer and liver transplant
Hepatitis C