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Nursing Science 3 > WEEK 5 - Hepatic Disorders > Flashcards

WEEK 5 - Hepatic Disorders Flashcards

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1
Q

What is the purpose of the hepatic portal system?

A
  • Allows the liver to take out glucose for storage after meals
  • Allows toxic molecules to be partially detoxified before blood moves on to the heart
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2
Q

What is hepatitis?

A

Inflammation of the liver characterised by:

Hepatomegaly
Poor appetite
Abdominal discomfort
Abnormal liver function
Jaundice
Clay coloured stool
Tea coloured urine
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3
Q

What are the causes of hepatitis?

A

Infection - viral, bacterial, parasitic
Alcohol
Drugs and toxins
Transfusion of incompatible blood

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4
Q

Characteristics of Hep A?

A
  • RNA virus
  • Transmitted via faecal-oral route (contaminated food/water)
  • Asymptomatic infection in children
  • High risk groups: travellers, men who have sex with men
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5
Q

Characteristics of Hep B?

A
  • Transmitted parenterally, sexually and perinatally
  • DNA virus
  • Becomes chronic after six months
  • The earlier the age of infection the greater the likelihood of carrying it for life
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6
Q

Characteristics of Hep C?

A
  • RNA virus
  • Effects intravenous drug users (spread parenterally)
  • Becomes chronic after 6 months
  • Can cause liver failure if left untreated
  • Only 1 in 4 will recover
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7
Q

Characteristics of Hep D?

A
  • RNA virus
  • Can only occur in people with Hep B
  • Can be prevented with Hep B vaccine as they share molecules of their viral coats
  • Causes a more severe infection
  • Spread parenterally, sexually and perinatally (same as Hep B)
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8
Q

Characteristics of Hep E?

A
  • No vaccine, has many strains
  • Linked to undercooked meat and seafood
  • Spread via faecal-oral route
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9
Q

Characteristics of Hep G?

A
  • Structurally similar to Hep C
  • Little or no symptoms
  • Spread parenterally, sexually and perinatally
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10
Q

What is the pathophysiology of hepatitis?

A
  • Causes direct cellular injury: necrosis and scarring of hepatocytes, hyperplasia and infiltration by mononuclear phagocytes
  • Leads to an immune response that damages and obstructs the bile ducts
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11
Q

What clinical manifestations occur in acute fulminating hepatitis?

A

Necrosis
Encephalopathy
Liver failure
Death

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12
Q

Clinical testing for hepatitis?

A
  • Abnormal LFTs = raised AST (aspartate transaminase) and ALT (alanine transaminase)
  • ALP = biliary system obstruction (lines the biliary duct)
  • LFTs may be in normal range in chronic liver disease
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13
Q

Describe the four stages of hepatitis

A
  1. Incubation period - most infectious during this time
  2. Prodromal phase - early, non specific syndrome: fatigue, GI disturbances, weight loss, anorexia, headache, rash, fever, jaundice (last step)
  3. Icteric phase - jaundice, yellow skin, itching, tea coloured urine, clay coloured stool, fatigue, hepatomegaly
  4. Recovery phase - jaundice and other S&S subside, liver function returns to normal, full recovery in most people
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14
Q

Diagnosis of hepatitis?

A

Not based on symptoms alone as they are nonspecific

  • Blood tests for virus-specific antibodies
  • HBsAg - Hep B specific antigen
    LFTs for liver function indication
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15
Q

Treatment for acute viral hepatitis?

A
  • Restriction of physical activity
  • Low fat and high carb diet
  • Smaller, more frequent meals to spread out metabolism
  • Hand washing and avoid contact with bodily fluids

(no real treatment)

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16
Q

Treatments for chronic hepatitis?

A
  • HepB: treatments to slow progression

- HepC: curable with 95% success rate

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17
Q

What is hepatic encephalopathy?

A
  • Neurological impairment secondary to hepatic dysfunction

- Characterised by neural disturbances due to increased ammonia levels

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18
Q

How does ammonia cause neural disturbances?

A
  • Ammonia is a byproduct of protein metabolism
  • Inability of the liver to detoxify ammonia = ammonia build up = reaches the brain via the BBB
  • Ammonia is metabolised into glutamine - interferes with neurotransmitters, astrocyte oedema = brain herniation, oedema, death
19
Q

Diagnosis of hepatic encephalopathy?

A
  • Hx of liver disease in addition to:
  • Signs and symptoms
  • Blood tests (for high ammonia levels)
20
Q

Treatment for hepatic encephalopathy?

A
  • Fluid and electrolyte correction
  • Restrict dietary protein
  • Neomycin (eliminates bacteria for protein metabolism)
  • Lactulose (promotes excretion of ammonia)
21
Q

What is liver cirrhosis?

A

Occurs at the end of chronic liver disease

Irreversible inflammatory condition where liver tissue is replaced by dysfunctional fibrotic tissue

22
Q

What are the different types of liver cirrhosis?

A
  1. Alcoholic cirrhosis
  2. Biliary cirrhosis
  3. Post-necrotic cirrhosis
  4. Metabolic cirrhosis
23
Q

Pathophysiology of liver cirrhosis?

A

Poorly understood

  • Fibrosis due to inflammation and necrosis
  • Functional hepatocytes replaced by scarred nodules
  • Leads to a hard, dysfunctional liver
  • Obstruction to vascular network reduces the blood flow to the liver and may lead to portal hypertension
  • Biliary duct obstruction leads to bile stasis and leakage of bile = necrosis of hepatocytes, jaundice and pain
24
Q

Pathophysiology of alcoholic cirrhosis?

A

Metabolism of alcohol produces acetaldehyde = damages hepatocytes, causes inflammation

25
Q

Pathophysiology of biliary cirrhosis?

A

Obstruction of biliary duct blocks bile flow = inflammation and scarring of hepatocytes

Primary - autoimmune condition
Secondary - physical obstruction (tumours, gallstones, pancreatitis)

26
Q

Pathophysiology of post-necrotic cirrhosis?

A

Severe damage from viral hepatitis, drug toxicity or autoimmune disease - necrotic tissue is replaced with fibrous nodular scar tissue

27
Q

Pathophysiology of metabolic cirrhosis?

A

Disorders associated with metabolic function eg. Wilson’s disease, heamochromatosis

28
Q

Clinical manifestations of alcoholic cirrhosis?

A
  • Anorexia
  • Fatigue
  • Nausea
  • Infection
  • Weight loss
  • Hepatomegaly
  • Pain in the right upper quadrant
29
Q

Diagnostic tools for alcoholic cirrhosis?

A

Clinical hx
LFTs
Liver biopsy

30
Q

Treatment for alcoholic cirrhosis

A

Cessation of alcohol
Rest
Correct diet
Management of complications

31
Q

Clinical manifestations of biliary cirrhosis?

A

Jaundice
Itching
Abdominal pain
Fatigue

32
Q

Diagnosis of biliary cirrhosis?

A

Serologic tests = increased bilirubin, ALP and lipids - issues with bile ducts
Liver biopsy
Cholangiography

33
Q

Treatment of biliary cirrhosis?

A
  • Corticosteroids and azathioprine = suppress immune response
  • Resolve cause of obstruction
  • Liver transplant
34
Q

What is portal hypertension?

A

High blood pressure in the portal venous system, most commonly due to cirrhosis, hepatitis or left sided heart failure

35
Q

What is normal blood pressure in the portal system and what does it increase to in portal hypertension?

A

Normal = 3mmHg

Portal HTN = >10 mmHg

36
Q

What are the clinical manifestations of portal HTN?

A
  • Increased pressure leads to collateral vessel development in the oesophagus, stomach
  • Varices (distended veins) = melina and anaemia
  • Splenomegaly
  • Ascites
37
Q

What is ascites?

A

Accumulation of fluid in the peritoneal cavity, also known as third spacing, due to sodium retention in the kidneys

38
Q

What are the clinical manifestations of ascites?

A
  • Abdominal distension and discomfort
  • Dyspnoea
  • Difficulty walking
39
Q

Treatment for ascites?

A
  • Dietary restriction of Na+
  • K+ sparing diuretics
  • Paracentesis to drain the peritoneal space
40
Q

When does hepatic necrosis occur?

A

Final stages of liver disease, occurs when 80-90% of the liver has undergone necrosis, prolonged insult tot he liver

41
Q

Causes of fulminant hepatic failure (acute)?

A
  • Hep A, B, D and E
  • Viruses in immunocompromised patients
  • Paracetamol OD
  • Liver ischaemia secondary to hepatic venous obstruction
  • Cardiogenic shock or neoplasms
42
Q

Causes of chronic hepatic failure?

A
  • Alcohol abuse and cirrhosis
  • Cytotoxic drugs (eg. methotrexate)
  • Genetic metabolic diseases
43
Q

Treatment of liver failure?

A
  • Eliminating alcohol consumption
  • Decreasing ammonia intake by controlling protein intake
  • Preventing infection
  • Transplant
44
Q

Which of the hepatitis viruses are DNA and which are RNA?

A

DNA: Hep B
RNA: Hep A, C, D

?? unknown: Hep E, G

Nursing Science 3 (21 decks)

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