week 7 Flashcards
liver and its associated structures, including the gallbladder, bile ducts, and pancreas.
- These organs play a crucial role in digestion and metabolism.
Hepatobiliary
large, complex organ located in the upper right quadrant of the abdomen.
Functions:
- Filtering blood: The liver removes toxins and waste products from the blood.
- Producing bile: Bile is a fluid that helps to break down fats in the small intestine.
- Storing glucose: The liver stores excess glucose as glycogen.
- Synthesizing proteins: The liver produces many proteins, including albumin and clotting factors.
liver
is a small, pear-shaped organ located beneath the liver.
Functions:
- It stores bile produced by the liver.
- When food enters the small intestine, the ___ contracts and releases bile into the duodenum, where it helps to break down fats.
The gallbladder
________ are a network of tubes that carry bile from the liver and gallbladder to the small intestine.
The bile ducts
is a gland located behind the stomach.
Functions:
- It produces digestive enzymes that help to break down carbohydrates, proteins, and fats
- produces insulin, a hormone that helps to regulate blood sugar levels
The pancreas
- detects tumors, cysts, and stones
- conducive gel used
- NPO 8 hours before (b/c food causes gallbladder to contract and alters results)
abdominal ultrasound
MRI vs CT
____________
- Allows for exposure at different depths
- With or without use of oral and IV contrast medium – accentuates density differences
- If using IV contrast –
o Assess renal function – BUN and Cr labs
o Assess iodine and shellfish allergy
o Warn about “flushed feeling” with IV contrast admin
o Force fluids afterwards
______________
- Noninvasive
- Radiofrequency waves and magnetic field
- Detects disease, lesions, sources of GI bleed
- With or without IV contrast – gadolinium
- Contraindicated for
o Person with metal implants
o Pregnant person
CT
MRI
If using IV contrast –
o Assess renal function – BUN and Cr labs
o Assess iodine and shellfish allergy
o Warn about “flushed feeling” with IV contrast admin
o NPO 8 hours
o Force fluids afterwards
o Assess renal function – BUN and Cr labs
o Assess iodine and shellfish allergy
o Warn about “flushed feeling” with IV contrast admin
Xo NPO 8 hours
o Force fluids afterwards
remember IV contrast and kidneys!
________________
- Indicated if diagnosis of cholecystitis (gallstones) remains uncertain FOLLOWING an ultrasound
- ________ is a nuclear medicine study
- Nuclear medicine is what is injected IV
- Nuclear medicine is taken up by hepatocytes and excrete into bile
- A series of images are created to show the flow of bile from your liver to your gallbladder and then into your small intestine.
- Demonstrates patency of common bile duct and ampulla
HIDA scan – hepatobiliary scintigraphy
HIDA scan Demonstrates patency of common bile duct and ampulla
o The common bile duct is a tube that carries bile from the _____ and _____ to the _____________
o The ampulla is a small opening in the ___________, the first part of the small intestine. The common bile duct and the pancreatic duct join together at the ampulla.
o The common bile duct is a tube that carries bile from the liver and gallbladder to the small intestine.
o The ampulla is a small opening in the duodenum, the first part of the small intestine. The common bile duct and the pancreatic duct join together at the ampulla.
- visualizes and accesses the pancreatic, hepatic, and common bile ducts
- the endoscope is inserted through the mouth and advanced into the duodenum, the first part of the small intestine.
- The contrast dye is then injected into the common bile duct, which flows retrograde (backward) towards the liver and gallbladder.
ERCP - Endoscopic retrograde Cholangiopancreatography
ERCP - Endoscopic retrograde Cholangiopancreatography
Pre-procedure
- NPO 8 hours
- Consent form signed
- Admin sedation
Post-procedure
- Check vitals – looking for signs of ________- or __________
- ___________– most common complication
- Check for return of gag reflex
perforation or infection
pancreatitis
- Percutaneous procedure
- Needle inserted at ICS on right side where liver is located
- Aspirate to obtain hepatic tissue
- Ultrasound/CT guidance used concurrently sometimes
- Liver is very vascular
Liver biopsy
liver biopsy
Pre-procedure
- Check ________
- Make sure patient’s blood is _________
- Consent form signed
- Baseline vitals
- Explain – hold breath after ________ when need is inserted
Pre-procedure
- Check coags
- Make sure patient’s blood is typed and cross matched
- Consent form signed
- Baseline vitals
- Explain – hold breath after expiration when need is inserted
liver biopsy
Post-procedure
- Frequent vitals – looking for signs of internal bleeding =
increased HR #1
increased RR
BP decreased (later)
- Keep on _______ side for 2 hours
- HOB _______ for 12-24 hours
- Assess for complications – pneumothorax, peritonitis, shock
Post-procedure
- Frequent vitals – looking for signs of internal bleeding =
increased HR #1,
increased RR,
BP decreased (later)
- Keep on right side for 2 hours – the side of the liver/effected side b/c we want to put pressure on the liver to prevent bleeding
- HOB flat for 12-24 hours
- Assess for complications – pneumothorax, peritonitis, shock
Liver enzymes – ALT, AST, Alk Phos
elevated levels good or bad?
which one is specific to liver?
which 2 are not specific to liver?
Liver enzymes – ALT, AST, Alk Phos
Elevated = liver disease
ALT – specific to liver
AST and Alk Phos – not specific to liver
Liver enzymes – (3)
ALT, AST, Alk Phos
Serum Bilirubin
Elevated = _______ disease
Bilirubin – the product of RBC breakdown
Total bilirubin = conjugated/direct bilirubin + unconjugated/indirect bilirubin
liver
Conjugated/direct bilirubin vs Unconjugated/indirect bilirubin
________________
- Bilirubin that made it to the liver
- Water soluble
- Can be found in urine
- Elevated levels associated with obstructive jaundice – can’t get out of the body normally (stool) b/c of obstruction so its peed out
_________________
- Bilirubin did not make it to the liver (has not been conjugated by the liver)
- Not water soluble
- Can’t be found in urine
- Elevated levels associated with hepatocellular and hemolytic conditions – issue with liver itself or prior to the liver
Conjugated/direct bilirubin
- Bilirubin that made it to the liver (has been conjugated by the liver)
Unconjugated/indirect bilirubin
- Bilirubin did not make it to the liver (has not been conjugated by the liver)
Elevated levels associated with obstructive jaundice – can’t get out of the body normally (stool) b/c of obstruction so its peed out
Conjugated/direct bilirubin vs Unconjugated/indirect bilirubin
Conjugated/direct bilirubin
- Elevated levels associated with hepatocellular and hemolytic conditions – issue with liver itself or prior to the liver
Conjugated/direct bilirubin vs Unconjugated/indirect bilirubin
Unconjugated/indirect bilirubin
If obstructed from entering intestines excess Bilirubin
- Deposits in _____ – yellow color, itching
- Deposits in urine – _____ color urine
- Clay colored ______ (lacking brown color) – bilirubin isn’t getting to small intestines
If obstructed from entering intestines excess Bilirubin
- Deposits in skin – yellow color, itching
- Deposits in urine – dark color urine
- Clay colored stool (lacking brown color) – bilirubin isn’t getting to small intestines
Serum ammonium
Elevated = _____ disease
liver
Normally ammonia is converted to urea in liver
- So an increase would mean there is an issue (with the liver) and ammonia is building up, not being converted to urea
Normally ammonia is converted to ____ in liver
- So an increase in ammonia would mean there is an issue (with the liver) and ammonia is building up, not being converted to _____
urea
Built up ammonia results in ___________ (related to cirrhosis which damages liver function)
Ammonia crosses the blood brain barrier
- _____ changes
- ________ function changes
- _________ function changes
- End stage if not fixed = ______
Built up ammonia results in hepatic encephalopathy (related to cirrhosis which damages liver function)
Ammonia crosses the blood brain barrier
- LOC changes
- Intellectual function changes
- Neurological function changes
- End stage if not fixed = coma
Serum protein and albumin
Low = _______ disease
Protein and albumin are made in liver
- So a decrease would mean there is an issue with the liver and protein/albumin is not being made
Serum protein and albumin
Low or high = liver disease
LOW
Protein and albumin are made in liver
- So a decrease would mean there is an issue with the liver and protein/albumin is not being made
Prothrombin time (PT)
Prolonged = bleed risk
Prothrombin (protein) made in _______ and is essential for _________
- So a decrease in prothrombin would mean there is an issue with the _______ and prothrombin is not being made
Prothrombin (protein) made in liver and is essential for clotting
- So a decrease in prothrombin would mean there is an issue with the liver and prothrombin is not being made
Prothrombin time (PT) is how long it takes to clot
- Quick/low number =
- Prolonged/high number =
- Quick/low number = good
- Prolonged/high number = bad (bleed risk) and this is what we see with liver dysfunction
- So a ___crease in prothrombin would mean there is an issue with the liver and prothrombin is not being made
- So an ___crease in prothrombin TIME would mean there is an issue with the liver making prothrombin and thus the clotting time is longer
decrease in prothrombin
increase in clotting time
- Only way to distinguish between the hepatitis viruses
- For Hep __ and Hep __ – a viral genotype is done
- used to identify different strains or variants of a particular virus.
- T/F - Hep B has at least 8 different genotypes
- T/F - Hep C has 6 genotypes (50 subtypes)
- Antigen/antibody testing for viral hepatitis
- B and C
- viral genotype
- T
- T
Pancreatic enzymes
Elevated = good or bad?
BAD
Pancreatic enzymes
Elevated = pancreas injury
Serum lipase vs Serum amylase
_________________
- Enzyme digests carbohydrates
- Elevated within 12 hours of acute insult (pancreatitis)
- Peaks in 24 hours
- Returns to normal in 48-72 hours
____________
- Enzyme digests fat
- Elevated within 24-48 hours of acute insult (pancreatitis)
- Returns to normal in 5-7 DAYS
Hepatitis
Liver inflammation
s/s
- Asymptomatic
- Anorexia, n/v, weight loss or gain?
- _____ pain – liver location
- Malaise
- is liver palpable?
- _______– high bilirubin
- _______– high bile salts
- _______ – bile excreted via urine
Hepatitis
Liver inflammation
s/s
- Asymptomatic
- Anorexia, n/v, weight loss
- RUQ pain – liver location
- Malaise
- Hepatomegaly – enlarged liver, palpable
- Jaundice – high bilirubin
- Pruritis – high bile salts
- Dark urine – bile excreted via urine
Clinical course of viral hepatitis
_________________
- varies
- Abrupt or insidious
- Lasts 5-10 days
- s/s –
o flu like symptoms – chills, fever, malaise, myalgia (achy muscles), athralgias (achy joints), fatigue, anorexia, weight loss, headache
o n/v
o diarrhea or constipation
o RUQ pain
1 incubation period
Clinical course of viral hepatitis
1. _________ period - time between exposure to a pathogen and the onset of symptoms.
2. _________ period - rapid onset of symptoms and a strong immune response.
3. _________ period – recovery
Acute infection
convalescence
Incubation
- Incubation period - time between exposure to a pathogen and the onset of symptoms.
- Acute infection period - rapid onset of symptoms and a strong immune response.
- convalescence period – recovery
flu like symptoms – (9)
chills,
fever,
malaise,
myalgia (achy muscles),
athralgias (achy joints),
fatigue,
anorexia,
weight loss,
headache
Clinical course of viral hepatitis
_________________
- Lasts 1-4 months
- s/s –
o icteric – jaundice
o anicteric – not jaundice
o palpable liver
o some flu like symptoms may continue
2 acute infection period
Clinical course of viral hepatitis
_________________
- symptom recovery 2-3 weeks
- full recovery 2-4 months
- s/s –
o malaise
o fatigue
3 convalescence period – recovery
Hep ____ virus
- Transmission – fecal-oral, contaminated food/water
- s/s – mild, flu-like, less severe Hep virus
- prevention – hand hygiene, Hep A vaccine, gamma-globulin injection after exposure
- chronic infection – never
- incubation period – 2-4 weeks
A
Hep ___ virus
- Transmission – infected blood, perinatal
- s/s – ranges from asymptomatic to fulminant (sever) liver failure
- prevention – good hygiene, Hep B vaccine, Hep B immune globulin within 7 days of exposure
- chronic infection – low
- incubation period – 1-4 months
B
Hep ___ virus
- Transmission – infected blood, perinatal
- s/s – acute infection, asymptomatic or mild, but infection rarely completely resolves
- prevention – good hygiene, screening blood
- chronic infection – high
- incubation period – 7-8 weeks
C
prevention
Hep ____
-vaccine - for all kids starting at 12 y/o and special high-risk adult populations
-pre-exposure prophylaxis = vaccine
-post-exposure prophylaxis =
o vaccine or
o immune globulin – for short-term protection (about 2 months), given within 2 weeks of exposure
A
prevention
Hep ___
-vaccine 3 doses, several months apart - for all kids beginning in newborns and special high-risk adult populations
-post exposure prophylaxis = vaccine
o within ideally 24 hours of exposure, but up to 7 days max
B
hep ____
- no vaccine
C
viral hep education
- hygiene – wash hands after ______
- drink ________ water
- if traveling to _____________ – drink bottled water, avoid washing food in tap water, avoid ice
- don’t share ________, eating utensils, or drinking glasses
- don’t share ________ for injection, body piercing, or tattoos
- don’t share razors, _______ or toothbrushes
- use condoms
- cover cuts/sores with band aids
- if _______ – never donate blood, body organs or tissues
education
- hygiene – wash hands after toilet
- drink treated water
- if traveling to underdeveloped countries – drink bottled water, avoid food washing tap water, avoid ice
- don’t share bed linens, eating utensils, or drinking glasses
- don’t share needles for injection, body piercing, or tattoos
- don’t share razors, nail clippers, or toothbrushes
- use condom
- cover cuts/sores with band aids
- if infected – never donate blood, body organs or tissues
viral hep care
T/F
1. rest
2. nutrition - well balanced
3. adequate calorie
4. if fat isnt tolerated - low fat
5. vitamin supplements like b complex and vitamin K
6. antihistamines for pruritis relief
7. no alcohol
8. low doses of tylenol and/or isoniazid
9. notify contacts for testing
10. no hep A drug therapy
11. drug therapy for Hep B only if chronic
12. drug therapy for Hep C only if chronic
13. must genotype for drug therapy for Hep A, B and C
- rest
- nutrition - well balanced
- adequate calorie
- if fat isnt tolerated - low fat
- vitamin supplements like b complex and vitamin K
- antihistamines for pruritis relief
- no alcohol
X 8. no hepatoxic drugs - tylenol and/or isoniazid - notify contacts for testing
- no hep A drug therapy
X 11. drug therapy for Hep B only if severe with liver failure - drug therapy for Hep C only if chronic
X 13. must genotype for drug therapy for Hep B and C
icterus is ________
yellow pigment of sclera, skin, and hard palate
cause by high bilirubin in blood (>____)
a symptom or a disease?
jaundice
>2.5
a symptom, not a disease
bilirubin normally excreted via_______, so if everything is working right = brown poop and yellow pee
but if there is an obstruction of bile flow (____________ jaundice) = bilirubin is excreted via ____ tract (brown pee) and no bilirubin is excreted via ____ tract (white poop)
normally excreted via stool, so if everything is working right = brown poop and yellow pee
but if there is an obstruction of bile flow (obstructive jaundice) = bilirubin is excreted via GU tract (brown pee) and no bilirubin is excreted via GI tract (white poop)
s/s
- urine dark brown
- clay colored stool – if obstructive jaundice
- yellow skin, sclera, hard palate, etc.
jaundice
types of jaundice
- ________– increased breakdown of RBC
- __________– liver unable to take up/conjugate bilirubin from blood
- _________– decreased or obstructed flow of bile
hepatocellular
hemolytic
obstructive
- hemolytic – increased breakdown of RBC
- hepatocellular – liver unable to take up/conjugate bilirubin from blood
- obstructive – decreased or obstructed flow of bile
