Week 7 - Assessment, Study Questions, Meds Flashcards
define ascites
- increased amt of fluid in the peritoneal cavity
define bile
- fluid responsible for digestion of food, absorption of fats & fat soluble vitamins, and stimulation of peristalsis
define cholecystitis
- inflammation of the gall bladder
define cholelithiasis
condition in which there are stones present in the gall bladder
define cirrhosis
- scarring of liver tissue which interferes w normal liver function & results in structural changes within the liver
define hepatic encephalopathy
complication of liver cirrhosis caused by ammonia in the brain
define splenomegaly
enlarged spleen
define hepatitis
- inflammation of the liver
define portal HTN
- increase in pressure in the portal vein caused by obstruction or congestion
define steatorrhea
- fatty stools
define varices
- dilation of a vein that is tortuous
what is the fnxn of the hepatic portal vein
- moves blood from the spleen & GI tract to the liver
how is bilirubin formed
- from the breakdown of hgb
conjugated bilirubin is called…
- direct
unconjugated bilirubin is called..
- indirect
what causes jaundice
- increase in bilirubin lvls
what causes prehepatic jaundice? is direct or indirect high
- when RBC are destroyed at high rates & the liver cannot conjugate fast enough
= high unconjugated bilirubin
what causes hepatic jaundice? what is elevated
- when bilirubin cannot be conjugated due to liver disease
- high unconj & conj
what should we ask during PMHx for a liver assessment (3)
about anything that can damage the liver
- alcohol
- meds (such as tyenol)
- fatty foods
what assessment findings will we find in a pt with prehepatic jaundice (3)
- elevated unconj
- amber urine
- normal stool
what assessment findings will we find in a pt with hepatic jaundice
- elevated unconj & conj
- elevated liver enzymes
- dark urine
- pale or N stool
what assessment findings will we find in a pt with post hepatic jaundice
- elevated unconj & conj
- elevated liver enzymes
- dark urine
- pale stool
what should we assess during inspection of a liver assessment
- skin, mucous membranes, and eyes for jaundice
- color of the urine
- color of the stool
- fat in the stool
- melena (due to varices, bleeding disorders)
what is the normal liver span
6-12 cm
is the liver typically palpable?
- no
what kind of palpation is used for liver palpation?
- deep
what quadrant is the liver found? spleen?
- liver = RUQ
- spleen = LUQ
what are 3 types of diagnostics for hepatitis
- viral serological tests
- serum liver enzymes
- liver function tests
what is included under viral serological tests
- measures the viral antibodies & antigens
what is included under liver enzymes tests
- AST & ALT
- ALP (or ALK) and GGT
what do liver enzyme tests tell us
- do not differentiate between different types of hepatitis
- but can determine the type of liver injury
what does elevated ALT and AST indicate
- liver cell injury
what does elevated ALP and GGT indicate
- bile duct injury
what is included under liver function tests
- serum albumin
- serum bilirubin
- prothrombine time
deteriorating liver function is demonstrated by which liver function test findings
- increased bilirubin
- increased bleeding time
- decreased albumin
what liver function test findings is present during mild acute viral hep? viral hep with detectable jaundice?
- mild acute = normal albumin, bilirubin, and INR
- jaundice = elevated bilirubin
what viral serological tests are used for hep A
anti HAV IgM = indicates acute infection
anti HAV IgG = indicates past infection
what viral serological tests are used for hep B (4)
- HBsAg = hep B surface antigen
- anti HBs = antibody towards HBsAG = indicates immunity
- anti HBc = indicated infection
HBV DNA
what viral serological tests are used for hep C
- anti HCV = indicates either past OR current exposure
- HCV RNA = will confirm if the disease is active or not
list 4 causes of hepatitis
- drugs
- chemicals
- viral infections
- autoimmune diseases
what are the 3 phases of hepatitis
- pre-icterus or incubation period
- icteric
- convalescent or post icterus
which 2 types of hep can cause chronic injury
hep B & C
list causes of hep A (5)
- contaminated water
- contaiminated food
- poor sanitation
- pooor hygeine
- crowded conditions
list 5 causes of hep B and C
- blood products
- tattoos/body piercings
- contaminated needles
- IV drug users
- sexual intercourse
which 2 types of hep have a vaccine
A & B
what is NAFLD
- non alcoholic fatty liver disease
what is NAFLD characterized by? what can it lead to?
- characterized by hepatic steatosis
- can progress to inflammation & scarring = NASH
list 3 complications of NAFLD
- cirrhosis
- cancer
- liver failure
list symptoms of NAFLD
- most have none
- fatigue, malaise
- abdominal discomfort in RUQ
- enlarged liver & spleen
what are 4 complications of hepatitis
- inflammation
- fibrosis
- cirrhosis
- liver failure
what labs might you order for cirrhosis
- K, Na
- INR/PT
- liver enzymes
- total bili
- glucose
- ammonia
why might a pt with cirrhosis be on a low sodium diet
- to prevent worsening of edema
why might a pt with cirrhosis be on a high protein, high cal diet
- damage to the liver = stops storing glucose
= if dont eat for few hours, body will start using ur muscle for energy
= muscle wasting & malnourishment
= high protein & cal to avoid
why might a pt with cirrhosis be SOB
- due to ascites = decreased expansion of lungs
what is a paracentesis
- removal of fluid from the abdomin
what is a risk associated with paracentesis in someone who has cirrhosis
- risk of bleeding
why is an endoscopy used for for someone w cirrhossi
- to detect varices
what are ways to assess for ascites
- fluid wave
- “outie” belly buttin
- striae
- inspect for distension
describe how fluid wave works
- firmly strike the left flank
- and then with ascites, you will feel a distinct tap on the right hand (on the other side of the stomach)
what are signs of hepatic encephalopathy
- starts w insomnia & confusion
- progress to lethargy
- then coma
what is the function of the gall bladder
- to concentrate & store bile
- then release it to the duodenom when needed
what is the gall bladder & bile important for
- fat breakdown
what are 2 diagnostic studies for cholelithiasis
- US
- ERCP
what are the benefits of US for cholelithiasis diagnossi
- 90-95% accurate
- useful for those allergic to contrast medium
what is ERCP
Endoscopic Retrograde Cholangiopancreatography
- a specialized endoscopic technique
what is ERCP good for
allows visualization of:
- gallbladder
- cystic duct
- common hepatic duct
- common bile duct
what are signs of cholelithliasis (4)
- RUQ
- steatorrhea
- NV
- shoulder discomfort (due to referred pain)
what sign indicated cholelithiasis
- murphy’s sign
what is murphy’s sign
- ask pt to axhale
- place hand below costal margin on R side at mid clavicular line
- ask pt to inspire
what indicates a positive murphy’s sign
- if the pt stops breathing in & winces with a “catch” in breath
what blood work findings might you find in a pt with cholelithiasis
- increased WBC due to inflammation
- increased bili (direct and indirect)
- increased liver enzymes
describe how an ERCP works
- fibre-optic endoscope is inserted thru the mouth to the descending duodenom
- then CBD and pancreatic ducts are cannulated
what are risk associated with ERCP
- perforation & bleeding
- infection
- pancreatitis (abdom pain, NV)
what is tetany
- a condition that is due to low blood calcium
- characterized by spasms of the hands & feet, cramps, spasm of the voicebox (larynx) and overactive neuro reflexes
what 2 signs indicate hypocalcemia
- Trousseau sign
- Chvosek sign
what is trousseau’s sign
- when a blood pressure cuff is inflated & it causes the flexion of the hand
what is Chvosek’s sign
- tapping of the cheek causes abnormal rxn of the facial nerve
what 2 signs indicate pancreatitis
grey turner’s & cullen’s
what is grey turner’s sign
- bruising of the flank
what is cullen’s signm
- bruising around the belly button
what type of pain is present in pancreatitis
- LUQ or mid epigastric that radiates to the back
- sudden, deep, piercing, continuous
what causes aggravation of pancreatitis pain
- eating
- recumbent position
why would you want to manage / avoid constipation in a pt with liver cirrhossi
- want to prevent build up of ammonia
what is palmar eythema ? what causes it?
- redness of the palms
- rt estrogen
what kind of laxative may be used for hepatic encephalopagthy?
lactulose
what does lactulose do?
- enhances intestinal excretion of ammonia
what are 2 side effects of lactulose
- cramping & flatulence
what is propanolol
- nonselective beta blockers
what can propanolol be used for?
- liver cirrhosis
what are some side effects of propanolol
- bronchospasms
- hypotension
