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NURS 2514 > Week 7 - Disorders of the Liver > Flashcards

Week 7 - Disorders of the Liver Flashcards

1
Q

what is nonalcoholic fatty liver disease (NAFLD)

A
  • spectrum of disease that ranges from simply fatty liver (steatosis) that causes no hepatic inflammation
  • to severe liver scarring (nonalcoholic steatohepatisis)
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2
Q

what causes NAFLD

A
  • fat deposition (hepatic steatosis) in the liver from causes that aren’t alcohol, viral hepatitis, or autoimmune disease
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3
Q

who is at an increased risk of NAFLD (3)

A
  • metabolic syndrome
  • obesity
  • type 2 DM
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4
Q

what does NAFLD cause an increased risk of

A
  • CVS risk
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5
Q

how does type 2 DM increase the risk of NAFLD

A
  • due to insulin resistance
  • insulin resistance causes the hepatocytes to increase fat storage & decrease fatty acid oxidation
  • in other words, decreased secretion of fatty acids into the bloodstream, and increased synthesis & uptake of free FA
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6
Q

what is steatosis

A
  • the accumulation of fat in the liver
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7
Q

what can steatosis lead to? how?

A
  • fat in hepatocytes becomes vulnerable to degradation

- cell death & inflammation = steatohepatitis

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8
Q

what is NASH

A
  • nonalcoholic steatohepatitis

- when both steatosis & inflammation occur in the absence of alcohol

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9
Q

what can NASH lead to

A
  • inflammation –> fibrosis and then cirrhosis
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10
Q

list causes of toxic & drug induced hepatitis (3)

A
  • systemic poisons
  • those converted in the liver to toxic metabolites
  • alcohol
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11
Q

what are 2 examples of systemic poisons that cause toxic

A
  • carbon tetrachlroide

- gold compounds

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12
Q

what is an example of an agent that is converted in the liver to toxic metabolites

A
  • tyenol
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13
Q

what increases the risk of toxic & drug induced hepatitis

A
  • polypharmacy
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14
Q

how long does it take for liver necrosis to occur after acute exposure to a toxic substance

A
  • 2-3 days
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15
Q

what is chronic hepatitis

A
  • liver inflammation peristing for more than 6 months
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16
Q

what are the 3 most common causes of chronic hepatitis

A
  • HBV
  • HCV
  • alcoholism
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17
Q

what can chronic hepatitis cause

A
  • continued hepatocyte destruction which leads to
  • irreversible scarring & fibrous alteration in the liver architecture which leads to
  • cirrhosis (“cirrhosis is fibrosis”)
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18
Q

what is cirrhosis

A
  • an irreversible distortion in liver architecture

- resulting in extensive fibrosis & hepatocyte dysfunction

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19
Q

what is the leading cause of cirrhosis

A
  • alcohol abuse
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20
Q

the major manifestations of cirrhosis is a result of.. (3)

A
  • hepatocyte failure
  • portal hypertension
  • or both
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21
Q

what is portal hypertension

A
  • high pressure in the portal vein
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22
Q

what causes portal hypertension

A
  • the extensive fibrosis that occurs during cirrhosis results in increased resistance to blood flow
  • which has profound consequences on the low pressure portal blood flow & leads to portal hypertension
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23
Q

what does fibrosis of the bilary system cause?

A
  • cholestasis = impaired flow of bile from the liver
24
Q

list the effects of portal hypertension (4)

A
  • edema & ascites
  • varicosities
  • splenomegaly
  • gastropathy
25
Q

list the effects of liver cell failure (10)

A
  • ascites & edema
  • jaundice
  • coma
  • fetor hepaticus
  • spider nevi
  • gynecomastia
  • loss of sexual hair
  • testicular atrophy
  • liver “flap”
  • bleeding tendencies –> anemia
26
Q

what is ascites

A
  • accumulation of fluid in the peritoneal cavities
27
Q

when does ascites occur in cirrhosis

A
  • in the later stages
28
Q

list 3 reasons why ascites & edema occur during cirrhosis

A
  • portal hypertension
  • hepatocyte failure
  • hepatorenal syndrome
29
Q

how does portal hypertension cause ascites & edema?

A
  • the high pressure in the portal vein causes fluid to be pushed out into the tissues (increased hydrostatic pressure) & across tissues (such as into the peritoneal cavity)
30
Q

how does hepatocyte failure cause ascites

A
  • hepatocytes are responsible for albumin

- hepatocyte failure = decreased albumin = decreased plasma osmotic pressure (which typically keeps fluid in)

31
Q

describe how hepatorenal syndrome can cause ascites (3 main things)

A
  • the liver is responsible for breaking down aldo
  • hepatocyte failure = impaired breakdown of aldo
  • also, there is reduced inactivation of ADP
  • also, there is diminished secretion of ANP (which increases the excretion of water & Na)

= retention of water & Na

32
Q

what are 3 consequences of ascites

A
  • upward pressure on diaphragm impairs respiration
  • peritonitis
  • impaired digestion & absorption
33
Q

how does portal hypertension cause splenomegaly

A
  • the high pressure can cause blood to back up into the spleen (remember that the portal vein carries blood from the spleen & GI)
34
Q

what are 3 consequences of splenmegaly

A
  • causes the spleen to trap blood elements =
  • thrombocytopenia (which leads to bleeding disorders)
  • anemia
  • leukocytopenia
35
Q

what are varicosities

A

enlarged veins

36
Q

list 3 places where portal hypertension causes varicosities

A
  • esophagus
  • rectal
  • abdomin
37
Q

how does portal hypertension cause varicosities`

A
  • the hypertension causes blood to back up into the systemic veins
    = formation of bypass channels called anastomosis
38
Q

what do esophageal varices cause

A
  • since these veins are fragile. they can rupture and cause upper GI bleeds
    = hematemesis & melena
39
Q

what do rectal varices cause

A
  • hemorrhoids
40
Q

what can rectal varices cause

A
  • bleeding
41
Q

what is the upper GI bleed caused by esophageal varices complicated by

A
  • thrombocytopenia

- coagulopathy

42
Q

what do abdominal varices cause

A
  • caput medusae (causes the abdomin to look like the head of medusa)
43
Q

how does hepatocyte failure cause bleeding tendencies & anemia

A
  • causes impaired clotting factor synthesis, vit K deficiency, and/or thrombocytopenia (due to splenomegaly from portal HTN)
    = bleeding disorders & blood loss anemia
44
Q

how does hepatocyte failure cause jaundice

A
  • causes hepatic jaundice

- also thru intrahepatic cholestasis

45
Q

how does hepatocyte failure effect hormones

A
  • causes impaire breakdown of steroid hormones such as estrogen, testosterone, and aldo
46
Q

what does impaired steroid hormone breakdown cause (6)

A
  • water/Na+ retention
  • testicular atrophy
  • gynecomastia
  • amenorrhea
  • spider nervi
  • abnormal hair growth
47
Q

what is testicular atrophy?

A
  • shrinkage of the testicles
48
Q

what is gynecomastia? what causes it?

A
  • swelling of breast tissues in men

- due to increased estrogen

49
Q

what is amenorrhea

A
  • absence of menstruation
50
Q

how does hepatocyte dysfunction effect CNS function & cause risk of coma

A
  • due to impairment of urea production causing ammonia accumulation
  • ammonia can cross the blood-brain barrier causing hepatic encephalopathy
51
Q

what can cause worsened hepatic encephalopathy

A
  • large meal high in protein
  • GI bleeds
  • constipation
  • anything that causes decreased blood vol, K+
  • renal dysfunction
52
Q

how can hepatic encephalopathy by treated

A
  • with lactulose
53
Q

what are 2 other conseuuences of increased ammonia

A
  • fetor hepaticus (foul breath)

- liver “flap” (coarse hand tremor)

54
Q

how does impaired hepatocyte function effect drug metabolism

A
  • can cause impaired clearance of drugs = drug toxicity

- due to diminished conjugation or cytochrome P450 activity

55
Q

what does impaired drug clearance cause

A
  • elevated levels of drugs or metabolites in the blood & toxic effects
56
Q

see table 46-13 for all factors that precipitate hepatic encephalopathy, too long for flashcards

A

…

57
Q

what is a way to remember the conseuqneces of portal hypertension

A 
Ascites 
Bleeding tendencies (due to varices & thrombocytopenia due to splenomegaly)
Caput medusae & varices
Diminished liver function 
Enlarged spleen

NURS 2514 (75 decks)

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