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Liver
| Question | Answer |
|---|---|
| The liver is the larges internal organ in the body and it weighs approximately: | 3-4 lbs |
| Name the general categories for functions of the liver. | Storage, metabolism, synthesis, and detoxification. |
| What does the liver store? | Important substances and nutrients. |
| What does the liver metabolize? | All of the things that you eat, the liver metabolizes those nutrients. |
| What does the liver synthesize? | It forms a lot of proteins and a lot of other protective substances. |
| How does the liver detoxify the body? | The liver is responsible for detoxifying everything that you ingest. |
| The biggest complication of liver transplant is: | Bleeding, bleeding bleeding! |
| The liver receives deoxygenated blood from the digestive organs through the: | Portal Vein |
| What is the major route to the liver? | Portal Vein |
| Blood exits the liver through the: | Hepatic Vein |
| The hepatic vein hooks into the big long vessesl that carries blood from your body, the: | Inferior Vena Cava |
| The liver receives oxygenated blood from the: | Hepatic Artery |
| What are some things the liver can regenerate from? | Hepatitis A |
| What conditions can the liver not regenerate from? | Cirrhosis, liver cancer, acute liver failure. |
| What will happen if the liver cannot regenerate? | It will go into liver failure and the only hope is a liver transplant. |
| When matching liver transplants, you have to match: | The size of the donor with the size of the recipient. There can be a difference between 10-15% of body weight. |
| What happens to the livers ability to function as people get older? | A slowing metabolism reduces the effectiveness of detoxifying the body. |
| A pigment of Hgb released when RBC breaks down is called: | Bilirubin |
| Unconjugated bilirubin travels to the liver attached to: | a protein molecule |
| Once the unconjugatd bilirubin gets to the liver it is removed from the protein and combined with: | glycuronic acid |
| Before teh bilirubin comes in contact with the liver, it is: | unconjugated |
| Once the liver processes the bilirubin, it is then: | conjugateed |
| Conjugated bilirugin flows through the hepatic duct which flows through the: | Common bile duct into the duodenum. |
| In the duodenum, bilirubin is converted into: | Urobilinogen by acitvity of the bacerial action in the duodenum. |
| If unconjugated bilirubin cannot be converted to conjugated bilirubin, what happens? | This is why we have jaundice, because unconjugated bilirubin is not water soluable so it can't get out in the urine. |
| If our common bile duct is blocked with a gallstone, conjugated bilirubin can't get through, what happens to the conjugated bilirubin? | Because it is water soluable, it can back up and be absorbed by the blood and carried tot he kidneys and the kidneys will excrete it as bilirubin. This will make the urine brown and your stool clay colored. |
| When we have liver disease, patients can develop | Jaundice |
| This is always abnormal and occurs secondary to inability of th liver to remove bilirubin from the blood. | Jaundice |
| What is normal total bilirubin? | <1.0 |
| What does tnhe total bilirubin need to be at for a patient to appear jaundice? | >2.5 |
| Where is jaundice first seen? | Sclera of the eyes, under the tongue and the lips. |
| In persons of color, where will you see signs of jaundice? | In the eyes and mucous membranes. |
| When you have normal liver function, but you have excessive RBC breakdown this is the cause of: | Hemolytic Jaundice or pre-hepatic jaundice |
| Where do we get our bilirubin from? | Breakdown of RBC's |
| What typically causes a hemolytic jaundice or pre-hepatic jaundice? | A blood reaction when someone gets the wrong kind of blood. |
| Total bilirubin is comprised of: | Total unconjugated (indirect) bilirubin and Total conjugated (direct) bilirunin. |
| If there is a whole bunch of unconjugated bilirubin, the patient is going to end up with and increase in: | Urobilinogen because the liver can handle it. |
| What will these labs be in pre-hepatic jaundice? | Serum Bilirubin will be the total and it will be increases. Urine and Fecal Urobilinogen with be increased. Unconjugated bilirubin will be increased. |
| Inability of a diseased liver to clear normal amounts from the blood. | Hepatocellular jaundice |
| When we have a problem with the liver we are going to see: | hepatocellular jaundice |
| With hepatocellular jaundice, what will the unconjugated, conjugated and total bilirubin labs be like? | There is a backup so the unconjugated will be increased. Conjugated will also be increased. This will in turn increase your total bilirubin. |
| How will lever enzymes be effected with hepatocellular jaundice? | elevated |
| What do liver enzymes indicate. | They are indicators of liver CELL DAMAGE. |
| This liver enzyme can be elevaated with muscle damage, liver damage, or heart damage. | AST/SGOT (aspartate aminotransferase)"A Stupid Test" |
| When there is damage to the liver, the liver sends out a chemical SOS from the hepatocellular tissue. | ALT/SGPT (alanine aminotransferase) "Always Liver Test" |
| If you are trying to determine if a patient has liver disease or not, always look at the | ALT |
| This is used to determin if someone had cardiac damage. It is non-specific. It is elevated with liver disease, but also cardian and smooth muscle. | LDH (lactate dehydrogenase) |
| This comes from the lining of the common bile duct, so if you have something going on in the common bile duct like a gall stone or pancreatic cancer, you are going to see an increase in it. | AP (alkaline phosphatase) Also elevated in puberty and pregnancy. |
| this is a sensitive indicator of liver disease but it is a major indicator of alcohol abuse. | GGPT (gamma-glutamyl transferase) |
| The number one reason for liver transplant is: | Hepatitis C with alcoholic liver diseasse. |
| If we want to look at specifics that indicate hepatocellular jaundice, we look at: | liver enzymes |
| What liver enzyme is most specific to the liver? | ALT |
| When conjugated bilirubin gets trapped and can't get out, it backs up in to the blood because it is: | water soluable |
| Water soluable conjugated bilirubin that backs up in the blood gets out through: | the urine |
| When conjugated bilirubin gets trapped and can't get out, it is called: | posthepatic jaundice |
| With posthepatic jaundice what will conjugated and unconjugated labs be? (indirect and direct) | They both will be elevated |
| With this type of jaundice, there is no problem at the beginning, but everything is backing up. | posthepatic jaundice |
| Most commonly the obstruction causing posthepatic jaundice is caused by: | a tumor or a gallstone |
| Is urine bilirubin considered unconjugated or conjugated bilirubin? Why? | Conjugated, becaue it is water soluable. It has to be water soluable to be excreted in the urine. |
| Posthepatic jaundice is caused by the presence of an: | obstruction |
| A patient with posthepatic jaundice will have elevated levels of: | AP |
| What happens when an adult suffers from jaundice? | The only thing they are goin gto suffer is discomfort and altered body image. It will not hurt them. Jaundice will not do an damage to an adult. |
| What are some nursing interventions for a patient with a diagnosis of Alteration in Comfort r/t effects of pruritis? | Check skin and sclera. Measure the abdomen. provide interventions for pruritis. |
| What are some interventions for pruritis? | Tepid sponge bath, apply cool cloths to skin, non-drying lotions, loose light fitting clothing, keep room temp. cool, light cotton bed sheets, keep fingernails short. |
| If all intervention for pruritis are in place and the patient is still uncomfortable, what do we do next? | We give them medications such as benedryl or questran. Cortisone would work, but it is really expensive. No calamine lotion. |
| This is a first gereration drug given to decrease cholesterol and pull the bile salts from the skin or the bilirubin from the skin into the blood and then back in the gut to be excreted through the stool. | Questran |
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