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Metabolic Functions
Metabolic Functions of the Liver
| Question | Answer |
|---|---|
| How does the liver metabolize fat? | The oxidizes your fatty acids so that they can be used for energy. |
| What percentage of cholesterol is converted to bile salt by the liver? | 80% |
| What does the liver synthesize cholseterol in to? | Bile salt |
| 20% of the cholesterol that is synthesized by the liver plays a role in: | cell membrane formation |
| When patients have disorders of the common bile duct, they develop gallstones, and what are they comprised of? | cholesterol |
| Why would cholesterol be increased in a person with obstructive jaundice? | Because it cannot flow through the common bile duct so it will build up. |
| Why would cholesterol be decreased in a person with Hepatitis and cirrhosis? | Because the liver can't synthesize the cholesterol. |
| Test would we look at when wanting to monitor fat metabolism and the synthesis of cholesterol? | Serum cholestreol. |
| What organ besides your pancreas plays a major role in maintaining normal blood glucose levels? | The liver. |
| What functions does the liver perform to maintain normal glucose levels? | glycogenisis, glycogenolysis, gluconeogenesis |
| What is glydogenesis? | The formation of glycogen which is the storage form of glucose. |
| If you eat a candy bar, what is the liver going to do with the sugar from that candy bar? | It is going to convert that sugar into glycogen. This process is glycogenesis. |
| What is secreated by the pancreas when the blood sugar is low? | Glucagon |
| What causes the liver to breakdown glycogen to to glucose so that it can be used for energy? | Glucagon secreted by the pancreas. |
| What is glycogenolysis? | Whent the liver breaks down the glycogen to glucose. |
| What is glyconeogeneis? | When the liver takes non-carbohydrate sources like fats and amino acids and converts them to glucose. |
| What is the specific lab test we can look at to monitor the carbohydrate metabolism by the liver? | Galactose Tolerance Test |
| What is a galatose tolerance test? | It is a test that confirms whether sugar is being converted by the liver to glucose and then converted to glycogen. This test can estimate impaired liver function. |
| If you have a normal functioning liver what will happen to your galactose levels? | They will go down. |
| If you have a diseased liver, what would you see in regards to the galactose? | It might go down a little bit, but it will pretty much stay high. |
| Why wouldn't we use a glucose test instead of a galactose test? | Because a glucose tolerance test will only be affectd by the pancreas and the galactose test is specific to the liver. |
| What will happen if th livers ability to metabolize carbohydrates is altered? | There will be alterations in glucose levels, but they are similar to what you see in diabetics. You will also see weight loss, fatigue, and you may see the poly's. |
| If the glucose levels change from altered function of the liver does this mean that the patient is now a diabetic? | No, it just means that they have impaired glucose metabolism. |
| When you have protein in your system the protein will break down and give you: | Nitrogen |
| When you have nitrogen floating around in the intestines, the intestines have a lot of hydrogen ions in them and they combine with the nitrogen to create: | Ammonia |
| Ammonia is absorbed by what that carries it to the major route into the liver, the portal vein. | Blood vessels that line the walls of the intestines. |
| What happens to ammonia when it reaches the liver through the portal vein? | It is detoxified and converted from ammonia to urea. |
| What happens to the urea that was converted from ammonia? | It is excreted by the kidneys. |
| What does the liver do with proteins? | It takes the amin group off and then converts the proteins to carbohydrates. |
| What is a major problem of having too much ammonia in the blood? | The ammonia can cross the blood brain barrier. |
| What is the blood brain barrier? | It is like a filter, a protective mechanism that keeps things from getting into the brain. |
| What on of the only things that can cross the blood brain barrier? | Ammonia |
| What is portal systemic encephalopathy (PSE)? | Brain damage due to too much ammonia because the liver cannot detoxify it. |
| What is the first stage of PSE? | Prodromal - Subtle |
| What are some characteristics of the prodromal - subtle stage? | Subtle changes, loss of memory, or inappropriate behavior like combing hair with a fork. |
| Why is the math problem a good way to check patients for PSE? | Because patients in the first stage of PSE get stuck and cannot make revisions. |
| What is the second stage of PSE? | Impending or Marked Confusion - Disorientation |
| What are the characteristics of the second stage of PSE | Patients are really disoriented, don't know where they are. |
| What is the third stage of PSE? | Stuporous |
| What are the characteristics of the third stage of PSE? | These patients are barely cognizant. Like someone who is extremely intoxicated. They can't answer who they are or where they are. |
| What is the fourth stage of PSE? | Coma |
| Why would a patient going into PSE have neuromuscular disturbances? | Because of the ammonia. It has an irritating effect on the brain. |
| What kind of precautions should be taken in a patient with PSE? | Seizure precautions. |
| What is asterixis? | "liver flap" It is an assessment tool. Have the patient extend both arms out and flex their hands in. If they patient is experiencing PSE, their hands will flap. |
| When do you typically see asterixis? | Somewhere around the second stage before they get to the third stage. You may start to see it in the prodromal, but you will definitely see it in the second stage. |
| What can happen to patients after a coma from PSE? | They can end up brain dead. There is a 90% mortality rate. |
| What can liver disease and protein do to PSE? | It can make it worse because the additional protein is going to elevate their ammonia levels. |
| What effects can an infection have on PSE? | Infection increase the metabolism and breakdown of protein, so infection can make PSE worse. |
| What is another name for PSE? | Hepatic Encephalopathy |
| What will hypovolemia do the ammonia levels in the blood? | It will concentrate them. |
| What effects will hypokalemia have on PSE? | Low potassium and metabolic alkalosis change the structureof the blood brain barrier so that substances will penetrate the blood brain barrier easisr. |
| If you have low potassium or you have bmetabolic alkalosis in patients with liver disease , your patient can go into what easier? | a coma |
| When we have GI bleeding, the blood pools and just sits. What happens that could affect PSE? | There is protein in the blood and the blood will break down and release protein which metabolizes into ammonia. |
| What is fetor hepaticus. | A real foul odor to the breatht that occurs because your liver metabolizes so many of the substances in your body, one of the ways to excrete them is through your breath. |
| What do you treat fetor hepaticus with? | MOM in the mouth for 20 minutes and remove with mineral oil. |
| What do we need to do for patients with PSE? | We need to get rid of the ammonia. |
| What are the the ways to reduce ammonia in a patient with PSE? | Decrease or eliminate protein from the diet, stop GI bleeding, suppress the intestinal flora, correcting imbalances, and promote excretion of ammonia vhy changing it with lactulose |
| What is hepaticaid? | It is a special nutritional supplement like Ensure but it has protein that is metabolized by muscle rather than the liver. |
| When we decrease or eliminate protein from the diet, the patient still needs protein, what do we do? | We can give them hepaticaid. |
| How do we stop GI bleeding? | Medications, Blakemore, sclerotherapy or banding or TIPS. |
| What medications would we use to stop GI bleeding? | Sandostatin, and Vasopressin |
| What does suppressing the intestinal flora do? | It reduces the production of ammonia. |
| Why is neomycin not used anymore to treat PSE. | Because it is nephrotoxic and ototoxic. |
| What do we use now instead of neomycin to treat PSE? | metrinodazole (Flagyl) |
| How does lactulose work? | It adds more hydrogen ions to your intestine. The additional hydrogen causes the ammonia to become ammonium and it cannot be absorbed so it is excreted in the stool. |
| How much lactulose would you give a patient if you were trying to flush the ammonia out of their system? | You would give them 50mL Q2hours until they get diarrhea snd then you would taper it back to 30-40 mL 3-4 times a day. |
| If the 50mL of lactulose per hour doesn't bring the ammonia levels down what do we do? | We give them an enema of lacutlose. Mix 700mL water with 300mL of lactulose give the enema and insert a rectal tube so they can hold it. |
| Why do you give the patient getting a lactulose enema a rectal tube? | To give it time to absorb and to give it time to work. |
| Why is it important to explain to the patient that they have to continue taking the lactulose when they go home. | Because the lactulose is to improve their nervous system and brain. If they don't take the lactulose, they don't get rid of the ammonia and they could go into a coma and they may die. |
| What kind of imbalances need to be corrected to keep the PSE patient from going into a coma? | Infection, low potassium, acid/base imbalances. |
| What are the purposes of fibrinogen and prothrombin? | They are for clotting. |
| What does albumin do? | It maintains osmotic pressure. |
| If the liver can't produce enough albumin and we end up with low albumin, what happens to the fluid in the blood vessels? | It leaks out so that fluid is going into your interstitial tissues and that is edema. |
| Any time a patient has low albumin the patient will be: | Edematous |
| What happens to the blood volume when you have edema? | We have a decrease in blood volume. |
| What happens to the blood flow to the kidneys when we have edema? | We have a decrease in renal blood blow to the kidneys. |
| What compensatory mechanism does the decrease in renal blood flow to the kidneys trigger? | Renin Angiotensin |
| What does Renin Angiotensin trigger the release of? | Aldosterone |
| What is aldosterone responsible for doing? | Aldosterone makes the body retain sodium and water. |
| When albumin is low,the body doesn't have enough albumin to hold the water and sodium in the vascular space and that causes what? | Edema and that then leads to a viscious cycle. |
| What are the two A's? | Albumin and Aldosterone |
| What do you need globulin for? | Antibody formation |
| What are the metabolic functions of the liver? | Fat metabolism, carbohydrate metabolism, protein metabolism, formation of plasma proteins,and globulin formation. |
| What happens to the prothrombin time with liver disease? | It is prolonged, not elevated. It just takes longer for the clotting. |
| What happens to the total serum protein with liver disease? | It is decreased. The liver is not forming the proteins. |
| What is the total serum protein lab test? | It is the combination of prothrombin, fibrinogen, albumin, and globulin. |
| How will albumin be effected when a patient has liver disease? | Decreased |
| How will globulin be effected when a patient has liver disease? | Decreased |
| Because the patient with liver disease is deficient in vitamin K, and the liver can't form fibrinogen and prothrombin, what is a risk for our patient. | Bleeding |
| How would you write a nursing diagnosis for a patient with liver disease who is at a risk for bleeding? | RF Injury r/t Inadequate Clotting |
| Why would somone with liver disease be on stool softeners? | To prevent constipation that could aggravate varices possibly. |
| Why do we need to avoid rectal manipulation in the patient with liver disease? | There are lots fo capillaries in the rectal area and it would be very easy to cause a major hemorrhage. |
| Why do we avoid injections and frequent blood draws in patients with liver disease? | Puncture marks could lead to bleeding and that is already a risk with this patient. |
| What are Ecchmosis and Purpura? | Ecchymosis is a big bruise and purpura is like little dots, little mini hemorrhages under the skin. |
| How long should pressure be applied on the venipuncture site of a person with liver disease? | Maybe as long as 5 minutes. |
| What is it important to teach a patient about thier nose if they have liver failure. | Not to blow their nose. |
| Why won't vitamin K be very effective in a patient that has liver disease? | Because the patient needs fibrinogen and prothrombin to clot also. |
| The liver is responsible for detoxifying: | All the drugs. Everything you take in, the liver detoxifies. |
| Why do you have to be careful when you use sedatives and hypnotics? | Because the liver detoxifies your drugs and any drugs that are given to the patient are gong to accumulater very readily and you could have toxic liver. |
| Why will the natural occuring hormones in the body accumulate in the liver when a patient has liver disease? | Aldosterone and esterogen can't be broken down by the liver. |
| What is Palmar Erythema? | Reddened palms. When the estrogen builds up in the body, it cause this pinkness in the palms. |
| What occurs as a result of too much estrogen built up in the body in patients with liver disease? | Gynecomastia, palmar erythema, testicular hypertrophy, lair loss, and menstrual changes. |
| Once aldosterone is present in the system, the liver usually breaks it down. But the problem is that with liver disease, the liver can't break it down, what does this cause? | Even more fluid accumulation. |
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