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Liver A
Liver flashcard
| Question | Answer |
|---|---|
| What vessels supply blood to the liver? | portal vein and hepatic artery |
| How much blood does the liver get per minute? | Approx 1500 ml (give or take a hundred maybe) |
| What percentage of blood does the hepatic artery supply to the liver? | 25% |
| What percentage of blood does the portal vein supply to the liver? | 75% |
| How much blood does the liver store? | 450 ml |
| Glycogenesis | Formation of glycogen from glucose |
| Lipogenesis | formation of fat from CHO |
| Glycogenolysis | breaking down of glycogen |
| Gluconeogenesis | AA + glycerol + lactic acid = glucose |
| `How much bile does the liver produce each day? | 600-1200 ml (that's a LOT of bile!) |
| `What is the liver's role as it relates to protein? | breaks down dietary protein, synthesizes albumin, forms urea from ammonia (the waste products of protein catabolism), synthesizes clotting factors |
| `Why is it so important that the liver detoxify ammonia? | High ammonia levels are very toxic to the body tissues, especially neurons. |
| `Where does bilirubin come from? | Old RBCs that are pulled out of circulation and broken down for recycling or excretion. The heme group is not recycled, it is converted to bilirubin. |
| `What type of bilirubin will be high if you have problems with intrahepatic cells? | Unconjugated/indirect |
| `What type of bilirubin will be high if you have lots of hemolysis? | Unconjugated/indirect |
| `What type of bilirubin will be high if you have a problem with bile flow (such as an obstruction?) | Conjugated/direct |
| `Why do you have anemia with liver disease? | B-12 issues |
| `What clinical manifestation will you have if the bile salts are not being processed correctly? | Jaundice |
| `At what level of serum bilirubin will you see jaundice? | 1) excessive destruction of RBCs, 2) Impaired uptake of biliR by the liver, 3) Decreased conjugation of biliR, 4) Obstruction of bile flow |
| `The urine is dark (but no jaundice), what is the problem? | Liver not able to take up biliR correctly |
| `The urine is dark AND you have jaundice. What is the problem? | You are not processing biliR in the liver |
| `What type of jaundice? Mild jaundice, stools normal, elevated unconjugated biliR, no biliR in urine? | Pre-hepatic jaundice |
| `What type of jaundice? Both conjugated and unconjugated biliR are high, urine is dark? | Intrahepatic or hepatocellular jaundice |
| `What type of jaundice? Conjugated biliR is high, stools are clay-colored, dark urine, serum alkaline phosphatase eleavted, amino transferase elevated, bile salts elevated, pruritis? | post-hepatic or obstructive jaundice (AKA cholestatic jaundice) |
| `What's the max amount of fluid you should pull off with paracentesis? | 1.5 to 2 L (ATI says 1L) |
| `What's the biggest issue when your patient is going to CT/MRI? | They will have to lie flat. May not be able to d/t difficulty breathing. They will need pulse ox and O2 while in scanner. Also, make sure they can follow directions (ammonia issue!) |
| `What is your biggest concern with liver biopsy? | Risk for bleeding. |
| `How will you prep patient for liver biopsy? | stop aspirin or Plavix 1 week prior, no alcohol 1 week prior |
| `What will you do with the patient after liver biopsy? | Watch dressing for bleeding, position on the right side for 1-2 hrs to put pressure on liver. |
| `Don't you love it when the ATI has different info than lecture? | Me too! :-) |
| `How do you prep patient for paracentesis? | measure abd girth, weigh pt, have them void (or put in foley), baseline vitals, position sitting or supine, sedation prn |
| `What do you do for your patient after paracentesis? | maintain pressure at site for several minutes, place pt on unaffected side for 1-2 hrs, monitor temp q 4 for 48 hours, give fluids or albumin prn, document assessment of the fluid (gross) |
| `Your patient's paracentesis site continues to leak after the procedure. What do you do? | Change dressings as needed. (dry steril gauze) |
| `What might your patient need after paracentesis? | Potassium |
| `What lab tests are conducted after paracentesis? | albumin, protein, glucose, amylase, BUN, creatinine (i imagine also electrolytes b/c you're pulling off a bunch of fluid) |
| How will you prevent hypovolemia during paracentesis? | Slow drainage, albumin, and monitor for s/s of hypovolemia |
| `Your pt had a paracentesis an hour ago. She is now complaining of suprapubic pain. What do you do? | Call the doc. This is a sign of a bladder perforation. Other S/S are hematuria, low/no urine output, suprapubic distention, symptoms of cystitis, fever. |
| `Your pt had a paracentesis and is now complaining of N/V and a sharp, constant abd pain. What do you do? | Call the doc. These are signs of peritonitis. Other signs are fever, diminshed or absent breath sounds. |
| `Your liver patient had an angiography. What is your big concern? | Bleeding at the insertion site |
| `AST will be elevated in.... | inflammation. NOT SPECIFIC for liver |
| `ALT shows... | parenchymal inflammation. Specific for liver! |
| `GGT is increased with... | alcohol-related problems |
| `ALP is increased with... | obstruction |
| `High ammonia levels cause... | changes in LOC, asterixis |
| `Cholesterol will be _______ in severe hepatocellular disease. | Could be up or down. Trick question! |
| `Albumin will be ________ with liver disease. | decreased |
| `BUN will be _____ with severe liver disease | decreased |
| `BUN will be ______ with hepatorenal syndrome | increased (along with Cr) |
| `PT will be ____ with liver dysfunction | increased |
| `PLT will be _____ or _____ with liver disease. | decreased OR wnl but poor quality |
| `Total Bilirubin will be _____ in liver disease | increased |
| `Direct bilirubin will be increased with.... | obstruction of ducts |
| `Indirect bilirubin will be increased with... | problems with intrahepatic cells, reduced parenchymal surface and hemolysis |
| `Urine bilirubin will be increased with... | hepatocellular disorders AND biliary tract obstruction |
| `Glucose will be _____ with pancreatic obstruction and ____ with severe liver disease. | Increased with pancreatic obstruction, decreased with severe liver disease. |
| `H & H will be ___ in liver disease | decreased d/t severe anemia and hemorrhage |
| `What is the most common cause of liver disease in the U.S that is not viral related? | alcohol (at least for males) |
| `What is the most common toxic cause of liver disease in developing countries? | mushrooms (other toxins?) |
| `What are two common pharmacological agents that cause liver disease? | tylenol and isoniazide (it's a TB drug) |
| `What is the MOST COMMON acute problem of the liver? | Hepatitis |
| `Which disease causes widespread inflammation of liver cells, altering their structure and function that leads to degeneration or necrosis? | Hepatitis |
| `What disease is this? Chronic progressive disease characterized by diffuse destruction and regeneration of parenchymal cells, leads to scarring and loss of fxn. | Cirrhosis |
| `What is/are the most common form(s) of hepatitis in the US? | The blood-born ones, B, C, D |
| `What are the three causes of hepatitis? | virus, chemicals, toxins. |
| Name some viruses that cause hepatitis? | rubella, varicella, retrovirus, yellow fever, adenovirus, Epstein Barr |
| `Your patient's liver enzymes peak, drop, then rise again...what's up? | This is a sign of chronic hepatitis and a poor prognosis |
| `Your pt has these S/S: HA, fatigue, low-grade fever, N/V, arthralgia, myalgia....what phase of hepatitis is he in? | Prodromal phase |
| `Your pt has these S/S; diarrhea, RUQ pain, lethargy, irritability, jaundice, severe pruritis. What phase of hepatitis is he experiencing? | Icteric phase (5-10 days after prodromal phase) |
| `Your pt has light-colored stools, dark urine, jaundice and palmar erythema. What's up? | These are signs of obstruction. |
| `How is Hep A transmitted? | fecal oral route |
| `How is Hep E transmitted? | fecal-oral route |
| `How is Hep G transmitted? | percutaneous (i don't know what that means) |
| `What is the incubation period for Hep A? | 30 days |
| `What is the incubation period for Hep B? | 12-14 week |
| `What is the incubation period for Hep c? | 6-7 weeks |
| `which form of Hep may be fatal? | which form of Hep may be fatal? |
| `Which form of hepatitis puts you at risk for carcinoma? | Hep D + Hep B |
| `What will identify the presence of the virus? | Serologic markers |
| `What does the presence of HB antibodies indicate? | Immunity to Hep B (either due to recovery or successful immunizations) |
| `What is cholysteramine? | A med that binds up bile salts to reduce itchiness |
| `What meds will you avoid if you have hepatitis? | choropromazine, aspirin, acetaminophen, phenothiazine and many sedatives |
| `What are the two main meds for treating pruritis in jaundice? | cholestyramine and antihistamines |
| `What med would you give for a pt who is at risk for hepatic encephalopathy? | Lactulose (it binds up ammonia) |
| `Which types of Hep are most common causes of chronic hepatitis liver inflammation? | Hep B, Hep C (B + D combo can also cause it) |
| `Chronic hepatitis is liver inflammation of _______ duration. | greater than 3-6 months |
| `Chronic hepatitis includes elevation of AST & ALT for a duration of _________. | greater than 6 months |
| `A pt with cirrhosis will have high direct/indirect bilirubin levels and back-up/no back-up in the portal hepatic vein. | high indirect (unconjugated) and a back-up in the portal hepatic vein |
| Can cirrhosis be controlled, or is it a death sentence? | It can be controlled if caught early. |
| `What is the most common form of cirrhosis in North America? | Alcoholic cirrhosis (aka Laennec's or Micro-nodular) |
| `What is the type of cirrhosis that is considered "world wide" cirrhosis? | Post-necrotic |
| `What type of cirrhosis is toxin-induced? | Post-necrotic |
| `What type of cirrhosis can be caused by malaria drugs? | Post-necrotic |
| `What causes cardiac-related cirrhosis? | prolonged right-sided heart failure or constrictive pericarditis |
| `What are the four classifications of cirrhosis? | Alcoholic, post-necrotic, biliary, cardiac |
| `Fibrosis and scarring of the liver leads to: | portal hypertension |
| `What is the main goal with treatment of cirrhosis? | To treat the underlying cause! (modify meds, trend labs, diet changes, monitor for GI bleed and renal failure, prevent infection) |
| `Finish this Nursing Dx for your cirrhosis pt: Ineffective perfusion related to ___________ and __________. | r/t bleeding tendencies and varices |
Created by:
tp667
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