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| 75% of liver's blood supply comes from |
Portal vein |
| Supplies liver with oxygen |
Hepatic artery |
| Most common phagocyte in human body |
Kupffer cells |
| Main function r/t Kupffer cells |
Engulf particulate matter |
| End product r/t gluconeogenesis |
Ammonia |
| Liver converts ammonia to |
Urea |
| Examples r/t Protein metabolism of liver |
Synthesizes almost all plasma proteins including albumin, alpha & beta globulins, blood clotting factors |
| Required for synthesis of prothrombin |
Vitamin K |
| Vitmains stored in large amounts in liver |
A, B-complex and D |
| Fraction of an administered medication that actually reaches systemic circulation |
Bioavailability |
| Bioavailability is decreased if medication is metabolized to a great extent by liver before it reaches systemic circulation |
First-pass effect |
| Enteropathic circulation |
Pathway from hepatocytes to bile to intestines and back to hepatocytes |
| Amount of bile salts excreted in feces |
Small fraction |
| Route r/t bilirubin elimination |
Excreted to bile |
| Most common changes to liver r/t Aging |
Decreases in size, weight and total hepatic blood flow |
| Abnormal liver function tests r/t Aging process |
Abnormal results indicate abnormal liver function and are not result of aging |
| Alcohol consumption r/t High risk for cirrhosis |
Men:60-80 g/day or 4 cocktails, Women: 40-60 g/day |
| Viral hepatitis vs. Alcoholic hepatitis r/t Liver tenderness |
VH:tender, AH:nontender |
| Amount of liver damage before liver function tests may become abnormal |
70%+ |
| ALT level increase vs. AST level increase vs. GGT level increase r/t Liver function |
ALT:primarily d/t liver disorders, AST:damage/death to organ tissues, GGT:cholestasis or alcoholic liver disease |
| Acute vs. Chronic r/t More common liver dysfunction |
Chronic |
| Most common and significant symptoms r/t liver disease |
Jaundice, Portal hypertension, Ascites, Varices, Nutritional deficiencies, Hepatic encephalopathy |
| Hemolytic vs. Hepatocellular vs. Obstructive jaundice |
Hemo:increased destruction of RBC's, Hepato:inability of damaged liver cells to clear normal amounts of bilirubin, O:extrahepatic obstruction from occulsion of bile duct |
| Extrahepatic vs. Intrahepatic obstruction |
I:obstruction involves small bile ducts w/in liver, E:occlusion of bile duct |
| Urine & Stool r/t Obstructive jaundice |
U:deep orange and foamy, S:light/clay-colored |
| Pathophysiology r/t Varices |
Develop d/t elevated pressure in veins |
| Treatment goal r/t Pt w/ascites |
Negative Na balance to reduce fluid retention |
| Commercial salt substitutes r/t Physician approval |
May contain ammonia which could cause hepatic coma, May also contain K |
| Second treatment option r/t Ascites |
Diuretic therapy |
| Pathophysiology r/t Esophageal varices |
Almost always d/t portal hypertension |
| Factors contributing to hemorrhage r/t Esophageal varices |
Muscular exertion, Straining at stool, Sneezing, Coughing, Vomiting, Esophagitis, Irritation of vessels d/t poorly chewed food, Reflux of stomach contents |
| Signs r/t Potential hypovolemia |
Cold clammy skin, Tachycardia, Drop in BP, Decreased urine output, Weak peripheral pulses |
| Order to removing Balloon tamponade |
Esophageal balloon deflated first, Pt monitored for recurrent bleeding, Gastric balloon deflated, Monitor for recurrent bleeding, Remove balloon tamponade |
| Treatment of choice r/t Esophageal varices |
Esophageal band ligation |
| Surgical decompression prevents variceal bleeding |
Decompression of portal circulation |
| Precipating factors r/t Hepatic encephalopathy |
Profound liver failure, Accumulation of ammonia and other toxic metabolites |
| Earliest symptoms r/t Hepatic encephalopathy |
Minor mental changes & motor disturbances |
| Medication used to decrease serum ammonia levels |
Lactulose |
| Pathophysiology r/t Generalized edema |
Hypoalbuminemia d/t decreased hepatic production of albumin |
| Bleeding r/t Hepatic impairment |
Production of clotting factors is reduced, Increased bruising and bleeding from wounds |
| Hep A vs. Hep B r/t Transmission route |
A:fecal-oral, B:blood |
| Active vs. Passive immunity |
Active acquire immunity:develop by own body, Passive acquired immunity:obtained from source outside of body like immune globulin, antiserum, or mother to baby |
| Most frequent side effect r/t Hep C treatment |
Hemolytic anemia |
| Only risk factor r/t Hep D |
Those w/Hep B |
| Almost always present w/Hep E |
Jaundice |
| Common chemicals r/t Nonviral hepatitis |
Carbon tet, Phosphorus, Chloroform & gold compounds |
| Common med that leads to hepatitis |
Acetaminophen |
| Most common cause of acute liver failure |
Drug-induced liver disease |
| Sudden/severe impaired liver function in previously healthy Pt |
Fulminant hepatic failure |
| Common causes r/t Fulminant hepatic failure |
Viral hepatitis, Toxic meds, Toxic chemicals, Metabolic disturbances, Structural changes |
| Replacement of normal tissue w/diffuse fibrosis that disrupts liver function |
Cirrhosis |
| Alcoholic vs. Postnecrotic vs. Biliary cirrhosis |
A:scar tissue surrounds portal areas, P:result of acute viral hepatitis, B:scar tissue around bile ducts |
