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Hepatic Disorders

NU122 Hepatic Disorders

What is Special about the Liver - it is the largest gland in the body
Where is the liver located - Upper right abdomen
Is the liver a very vascular organ - Yes is it
Where does the liver receive its blood supply from - Portal Vein - Hepatic Artery
What percentage of blood is from the portal vein - 80%
What percentage of blood is from the hepatic artery - 20%
What is the characteristics of the blood from the portal vein - rich in nutrients because it comes from the GI tract
What is the characteristics of the blood from the hepatic artery - rich in oxygen
What are the two main types of cells found in the liver - Hepatocytes - Kupffer cells
What do the Hepatocytes do - Form bile - Store glycogen
What do the Kupffer cells do - Phagocytic action engulfs bacteria and particulate matter entering the liver from the portal vein
What are the functions of the liver - Glucose Metabolism - Ammonia Conversion - Protein Metabolism - Fat Metabolism - Vitamin Storage - Bile Formation - Bilirubin Excretion - Drug Metabolism
How does the Liver Metabolize Glucose - After a meal glucose enters the liver via the portal vein and stored in hepatocytes as gylcogen
What are the two mechanisms the liver performs with the metabolism of glucose - Glycogenolysis - Gluconeogenesis
What is Glycogenolysis - Liver releases stored glycogen into the bloodstream to keep blood glucose levels normal
What is Gluconeogenesis - Liver converts amino acids to lactate into glucose in response to hypoglycemia
What is Ammonia a by product of - Protein digestion in the intestines - gluconeogenesis
What does the liver convert ammonia to - Urea
Where is urea excreted - in the urine
How does the liver aid in the metabolism of protein - It uses amino acids to synthesize all plasma protein - albumin - blood clotting factors
What role does albumin play in fluid balance - it produces oncotic pressure in the blood vessels because they are too large to pass through the pores. This oncotic pressure draws fluid back into the blood vessels keeping the tissues around them free from edema
How does the liver play a role in fat metabolism - Fatty acids are broken down by the liver into ketone bodies for energy production
When does the liver break down fatty acids for energy - When glucose levels are low - Usually in uncontrolled diabetes and starvation
What do fatty acids produce - Cholesterol
How does the liver aid in vitamin storage - The liver stores Vitamins A,B,D - Many B-complex vitamins - Iron and Copper
How does the liver aid in Bile formation - bile is formed by the hepatocytes
Where is the bile collected - in the bile ducts
Where is bile stored - the gall bladder
What is bile formed from - Water, Electrolytes, cholesterol, bilirubin and bile salts
What is the function of bile - Emulsifies fat as part of digestion
Where are the bile salts reabsorbed - in the distal ileum - entero-hepatic circulation
Where does Bilirubin come from - It is a pigment from the breakdown of red blood cells
How does the liver aid in the excretion of bilirubin - It is released by the kupffer cells to the hepatocytes where it is conjugated and added into the bile
Where is the bilirubin converted - Released into the small intestines and converted into urobilinogen
Where is urobilinogen excreted - Filtered through the kidneys and excreted through the urine
How does the liver aid in drug metabolism - By changing the bioavailability
What is bioavailability - The amount of drug that actually reaches systemic circulation
What is the first pass effect - If a drug is metabolized to a great extent by the liver is reduces the bioavailability
What are some liver function studies - Serum Protein studies - Biliburin Studies - Prothrombin time - Serum alkaline phosphatase - Serum ammonia - Cholesterol
What are the tests for serum aminotransferases - AST - ALT - GGT - LDH
What do increases in serum aminotransferases or AST,ALT, GGT or LDH indicate - Injury to the liver
What are some liver diagnostic studies - Ultrasound, CT, MRI - Nuclear medicine - Liver biopsy
What are ultrasounds, CTs, and MRIs used to identify - Normal and abnormal structures of the liver
What does nuclear medicine identify in the liver - Liver scans assess the size of the liver and flow of blood through the liver
What does a liver biopsy identify in the liver - Examines cells - Identifies lesions
What are the two types of Dysfunction of the liver - it can be - Chronic or Acute
What is the most common cause of Liver dysfunction - ETOH
How is liver dysfunction compounded with the use of Alcohol - Malnutrition
What can ETOH use lead to - Cirrhosis
What are some of the other causes of liver dysfunction - Infection - Anorexia - Metabolic Disorders - Nutritional deficiencies - hypersensitivity states
What are some of the manifestations of liver dysfunction - Jaundice - Portal Hypertension - Ascities - Varices - Heptatic encephalopathy or coma - Nutritional deficiencies
What is jaundice - Yellow or green tinged body tissue, sclera and skin
What is the yellowing related to - Total bilirubin levels > 2.5 mg/dL
What are the normal bilirubin levels - 0 - 0.9 mg/dL
What Causes Jaundice - Hepato-cellular damage - obstruction
How does hepato-cellular damage cause jaundice - the damaged liver cells cannot clear bilirubin from the blood
How does an obstruction cause jaundice - Bile blocked from flowing into intestine - bilirubin reabsorbed into blood thus staining tissue
What are the signs and symptoms of juandice caused by hepato-cellular damage - Loss of appetite, nausea - Malaise, fatigue, weakness - Headache, fever if due to infection, chills - Mildly or severely ill
What are the signs and symptoms of jaundice caused by an obstruction - Dark, orange-brown urine - light clay colored stool - Dyspepsia, intolerance of fats, impaired digestion - Pruritis
What is Portal Hypertension - Obstructed blood flow through the liver due to fibrosis of liver tissue - leads to increased pressure throughout the portal venous system
What can portal hypertension lead to - Ascites - Esophageal varices
What is Ascites - Fluid in peritoneal cavity
What are the causes of Ascites - Portal Hypertension - Vasodilation of splanic circulation - Aldosterone - decreased albumin levels - movement of albumin
How does Portal hypertension cause Ascites - Results in increased capillary pressure and obstruction of venous blood flow
How does Vasodilation cause Ascites - The vasodilation of splahnic circulation increases the blood flow to the major abdominal organs
How does aldosterone lead to Ascites - The changes in the ability to metabolize aldosterone leads to an increase in fluid retention
How does Albumin lead to Ascites - Decreased synthesis of albumin leads to the decreased serum osmotic pressure which leads to fluids into the cells - Albumin moves into the peritoneal cavity which further pulls fluid into the cavity
Pathogenesis of Ascites - Cirrhosis with Portal Hypertension - Splanchnic Arterial Vasodilation - Decrease in Circulating Arterial Blood Volume - Activation of renin-angiotensin and sympathetic nervous system and antidiuretic hormone - Kidney retains sodium and water
Pathogenesis of Ascites Continued - Hypervolemia - Persistent activation of systems for retention of sodium and water; ascites and edema formation - Contiued arterial underfilling; cycle repeats
What sound you record in the assessment of ascites - Abdominal girth and weights daily
What should you monitor for in the assessment of ascites - Potential fluid and electrolyte imbalances
What physical attributes may a person have with ascites - Striae - Distended veins - Umbilical hernia
How should you assess for fluid in the abdominal cavity - by percussion for shifting dullness - or by fluid wave
What should be restricted in the diet in a person with ascites - Sodium
What type of diuretic should a person be on - Spironalactone - aldosterone blocking
What does bedrest do for a person with ascites - improves diuresis
What is a paracentesis - Use to drain fluid from the abdomen by the insertion of a tube
What can be given to increase the hydrostatic pressure - Albumin
What is a TIPS Shunt - Transjugular Intrahepatic Portosystemic Shunt - allows blood return to inferior vena cava - may lead to increased ammonia levels or right sided heart failure
What is Hepatic Encephalopathy - Life-threatening complication of liver disease
What does Hepatic Encephalopathy result in - Accumulation of ammonia in blood
What are the normal ammonia levels in the blood - 15 - 45 mcg/dL
What should you assess for in a patient with Hepatic Encephalopathy - EEG - Neurological status often for changes in LOC - Potential Seizures - Fector Hepaticus - Monitor Fluid, Electolytes and Ammonia Levels
What is Fector Hepaticus - Earthy smelling breath
What is Asterixis - When a person cannot keep their hands in an upright position
What are the effects of constructional Apraxia - When a person cannot make simple shapes through drawing - They cannon write clear legible sentences
How can you decrease the ammonia Levels - By eliminating the underlying causes
What can you give to a patient to reduce the ammonia levels - Lactulose
Why would you give a person with high ammonia levels IV Glucose - to minimize protein catabolism
What dietary restrictions would be in place with a patient with high ammonia levels - Reduce protein intake
What medications should be discontinued in a person with increased ammonia levels - Sedatives - Analgesics - Tranquilizers
Why should you provide a person a safe environment with increased ammonia levels - To prevent injury due to confusion
What happens in about 1/3 of the patients with cirrhosis and varices - The bleed into the esophagus
What is the mortality rate of bleeding esophageal varices - 30 - 50% in the first bleeding episode
What are the manifestations of bleeding esophageal varices - Hematemesis - melena - deterioration - shock
How often should a person with cirrhosis patients be screened for esophageal varices - every 2 years
What is the pathogeneis pf bleeding esophageal varices - Portal hypertension(caused by resistance to portal flow and increased portal venous inflow) - Development of pressure gradient of 12 mm Hg or greater between portal vein and inferior vena cava(Portal Pressure Gradient)
What is the pathogeneis of bleeding esophageal varices continued - Venous collaterals develop from high portal system pressure to systemic veins in esophageal plexus, hemorrhoidal plexus and retroperitoneal veins - Abnormal varicoid vessels form in any of above locations - vessels may rupture life-threatening
What is should you treat for when a person has a bleeding varices - Shock
What if given to a patient in the treatment of bleeding varices - Oxygen - IV Fluids, Electrolytes and volume expanders - Blood and blood products
What medication is given to decrease bleeding - Vasopressin - Octreotide
What medication is given to reduce coronary vasoconstriction - Nitroglycerin in combination with vasopressin
What medication is given to decrease portal pressure - Propranolol and nadolol in combination
What surgical interventions an be used with bleeding varices - balloon Tamponade:Sengstaken-Blakemore Tube - Endoscopic Sclerotherapy - Esophageal Banding
Why should a nurse monitor a patients condition frequently with Bleeding varices - Because of Alcohol withdrawl
What should a nurse monitor for in a person with bleeding varices - For hepatic encephalopathy(blood breakdown in GI) - Monitor Treatments - GI Suction and Tube care - Oral Care - Quiet environment(Keep Calm) - Reduce anxiety, agitation, Family needs support
What should be done for a person with hepatic disorders and is vitamin deficient - Prescribed a multi-vitamin - Thiamine - Folic Acid - Vitamin K
What happens to a person after eating meals with hepatic disorders - They become hyperglycemic
Why does a person become hypoglycemic during fasting states - Decreased hepatic Glycogen reserves - Decreased gluconeogenesis
What does a decreased albumin production by liver cause - Systemic edema
What does a decrease in the production of clotting factors by the liver result in - Increased bruising - GI Bleeding - bleeding from wounds
What does a Decrease in sex hormone metabolism by the liver result in - Testicular atrophy - Loss of pubic hair - Menstrual irregularities
How long does it take for hepatic Cirrhosis take to develop - Approximately 30 years
What first develops in Hepatic Cirrhosis - A fatty liver
What develops after the fatty liver in Hepatic Cirrhosis - Fibrotic Tissue replaces the normal tissue
What are the Signs and symptoms of Compensated Hepatic Cirrhosis - Vascular Spiders - Reddened Palms - Unexplained epitaxis - Ankle Edema - Abdominal pain - Firm Enlarge liver - Vague indigestion in AM - Faltulent dyspepsia
What are the Signs and Symptoms of Decompensated hepatic Cirrhosis - Ascites - jaundice - Weakness - Purpura - Spontaneous Bruising - Epitaxis - Hypotension - Muscle Wasting
What are the nursing diagnosis for a Cirrhosis patient - Activity intolerance - Imbalanced Nutrition - Impaired Skin Integrity - Risk for Injury and Bleedin
What are the 2 types of Hepatitis - Viral - Non-viral
What is Viral Hepatitis - A systemic viral infection taht causes necrosis and inflammation of liver cells with characteristic symptoms and cellular and biochemical changes
What are the types of Viral Hepatitis - A, B, C, D, E
What is non Viral Hepatitis - Caused by toxins or drugs
How is Haptitis A Transmitted - Fecal-Oral Transmission - Spread by poor hygiene - Hand to mouth - Through food and fluids
What is the incubation period for Hepatitis A - 15 - 50 Days
How long will the illness last - 4 - 8 Weeks
What is the mortality rate with Hepatitis A - Very Low
What are the signs and Symptoms of Hepatitis A - Mild flu like symptoms - Low-grade fever - anorexia - Indigestion - Jaundice - Dark urine later - Enlargement of liver and spleen
When does the Anti-HAV antibody appear - After symptoms appear
How can you prevent Hepatitis A - Good Handwashing - Clean Water - Proper Sewage Disposal - Vaccine - Immunoglobulin for for contacts for passive immunity
What is the treatment for Hepatitis A - Bed Rest during acute phase - Nutritional Support
How is Hepatitis B and C Transmitted - Through Body Fluids - Blood - Sexual contact - Needles
What does Hepatitis B and C Lead to - major Cause of liver cancer and Cirrhosis
Is there a vaccine for Hepatitis B - Yes
What Can hepatitis B and C be treated with - interferon and anti-viral drugs
What does alcohol encourage in persons with Hepatitis B and C - the progression of the disease
When can Hepatitis D be Present - only in persons infected with Hepatitis B
How can you Prevent Hepatitis B and C - vaccine for hepatitis B - Passive Immunization for those exposed - Standard Precautions - Screening for blood and blood products
Does cancer originate in the liver - Usually not only a few does
What usually precedes Live cancer - Hepatitis B or C
What is the growth called with liver cancer - Hepatocellular carcinoma
What is the frequent site for metastatic cancer - The liver
What are some of the manifestations of liver cancer - Pain - dull continuous ache in RUQ, apigastrium or back - Weight loss - loss of strength - anorexia - anemia
How does jaundice occur with liver cancer - if bile ducts are blocked
How does ascites occur with liver cancer - if portal vein is obstructed
What is done in the pre-porcedure with a liver biopsy - Consent form - Coagulation tests - blood for transfusion available
What is done in the procedure in a liver biopsy - Expose right lateral chest wall - Instruct to inhale and exhale several times, then exhale and hold breath - physician will introduce biopsy needle between ribs into liver, aspirate tissue, and withdrawl needle
What should be done immediately after a liver biopsy is done - turn patient onto right side - place a pillow or sand bag under costal margin - instruct patient to remain in this position for several hours
How often should vital signs be taken in a patient with a liver biopsy - every 15 minutes for the first hour - every 30 minutes for the next 2 hours
What should you teach a patient that has just had a liver biopsy - avoid heavy lifting or any strenuous activity for one week
What are major complications in a liver biopsy - Bleeding - bile peritonitis
What makes surgery dangerous in patients with liver cancer - Cirrhosis
What are some palliative and sometimes curative treatment in patients with liver cancer - Radiation therapy - Chemotherapy - Percutaneous biliary drainage
When would a surgery be performed on a patient with liver cancer - if it is confined to one lobe - if function is adequate
What does the liver have the capability of doing - regenerating its cells
What are some of the surgeries that can be done for liver cancer - Lobectomy - Cryosurgery - Liver transplant
What are some of the anti-rejection medications that a person must take - Prograf - cellcept - cyclosporine - azathioprine - corticosteriods
Created by: saraken2007
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