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Stack #131712

a MCPHS- Provider I- Ch 39- Assessment & Management of Pts w/Hepatic Disorders

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
Created by: rpclothier