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Liver A

Liver flashcard

QuestionAnswer
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