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68wm6 p2 Dis Liv

Disorders of the liver

Define Cirrhosis: Degenerative disorder of the liver from generalized cellular damage
What is the Pathophysiology of Cirrhosis? *Liver parenchyma degenerates *Lobules are infiltrated with fat *Restriction of blood flow *Hepatomegaly and liver contraction
How does Cirrhosis of the liver systemicly effect the body? *Disturbances in digestion and metabolism. *Reduced protein synthesis. *Defects in blood coagulation. *Defects in fluid/electrolyte balance. *Ascites-accumulation of third spaced fluid and albumin in the abdomen.
True or False: Cirrhosis is a rapid onset disorder. False. Develops slowly over many years
What are the stages of Cirrhosis? *Destruction *Inflammation *Fibrotic regeneration *Hepatic insufficiency
What causes Laennecs cirrhosis? ETOH abuse/ protein deficiency
What causes Primary Biliary Cirrhosis? Destruction of bile ducts
What causes Secondary Biliary Cirrhosis? chronic bile retention after obstruction or infection of the major extra- or intrahepatic bile ducts
What causes Cardiac Cirrhosis? increased portal hypertension r/t R sided CHF.
List 4 clinical manifestations of Cirrhosis *Abdominal pain *Tissue wasting *Peripheral edema *Abdominal distention *Splenomegaly *Bleeding *Weight loss
List 4 Signs of cirrhosis *Anemia *Jaundice *Epistaxis *Coagulopathy *Hemorrhage *Disorientation *Ascites *Weight loss
What are some diagnostic findings of cirrhosis? *Elevated liver enzymes *Decreased serum albumin *Elevated ammonia *Prolonged PT.
What are the diagnostic tests that can be ran for cirrhosis? *ERCP - Endoscopic Retrograde Cholangiopancreatography *Esophagoscopy with barium *Scans and Biopsy *Ultrasound *Paracentesis-fluid from peritoneum
What should fluid be restricted to in the medical management of cirrhosis? 500cc - 1000cc
What is sodium restricted to in the medical management of cirrhosis? 1g - 2g
What is the medical management of cirrhosis? *Decrease buildup of fluids *Daily weights *Strict I&Os *Diuretics
What are two diuretics used for Tx of cirrhosis? Aldactone and lasix
When is protein restriction used as medical management of cirrhosis? Only in acute hepatic encephalopathy
What are possible complications of Paracentesis? *Abdominal organ perforation *Wound infection *Bladder puncture
Over how long should a paracentesis last? 30-90min
No more than how much fluid be removed at a time during paracentesis, and why? No more than 1-1.5L of fluid may be taken off at a time to prevent sudden changes in BP
What should you monitor a patient recieving a paracentesis for? *Hypovolemia *Electrolyte imbalance *Bleeding/drainage
What is a Peritoneal jugular shunt (leveen)? One way valve moving fluid from peritoneal cavity to superior vena cava
What are the complications of a peritoneal jugular shunt (leveen)? *Hemodilution *Pulmonary edema/CHF *Wound infection, peritonitis, septicema *Occlusion by thrombus
Portal hypertension leads directly to what? Esophogeal varices
How quickly can esophogeal varicies rupture? Suddenly or over several days
What is the pathophysiology of Hepatic Encepalopathy? Liver is unable to breakdown ammonia and it accumulates in the blood and crosses blood-brain barrier; interfering with neurotransmission, brain metabolism
List 3 S/Sx of Hepatic Encephalopathy *Inappropriate behavior *Disorientation *Asterixis (flapping tremors) *Twitching extremities *Stupor, coma
What is the medical management of Hepatic Encephalopathy to reduce blood ammonia levels? *Reduction of protein in diet *Lactulose *Give antibiotics *Maintain Fluids/Electrolytes
Define Hepatitis: Inflammation of the liver resulting from several types of viral agents, exposure to toxic substances or lenghty ETOH abuse
What is the most common form of hepatitis? Hepatitis A
What is the incubation period of hepatitis A? 10 - 40 days
How is Hep A contracted? Direct contact of fecal content via H20 & food
What is the incubation period of Hepatitis B? 28-160 days
How is Hep B contracted? Contact w/blood and body fluids
What is the incubation period of Hepatitis C? 2 weeks - 6 months
How is Hep C contracted? needle sticks & blood transfusions
What is the incubation period of Hepatitis D? 2-10 weeks
How is Hep D contracted? Contact of blood/body fluids
What is the incubation period of E(Enteric non A/non B)? 15-64 days
What are the newest found types of hepatitis? F&G
How do the pathological findings in the 7 types of hepatits differ? They dont. Pathological findings in all seven are IDENTICAL.
How widely can the symptoms of Hepatitis vary? patient maybe asymptomatic; others develop hepatic failure or hepatic encephalopathy
List 3 subjective symptoms of hepatitis. *General Malaise *Headaches/Chills *Photophobia *RUQ discomfort; N&V *Diarrhea & Constipation
List 3 Objective signs of Hepatitis. *Jaundice *Pruritis *Clay-colored stools *Dark, amber urine *Hepatomegaly w/lymphadenopathy *Rhinitis
What is the test for Hep E? There is no test for Hep E
What is used to test for Hep F? Electron microscope
What is used to test for HAA(A,B,C,D,G) Serum examined
What is the Tx for Hepatitis? No specific treatment other than management of S/Sx
How long should a person with Hepatitis remain on bed rest? Several weeks
What diet should hepatitis PTs have? Low Fat/High Carb w/vitamin supplement(C,B,K)
How long should alchohol be avoided during the Tx of hepatitis? 1 year
When should the Hep B vaccine be taken if exposed? immediately and one month after exposure
What is the Prognosis and mortality of Hep A? Recovery high, mortality 0.5%
What is the Prognosis and mortality of Hep B? Most serious with long term health effects, mortality 10%
What is the mortality rate of Hep E? Mortality rate 10% in pregnant women, otherwise not fatal
Created by: Shanejqb