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68wm6 p2 Dis Liv
Disorders of the liver
| Question | Answer |
|---|---|
| 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
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