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