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Week 5: Hepatic disease
Terms in this set (62)
What is the falciform ligament?
The ligament that divides the right and left lobes of the liver.
When transplants are done to the liver, which side gets transplanted?
The right side
Which duct stems from the gallbladder?
Which duct stems from the liver?
The common hepatic duct
What is the duct that joins the ducts from the gallbladder and the liver?
The common bile duct
The liver can lose ___ of cells before it stops functioning.
What is the main cell of the liver?
What is the function of Kupffer cells?
They line the sinusoids and engage in phagocytosis to rid the liver/body of toxins, bacteria, and debris.
What is the function of the sinusoids?
The capillary system for gas and nutrient exchange.
Describe portal circulation
The portal vein carries nutrients and toxins away from the GI tract and various parts of the body. This is where 2/3 of the blood to the liver goes in order to be purified and sent back to normal heart circulation.
The hepatic artery carries oxygenated blood from the lungs to oxygenate the liver. 1/3 of blood directed at the liver goes here.
What are potential causes of cirrhosis?
Hemochromatosis, Wilson's disease, alcohol and street drug use, medications, hepatitis, various autoimmune disorders/diseases, and congestive/chronic heart failure.
What is hemochromatosis?
An autoimmune disease that results in increased serum iron which increases iron deposits on the liver.
What is Wilson's disease?
An autoimmune disease that results in increased copper deposits on the liver.
Why does CHF cause liver failure?
The back up of fluid into the liver causes tissue damage and eventual cirrhosis.
Why are liver biopsies not routine practice as a diagnostic measure?
They can cause major bleeds as the liver acts as a blood reservoir, holding upwards of 500mL in the sinusoids.
Describe nursing aftercare of a patient who has undergone a liver biopsy
Have the patient lay on their right side for two hours to prevent bleeds. Post-op vital protocol. Monitor for signs and symptoms of hemorrhage/bleeds.
What does the liver store?
Glycogen and vitamins K and B12
How is blood glucose affected by liver disease?
You often see hyperglycemia as the liver loses its ability to store glycogen.
What is the function of vitamin K?
Producing clotting factors.
What is the function of vitamin B12?
Assists in the production of RBCs.
Why is hemorrhaging a major risk for patients with cirrhosis?
Deficiencies in clotting factors secondary to poor vitamin K production/storage
Why is anemia a manifestation of cirrhosis?
Patients are lacking vitamins such as B12 to produce RBCs
Normal serum albumin
Normal total bilirubin
Normal serum ammonia
What liver enzymes do we pay close attention to when considering liver disease/impairment?
AST, ALT, GGT, ALK phosphatase, ammonia, bilirubin, albumin
An AST/ALT ratio of ____ is indicative of alcohol abuse.
2:1 or greater
An AST/ALT ratio of ____ may indicate hepatitis or non-alcoholic fatty liver disease
Less than 2:1
Why do patients with liver disease have issues with fluid retention (i.e. ascites)?
The liver metabolizes aldosterone and helps synthesize albumin. Without aldosterone, hypovolemia can occur and without appropriate amounts of albumin, the patient can become edematous due to alterations in osmolality and fluid shifting into the interstitial space.
Why are albumin transfusions unhelpful in liver disease?
The fluid will continue shifting long-term as the liver is still not producing enough albumin. Helps in the short-term for symptom management, but is of no use in the grand scheme of treatment.
Aside from edema, what are some of the implications of low albumin?
Respiratory issues such as SOB from fluid pushing up on the diaphragm.
What is paracentesis?
An abdominal procedure used to drain fluid collected in peritoneal cavity.
Why do many patients with liver disease develop intense pruritis?
When the liver does not produce bile properly, the bile salts accumulate and deposit under the skin causing intense itchiness.
Fat in the stoool
Function of aldosterone in the body
Sodium and water retention
Composition of bile
Water, cholesterol, bilirubin, bile salts.
What does steatorrhea look like?
Clay-colored, frothy stools.
Why can liver disease not be treated with medications easily?
The liver detoxifies medications and the liver's ability to do so is impaired, increasing chances of toxicity as the body carries the drug longer secondary to poor metabolism.
What are some interventions for pruritis?
Oatmeal baths, keeping the skin moist and hydrated, and Atarax.
What causes jaundice? Where is jaundice most easily visualized?
Accumulation of bilirubin. Easily seen in sclera and oral palate. Can also notice bright yellow urine.
What is portal hypertension?
Abnormally elevated BP within the portal vein/system.
What is the biggest complication we should be worried about with portal hypertension?
How does esophageal varices occur?
The congestion within the liver causes congestion in other vessels behind, including the esophagus. The engorgement leads to varices.
Why is esophageal varices so concerning?
The veins are so engorged that they may easily rupture during eating high fibre/bulky foods, vomiting, coughing, sneezing, or straining. This can cause major hemorrhaging; you must also consider the lack of clotting factors which exacerbates the issue.
Performing a gastroscope and putting rubber bands around the varices to tie them off and prevent hemorrhaging.
What would make you suspect esophageal varices?
Nausea, hematemesis (coffee grind emesis), blood in stools, discomfort during swallowing.
How is ammonia metabolized and excreted? Why do ammonia levels build up with liver disease?
Ammonia is transported to the liver, detoxified, metabolized to urea, and excreted by the kidneys via urine. The liver cannot metabolize ammonia well in liver disease.
What is the consequence of elevated serum ammonia? Why is this such a concern?
Hepatic encephalopathy; ammonia is CNS toxic.
How does elevated serum ammonia manifest?
Confusion, agitation, abnormal behavior, disheveled behavior.
How do you treat elevated serum ammonia?
Lactulose; helps excrete ammonia and interferes with bacteria in the colon that break down the proteins needed to form ammonia.
What is the goal of lactulose treatment?
2-3 loose stools per day
What is asterixis?
"Liver flap"; the patient puts their hands out straight and start flapping a bit with their hands.
Transmission of hep A is through...
Transmission of hep B is through...
Percutaneous, sexual, perinatal, exposure to blood and blood products that are contaminated with hep B
Transmission of hep C is through...
Transmission of hep D is through...
Hep B infection precedes hep D so transmission is via hep B (percutaneous, sexual, perinatal)
Transmission of hep E is through...
What are the causes of hepatitis?
Aside from the various types of hepatitis as the primary infection (A-G), there is also other viruses such as cytomegalovirus, Epstein-Barr virus, herpesvirus, coxsackievirus, and rubella that can cause hepatitis. Can also be induced by drugs or chemicals, autoimmune diseases, metabolic disorders, and genetic abnormalities.
Clinical manifestations of hepatitis in the acute phase
Anorexia, nausea, occasional vomiting, RUQ discomfort, constipation, diarrhea, malaise, fatigue, headache, low-grade fever, arthalgias, skin rashes.
Primary biliary cirrhosis
A chronic and slowly progressive disease caused by inflammation and destruction of small bile ducts in the liver, leading to loss of bile ducts and blockage of bile flow (cholestasis)
What are the implications behind splenomegaly secondary to liver cirrhosis?
The enlarged spleen increases removal of blood cells, such as platelets, from circulation. Also affects RBC production.
What is fulminant hepatic failure and what commonly causes it?
Acute liver failure characterized by severe impairment of liver function associated with hepatic encephalopathy. Commonly caused by drugs, such as concurrent alcohol and acetaminophen use, or hepatitis B.
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