Term
| Liver function: amino acid metabolism |
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Definition
Normal: amino acids converted to ammonia, ammonia converted to urea (BUN) for excretion
Damage: ammonia not converted to urea
- Labs: high ammonia, low BUN
- Toxic ammonia: neuro symptoms, encephalopathy, coma |
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Term
| Liver function: protein metabolism |
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Definition
Normal: synthesizes albumin and protein
Damage: decrease production of both
- Labs: low albumin and protein
- Edema (from loss of intravascular osmotic pressure leading to fluid migration into interstitial spaces) |
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Term
| Liver function: carb metabolism |
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Definition
Normal: convert glucose to glycogen and back
Damage: can't keep glucose WNL
- Unstable blood sugars "hepatic diabetes"
- Hyperglycemia after eating bc can't save extra glucose as glycogen
- Hypoglycemic btwn meals (can't convert glycogen to glucose) |
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Term
| Liver function: lipid metabolism |
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Definition
Normal: synthesis of cholesterol and lipoproteins
Damage: decrease synthesis of cholesterol, triglycerides deposited in liver (fatty liver)
- Labs: low cholesterol |
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Term
| Liver function: synthesis of clotting factors |
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Definition
Normal: synthesizes clotting factors
Damage: decreased production of clotting factors
- Labs: higher PT (takes longer to clot)
- Accurate indicator of progress in acute hepatitis |
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Term
| Liver function: detoxification |
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Definition
Normal: detox from digestion (drugs, hormones), excreted by bile in kidney
Damage: impaired ability to remove toxins or metabolize meds
- Assess meds for ones metabolized by liver |
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Term
| Liver function: bile formation |
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Definition
Normal: produces bile salts from cholestrol
Damage: can't clear bilirubin from blood, less absorption of fat-soluble vitamins (A, D, E)
- Increased circulating bile
- Jaundice (dark urine)
- Nutritional deficiencies
- Pruritis |
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Term
|
Definition
- Drug and alcohol abuse
- Medications
- Sexual practices
- Foreign travel
- Family history |
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Term
|
Definition
- Liver enlargement and RUQ pain and tenderness
- Jaundice w/ tea colored urine
- Pruritus
- Ascites
- Edema, weight gain
- Spider angiomas
- Hematemesis from esophageal varices
- Easy bruising
- Malaise, weakness, fatigue
- Anorexia
- Confusion, lethargy, coma (from ammonia)
- Tremor, asterixis, weakness, slurred speech (hepatic encephalopathy) |
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Term
| Gold standard test for liver problems |
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Definition
| ultrasound: determine where fluid is located so it can be removed, if spleen is enlarged, if there are biliary stones |
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Term
|
Definition
- Route: poop, sexual
- Risk factors: travel, sex
- Potential for chronic infection: none
- Severity: mostly recover w/o lasting damage, rarely fatal
- Treatment: supportive |
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Term
|
Definition
- Route: blood, semen
- Risk factors: jobs w/ blood contact, promiscuity
- Potential for chronic infection: 90% infants, 6-10% adults
- Severity: mostly recover w/o lasting damage, rarely fatal
- Treatment: supportive, for chronic can give antivirals |
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Term
|
Definition
- Route: blood
- Risk factors: druggies, healthcare workers
- Potential for chronic infection: high
- Severity: usually chronic, not acute
- Treatment: supportive, antivirals |
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Term
| Causes of non-viral hepatitis |
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Definition
- Acetaminophen
- Alcohol
- Anesthetic agents |
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Term
| Patient teaching for hepatitis |
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Definition
- s/s of progression, acute episode
- Manage therapeutic regime
- Diet and exercise
- Hepatotoxins: meds, alcohol, smoking
- Safe sex/clean needles |
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Term
|
Definition
End stage liver disease
- Scarring of liver
- Replacement of healthy liver by areas of fibrosis
- Inflammation
- Bile duct occlusion with thick bile and pis |
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Term
|
Definition
Acoholism
Hepatitis C
Obesity
Autoimmune
Inherited diseases (cystic fibrosis)
Drugs, toxins, chronic HF w/ liver congestion |
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Term
|
Definition
Early liver enlargement then shrinking
Portal HTN, ascites, esophageal varices
Edema
Anemia, poor nutrition
Mental status changes r/t hepatic encephalopathy progressing to coma |
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Term
| Medical management of cirrhosis |
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Definition
GI: antacids, H2 blockers
EdemaL diuretics
Vitamins and nutritional supplements
NO alcohol
Ammonia: lactulose |
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Term
|
Definition
- Squeezes bile into stomach, bile helps digest fat
- Not essential, can remove it, possible problems are increased risk of diarhea, less able to absorb fatty foods |
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Term
|
Definition
- Neutralizes stomach acid
- Makes insulin and glucagon
- Can't take it out, we need it |
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Term
|
Definition
Acute inflammation of the gall bladder
- Interferes with normal drainage of bile into duodenum |
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Term
|
Definition
Gallstones: calculi in the gallbladder
- Interferes with normal drainage of bile into duodenum |
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Term
| Cause of s/s in cholelithiasis |
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Definition
- Can be silent with minimal symptoms
- When gallstone obstructs cystic duct/common bile duct the gall bladder becomes distended and inflamed |
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Term
|
Definition
- Severe right abdomen pain: cramping or constant, can radiate to back or right shoulder
- N/V
- Fever
- Clay colored stools
- Rebound pain: from inflammed peritineal space |
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Term
| Who is mosst likely to get gallstones? |
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Definition
Females
Fat
Fertile (multiple pregnancies or hormone replacement therapy) |
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Term
|
Definition
Ultrasound: best test, rapid and accurate
ERCP: common complication=pancreatitis |
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Term
| Medical management of gallstones |
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Definition
- Nutritional therapy
- Rest, IVF, analgesia, antibiotics
- Medications (6-12 mons) to dissolve small stones in non surgical candidates
- Nonsurgical removal w/ ERCP: widen opening of bile duct, let them fall out and catch them |
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Term
|
Definition
| Removal of the gallbladder |
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Term
|
Definition
Inflammation of pancreas
- Can be acute or chronic |
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Term
|
Definition
Med emergency, life threatening complications
- Pancreatic duct is constructed, enzymes back up, pancreas inflammed
- Causes: cholelithiasis, alcohol
- 2 types: acute interstitial, acute hemorrhagic |
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Term
| Acute interstitial pancreatitis |
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Definition
| Pancreas remains intact but edematous and inflammed |
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Term
| Acute hemorrhagic pancreatitis |
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Definition
| Necrosis and hemorrhage of the tissue |
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Term
| Acute pancreatitis manifestations |
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Definition
- Severe abdominal pain and guarding
- N/V
- Fever, jaundice, agitation, confusion
- Ecchymosis in flank or umbilical area
- Respiratory distress, hypoxia, renal failure, hypovolemia, shock |
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Term
|
Definition
Progressive inflammatory disorder w/ destruction of pancreas
- Cells replaced by fibrous tissue, increases pressure w/n
- Mechanical obstruction of pancreatic and common bile duct, causes destruction of secreting cells of pancreas |
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Term
| Manifestations of chronic pancreatitis |
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Definition
- Recurrent attacks of severe upper abdominal and back pain w/ vomiting
- Weight loss
- Steatorrhea |
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Term
| Medical treatment of pancreatitis |
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Definition
Rest pancreas (no food)
Treat cause (gallstones, gall bladder) |
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