Pellico: Ch. 25 Hepatic & Billiary Disorders

____% of liver's blood supply comes from the portal vein (nutrients), and ____ % comes from the hepatic artery (oxygen). 80 / 20 what important function of the liver is essential for the kidneys to function? Ammonia is converted to urea, which the kidneys then remove to bladder what are important proteins that the liver metabolizes? (2) What vitamin is required for the liver to synthesize prothrombin? Clotting Factors & Albumin / Vitamin K What are the 8 main functions of the liver? Glucose, Protein, Fat Metabolism and Ammonia coversion to Urea, Vitamin/Iron storage, Bile Formation, Bilirubin excretion, Drug metabolism When the liver breaks down fats for use as energy, what is released into the blood stream? Ketones Where is cholesterol synthesized? Liver Name the vitamins/minerals that are stored by the liver (6) A, B, D, K, Iron, Copper Liver Disease: AST, ALT, GGT, GGTP, LDH will all be high or low? Serum Ammonia? Cholesterol? Prothromibin Time? High / High / High (if bile duct related) Low (if liver cell related) / Longer Liver Disease: Globulin -Low or high? Bilirubin? High / High Hepatocellular vs. Obstructive Jaundice: appears mildy-severly ill, lack of appetite, nausea, weight loss, malaise, fatigue, weakness, headache, chills, fever maybe Hepatocellular Jaundice Type of jaundice caused by viral hepatitis, hepatotoxins (drugs/alcohol), metabolic disorders, ischemia, autoimmune hepatitis, or pregnancy Hepatocellular Jaundice Type of jaundice caused by gallstones, inflammation of the bile ducts, biliary strictures, malignancies of the biliary system, pancreatic cancer, liver cancer, or pancreatitis Obstructive Jaundice Type of jaundice caused by increased production of bilirubin due to hemolysis, hematologic disorders, resorption of a hematoma, or multiple transfusions Hemolytic Jaundice Type of jaundice caused by inherited disorders of bilirubin metabolism. Hereditary Hyperbilirubinemia Hepatocellular vs. Obstructive Jaundice: —Dark orange-brown urine and light clay-colored stools —Dyspepsia and intolerance of fats, impaired digestion, —Pruritis Obstructive Jaundice —Hemolytic —Hepatocellular —Obstructive Hereditary hyperbilirubinemia which 2 are most associated with liver disease? Hepatocellular and Obstructive —Obstructed blood flow through the liver results in increased pressure throughout the portal venous system Portal Hypertension Portal Hypertension results in ____(2) Ascites & Gastro-esophageal Varices Portal Hypertension caused HyPOtension where? Why is this a cyclical problem? Hypotension in the kidneys / Hyperaldosteronism in blood causes increased sodium/water in blood with decreased excretion of same. Ascites results! portal hypertension causing decreased systemic blood volume causing activation of ADH/angiotensin-renin mechanisms causing kidneys to retain sodium/water which all leaks into 3rd space of abdomen (repeat cycle) Ascites Straie are? Often seen with ____ Stretch marks / Ascites increased abdominal girth, weight gain, swelling of lower extremities (pedal edema), early satiety, anorexia, general weakness....dx? Ascites What are 4 treatments for Ascites? Diet (decrease salt!!), Diuretics, Paracentesis, Transjugular Intrahepatic Portosystemic Shunt (TIPS) What is carefully monitored by nurse during paracentesis? (3) (Vascular collapse) Pallor, Increased HR, Decreased BP the most effective regimen to control ascites and pedal edema is these two medications in combination. Which is the 'first line therapy' if by itself? Spironolactone (Aldactone) & Furosemide (Lasix) / Spironolactone (Aldactone) the most life-threatening complication of liver disease is ____ Esophageal Varices dilated, tortuous (twisting/bending) veins that are usually found in the submucosa of the lower esophagus caused by portal/venous hypertension Esophageal Varices A pt with Esophageal Varices should avoid ____ (4) to reduce risk of rupture/hemorrhage/death Alcohol, Physical Activity (lifting,straining), Vomiting, Coughing hematemesis, melena, deteriorating mental or physical status, cool clammy skin, hypotension, tachycardia.....dx? Esophageal Varices what medication type is used to decrease portal pressure? Beta Blockers Balloon Tamponade Esophageal Sclerotherapy Esophageal Banding Why is nitroglycering sometimes prescribed when giving vasopressors to stop bleeding of varices? Vasopressors can cause Angina (in some pts) how is ammonia produced in the body? Byproduct of breakdown of Proteins/Amino Acids by liver life-threatening complication of liver disease/failure resulting from accumulation of ammonia and other toxic metabolites in the blood Hepatic Encephalopathy------>Coma minor mental changes/motor disturbances followed by slight confusion, mood swings, sleep disturbances, followed by flipped sleep pattern, followed by increased drowsiness, stupor, slurred speech, coma.....dx? Hepatic Encephalopathy Asterixis a sign of Hepatic Encephalopathy where the pts hands cannot be held straight out without flapping down Constructional Apraxis a sign of Hepatic Encephalopathy that is the inability to reproduce simple figures (draw a star,ex.) breath that smells like freshly mowed grass, acetone, old wine, or a sweet fecal odor.....dx? What is this smell called? Hepatic Encephalopathy / Fetor Hepaticus Asterixis Hepatic Encephalopathy Treatment: Why is glucose given? Why Protein restricted? Why suction GI tract? Reduces Protein Catabolism / Reduces ammonia byproduct / removes ammonia in GI tract The diet of every pt with chronic liver disease is supplemented with what 5 vitamins? A, B (complex), C, K, and Folic Acid Hepatitis A, B, or C Etiology: Crowded, Contaminated Water? IV drug use? Infected bodily fluids? A / C / B Hepatitis A, B, or C Transmission: Sexual Contact/Percutaneous (thru the skin)? Fecal-Oral? B & C / A Hepatitis A, B, or C Incubation Period: 45-180 days? 14-180 days? 15-50 days? B / C / A Hepatitis A, B, or C Prevention: Vaccine? No Vaccine? A & B / C Hepatitis A, B, or C Outcome: Mild with recovery and no risk of hepatic cancer? May be severe with risk of hepatic cancer? Mild symptoms, with frequent reoccurence with risk of hepatic cancer? A / B / C fever, malaise, anorexia, N/V, Diarrhea, abdominal pain, jaundice, pain in RUQ.....dx? Hepatitis This is a major cause of Cirrhosis and Liver Disease worldwide Hepatitis B This is the most common reason for liver transplants Hepatits C Only persons with Hepatitis ____ are at risk to develop Hepatitis D B Hepatits E resembles Hepatitis ____ and is self-limiting with an abrupt onset. No chronic form. A High Protein, High Carb, Low Fat, Inc. Calorie, Inc. Fluid is a diet for what disease? Hepatitis Rest/Activity.....which for hepatitis? What drug must be avoided due to hepatotoxicity? What instead? Rest...then alternate / Compazine / Tigan What analgesic is mentioned as hepatotoxic in ppt? Tylenol The final stage of all chronic liver disease is _____ Cirrhosis —chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver. Cirrhosis In Cirrhosis, is sodium high/low? potassium? High / Low Name the 5 Cirrhosis Medication Treatments Spirolactone (Aldactone)- to block Aldosterone/K+ retain, Vitamin K (prothrombin synth.), Multivitamin, Lactulose (Cephulac) - reduces ammonia, H2/PPI's This skin condition is associated with Cirrhosis Pruritus (itching) Cholelithiasis is ____. Cholecystitis is ____ Gallstones / Acute Inflammation of Gallbladder Gallstones are made up of ____ or ____ Pigment or Cholesterol Type of gallstone that makes up 25% of cases and cannot be dissolved, must be removed Pigment Stones Type of gallstone that makes up 75% of cases. These patients are deficient in _____ resulting in too much ____ in the bile. Cholesterol Stones / Bile Acids / Cholesterol Cholesterol Stone Risks: women or men? Age? What do oral contraceptions/estrogen do to increase risk? Lifestyle? Races (2)? Women / 40+ / alter bile acid:cholesterol balance / Sedentary / Whites & Native Americans May have severe pain, N/V (usually after a heavy meal), Jaundice, Urine color change, Clay colored stool, fullness, vague URQ pain.....dx? Cholelithiasis What does Ursodeoxycholic Acid and Chenodeoxycholic Acid do? Dissolve Gallstones Incision in common bile duct for removal of stones. Tube inserted in duct for drainage of bile until edema subsides Choledochostomy Gallbladder is opened, stones, bile and pus are removed. T-Tube is inserted to ensure ductal patency Cholecystostomy Pancreas: Beta cells make ___, Alpha cells make ___ , Delta cells make ____. Which function: Endo/Exocrine? Insulin / Glucagon / Somatostatin / Endocrine What is the difference between Endocrine and Exocrine function? Endocrine uses ducts! Pancrease: what are the exocrine secretions (3) include what they digest Amylase-carbs, Trypsin-proteins, Lipase-fats Major Duodenal Papilla where the Ampulla of Vater empties into the duodenum when the pancreatic duct becomes obstructed and enzymes back up into the pancreas causing auto digestion and inflammation.....can lead to death Acute Pancreatitis —a progressive inflammatory disorder with destruction of the pancreas. Cells are replaced by fibrous tissue, and pressure within the pancreas increases. Mechanical obstruction of the pancreatic and common bile ducts and destruction of the secreting cells of the pancreas occur. Chronic Pancreatitis —Severe abdominal pain, sometime back, —Patient appears acutely ill, —Abdominal guarding —Nausea and vomiting, —Fever, jaundice, confusion, and agitation may occur, —Ecchymosis in the flank or umbilical area may occur, May develop respiratory distress, hypoxia, renal failure, hypovolemia, and shock...dx? Acute Pancreatitis —Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting,—Weight loss,—Steatorrhea.....dx? Chronic Pancreatitis 80% of Acute Pancreatitis is caused by _____ Biliary Tract Disease (obstruction) Pancreatitis Diagnostics: will show an elevation in what 2 pancreatic serums in 90% of cases? Amylase, Lipase (3x normal) What are the 2 factors that are the main contributors to developing Chronic Pancreatitis Alcohol & Smoking _____ —is the most useful study in the diagnosis of chronic pancreatitis ERCP