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12 Cards in this Set
- Front
- Back
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What are the two mechanisms which can lead to ascites
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-Decreased intra-vascular albumin
-Portal Hypertension |
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How does the livers protein synthesis role relate to the development of ascites?
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-hepatocyte damage may interfere with its capacity to synthesize albumin
-decreased serum albumin lead to a reduction of intravascular oncotic pressure -fluid leaks from the vasculature into the peritoneal space resulting is ascites. |
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How does portal hypertension cause ascites?
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-portal HTN causes the vessel downstream to be hypotensive
-kidneys preserve water and Na to counter the hypotension -Because the hypotension is only localized the increased water retention the Starlings forces to be unbalanced and the movement of fluid from the intravascular space to the peritoneal space occurs. |
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What treatment regimes would you consider for a patient with ascites?
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Salt restriction
Diuretic therapy IV albumin, and paracentesis |
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Define Liver encephalopathy?
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The deterioration of brain function due to toxic substances accumulating in the blood which are normally removed by the liver.
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Which zone of the liver acinus is responsible for detoxifying?
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Zone 3
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How could portal hypertension contribute to liver encephalopathy?
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Portal HTN may cause the blood from the intestine to bypass the liver and not be detoxified; this blood then may circulate b the brain where its toxic substances can induce damage.
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Ammonia is toxics to the brain, how does it induce encephalitis?
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Ammonia freely crosses the BBB and causes the astrocytes to swell resulting in encephalitis.
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What are some symptoms related to ascites a person may present with?
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-difficulty breathing
-gastro-intestinal reflux -umbilical herniation -spontaneous bacterial peritonitis (end-stage cirrhosis) |
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Asterixis is a symptom of liver encephalopathy; what is it?
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Asterixis is a tremor of the wrist when the wrist is dorsiflexed , it can be a sign of hepatic encephalopathy
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What is the prognosis for hepatic encephalopathy?
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Reversible
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If hepatic ammonia conversion in to urea is inhibited, what can you do to reduce the delivery of ammonia to the liver?
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Administer lactulose to acidify stools and trap ammonia NH3 as ammonium NH4.
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