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17 Cards in this Set
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Key Anatomy Review
Metabolism Overview Metabolism is the complete set of chemical reactions that occur in living cells Catabolism – Yields energy. An example would be cellular respiration Anabolism – Uses the energy from catabolism to construct cell components (proteins, nucleic acids, etc) |
Meal
¨ ↓ ¨ Digestion (stomach and small intestines) ¨ ↓ ¨ Proteins, fats, carbohydrates ¨ ↓ ¨ Polysaccharides, starches, cellulose, glucose, fructose, amino acids, fatty acids ¨ Small enough to cross into the blood, but not small enough to be useful to cells ¨ ↓ |
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Metabolism (liver)
↓ Uses a host of enzymes and chemical reactions to further break down digested substances into things like pyruvate, glycerol, lactate, glutamine, ATP, etc. that cells can use for catabolism and anabolism ↓ Waste products of metabolism (for example urea and CO2) eliminated primarily via urine, feces, & expired air |
Key Anatomy Review
Portal Circulation Portal circulation brings blood to the liver from stomach, Intestines, Spleen, Pancreas In the liver metabolism occurs After leaving the liver, the blood goes to the inferior vena cava and right atrium |
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Portal Circulation
If pressure builds→ portal hypertension Varices at critical anastomosis sites Bleeding Collateral Circulation and Shunting of blood around the liver Non-metabolized blood gets into general circulation Liver engorgement |
Think It Through
¨ Why might a person with right-sided heart failure develop hepatomegaly? |
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Bilirubin Metabolism
Breakdown of RBC ↓ Unconjugated (indirect) Bilirubin Not water soluble. None in Urine, only in blood |
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Liver conjugates (direct) Water soluble ↓ Excreted in bile Produced by hepatic cells |
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Bilirubin Metabolism
Large Intestines Bilirubin reduced to urobilinogen and stercobilinogen by bacteria ↓ Stercobilinogen eliminated in stool Gives brown color ↓ Most urobilinogen reabsorbed and taken back to liver to be excreted in bile Some excreted through kidneys |
Think It Through
¨ Some forms of jaundice cause increased urobilinogen in the urine, others don’t. Why? |
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Focused Nursing Assessment
Special attention to: Skin or membrane disruption Lifestyle (alcohol and drug use especially) Occupational /Environmental Risk factors Medication history Nutritional Status, General Abdominal assessment Fluid/lytes, Pain descriptions Neurological Status |
Liver Palpation
¨Focused Nursing Assessment:Fluid Wave Differentiating ascites (fluid), obesity, and gas With ascites – often have tight glistening skin, bulging flanks, fluid moves in a characteristic way. |
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Diagnostic Tests:
Liver Function Tests (LFT) Blood tests Liver Enzymes ALP – Bone and liver ALT – Primarily Liver AST- Primarily Liver GGT – Only present in Biliary tract, so more sensitive for liver damage Liver Enzymes are elevated in liver diseases |
Liver Function Tests (LFT)
Blood tests Alpha Fetoprotein – Hepatic cancer Tests for Hepatitis (see pg 1093) Acute infection Current infection, but not acute Previous infection Immunity Chronic Infection Chronic Carrier state |
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Albumin/Protein
¨Prothrombin time ¨RBC ¨Hgb and Hmct ¨Clotting times ¨Blood Ammonia ¨Bilirubin |
Urine Urobilinogen
¨Diagnostic Tests ¨Ultrasound or Scan ¨Ultrasound – NPO for 8-12 hours (decreases gas and GB contraction) ¨Scans (HIDA – Hepatobiliary Scintigraphy, Liver) – Consent for dye. Force fluids after |
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Paracentesis:
Can be diagnostic or Therapeutic Usually done at Bedside Pre-Care: Void Before, Position upright or sidelying Site prep, Stab wound below the umbilicus Drainage collected in a bottle – measured and sent to lab, May leave a drainage tube in place |
Paracentesis Post-Care
Protein loss Monitor infection Skin care and monitoring drainage if tube in place Only used for severe ascites with respiratory problems. Relief only temporary |
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Peritoneoscopy
1.Similar to other Laparoscopic procedures (pre/post care) 2.Able to visualize liver and biliary tree and can get specimens 3.General Anesthesia in OR 4.Consent; NPO for 8 hours 5.Empty bowel and bladder 6.Observe for bleeding and bowel perforation afterward |
Liver Biopsy
¨Can be in OR or at Bedside ¨Pre-Care:Check coagulation studies, Type and cross match for blood, Take V/S as baseline, Explain holding breath after expiration as, needle inserted. Consent |
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Liver Biopsy Post-Care
Check V/S q 15 X 2; q30 X 4; q 60 X 4, Keep on right site at least 2 hrs, Splint puncture site; pressure dressing Keep flat on BR for 12-14 hrs Assess for bleeding, shock, pneumothorax, bile peritonitis Monitor RUQ or referred right shoulder pain |
Comparing Diagnostic Tests
Liver Biopsy ¨ Liver Scan or HIDA |
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Paracentesis
Peritoneoscopy Ultrasound |
Referred pain to right shoulder
Contrast dye often used Bedrest. Position on right side Void before, NPO |
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Stab wound below umbilicus
Hold breath during needle insertion, Coagulation studies before |
Hemorrhage, pneumothorax, bile peritonitis, Bleeding and bowel perforation, Protein loss
Frequent Vital Signs after |
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Nursing implications for a client undergoing a liver scan or HIDA would include:
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A.Giving a low fat meal prior to the test
B.Making sure the client voids before the procedure C.Positioning in a right side lying position after the procedure D.Questioning the client about allergies to dye |
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Immediately following a liver biopsy, a client is placed on the right side. The nurse explains that this position should be maintained for several minutes to:
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A.Help prevent or stop bleeding
B.Increase comfort C.Prevent postural hypotension D.Facilitate bile drainage |
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One of your patients experiences a dull, achy, right shoulder pain following a needle liver biopsy. What should be your interpretation?
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A.This is common after a needle liver biopsy because of referred pain
B.This patient has probably developed an obstruction in the common bile duct C.The patient has probably developed peritonitis as a complication of the procedure D.The patient probably has muscle stretching and discomfort from the position maintained during the procedure |
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A client is admitted with possible primary liver cancer. Which of the tests below would be the most confirming of this diagnosis?
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A.Liver function tests
B.CT scan of the abdomen C.Alpha-Fetoprotein markers D.Paracentesis |
