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68 Cards in this Set
- Front
- Back
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Name four functions of the liver.
(there are MANY to choose from) |
-metabolizes PRO, CHO & fats
-metabolizes most drugs and steroid hormones -Makes albumin/clotting factors -detoxifies -makes bile -stores minerals/fat soluble vitamins -stores glycogen -eats damaged blood cells and foreign cells |
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There are two main types of hepatitis, name them.
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Non-viral
Viral |
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What are the types of non-viral hepatitis that you need to know?
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ETOH hepatitis
Toxic hepatitis Hepatobiliary hepatitis |
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What causes ETOH hepatitis? What is the actual damage that is done?
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chronic alchohol abuse
causes necrosis of liver cells |
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What causes toxic hepatitis?
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exposure to chemicals (acetaminophen...benzene....shrooms)
(exposure through occupation |
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How much acetaminophen is in 2 percocet tabs?
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650mg.....so you need to watch and keep patient under 4000mg of acetaminophen a day.
Drugs that contain acetaminophen are: percocet lortab darvocet tylenol |
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Why is the urine of liver failure patient's brown?
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b/c they are unable to break the bilirubin down in the liver to a secretable form. instead it is put into the urine as urobilogen.
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What causes hepatobiliary hepatitis?
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gallstones
-it is a complication of cholelithiasis. Stone blocked the bile and now the liver is inflammed and swollen |
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Other than cholelithiasis, what is another cause of hepatobiliary hepatitis?
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allopurinol (gout medicine)
which is semi ironic...b/c gout is caused by increased uric acid levels in blood and is found in chronic alcoholics...but then the med to treat this actually is causing another problem in their already damaged liver. hmmmmm. |
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What is the most common cause of hepatitis?
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viral hepatitis
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Viral hepatitis has local and systemic effects on the body. Name the local effects.
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In the liver:
1. inflammatory process damages hepatic cells and disrupts liver function 2. immune response damages hepatocytes and Kupffer cells 3. inflammation impairs bile flow |
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What happens to the liver when the bile doesn't flow out?
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leads to jaundice
(bile is the carrier of bilirubin) leads to hepatitis (bile needs to get out or liver will be inflammed) |
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What happens to the liver when the immune responses damage the hepatocytes and Kupffer cells?
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hyperplasia, necrosis and cellular regeneration
(so not necessarily a bad thing, when a person recovers the liver can return to a pre disease state) |
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What are the systemic effects of hepatitis on the liver?
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rash, fever, achiness in joints, malaise
(caused from antigen-antibody reaction...a result of present virus) |
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What are the three stages of acute viral hepatitis?
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pre-icteric phase
icteric phase post icteric phase |
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In what phase does jaundice occur?
pre icteric post |
Icteric phase
(this phase is MARKED by the onset of jaundice) |
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When does the pre-icteric phase occur?
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prior to jaundice
1-21 days |
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What phase is the person most likely to infect another?
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pre-icteric phase
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What are the manifestations of this pre-icteric phase?
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flu-like symptoms
malaise fatigue N/V/D/A HA muscle ache, polyarthritis RUQ pain low grade fever |
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What is another name of the pre-icteric phase?
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prodromal
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Patient is in the Icteric Phase. This is usually when they seek medical treatment. What are the manifestations that they might have during this stage?
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JAUNDICE
pruritus lighter colored stools lymphadenopathy brown urine enlarged liver change in pre-icteric symptoms (better appetite, no achiness) |
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Where is Jaundice usually seen first?
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in the sclera of the eyes
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How long does this icteric phase last?
When does it start? |
4-6 weeks
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What is another name for the post icteric phase of viral hepatitis?
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convalescent phase
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What are the manifestations of the last stage of viral hepatitis?
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serum bilirubin and enzymes return to normal
not as tired, but easily fatigued pain subsides minimal GI disturbances present |
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What is the source of HAV?
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contaminated water, food shellfish, humans, poor sanitation
(found in feces) |
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What is the mode of transmission for HAV?
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fecal-oral route; poor sanitation, alternate sexual activity
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What is the onset of HAV?
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abrupt; most contagious during incubation period and early course
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Can you be a carrier of HAV?
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no
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What are the lab dx of HAV?
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Anti HAV IgM
Anti HAV IgG |
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Which hep viruses have vaccines?
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A
B D (doesn't have its own vaccine, but if you get vaccinated against B, then you can't catch D) |
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What does a positive AntiHAV IgG mean?
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you have immunity
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What does a positive AntiHAV IgM mean?
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you have an acute infection
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Why don't you test for antigens to determine infection of HAV?
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antigens are only in the feces for a short period of time, so you have to check for Anti HAV IgM
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How do you treat an exposure to HAV?
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IG (immune globulin) injection 2-7 days post exposure; no good after 7 days exposure
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What is the source of HBV?
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blood, body fluids, IV drug use, STDs, needle stix
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What is the onset of HBV?
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slow, virus needs time to build up
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Can you be a carrier of HBV?
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Yes...you have to have the antigen to be a carrier, but you might never get sick with it.
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Which hep virusus can you be a carrier for?
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EVERYTHING except A
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What are the complications of HBV?
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chronic hepatitis
cirrhosis liver cancer |
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What are the lab findings for HBV?
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Anti HBs
HBsAG |
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What is the deal with the tiny "s" that is in the lab findings for HBV?
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HBV has a surface antigen that is identifiable. If you have Anti HBs, then you have an antibody suck to the antigen. If you have HBsAG, you just have the antigen.
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If you had to pick one of the HBV diagnostic tests to be positive for, which one would you pick and why?
Anti HBs HBsAG |
Anti HBs ** because it shows recovery from virus or immunity.
If you are positive for HBsAG, then you a have a current infection |
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What is the prevention for HBV?
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immunization - 3 injections
1 month, 2 months and at 6 months |
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What is the treatment for exposure to HBV?
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HBIG. if you are exposed, you can take this along with your immunizations. It gives you short lived instant immunity while your own immune system gears up. Its like borrowing someone else's IgG..but it is called IG.
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Your patient says that they were exposed to HBV awhile ago and wants an HBIG injection. What would be your question?
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How long ago.....HBIG is only good 24 hours to 7 days after an exposure
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In order to transmit a version of hepatitis virus, what MUST you have in your blood?
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the antigens of the virus
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What is the source of HCV?
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blood transfusions, IV drug use, STDs, needle stix
it is transmitted through blood and body fluids |
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Which hep viruses are abrupt with onset?
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A D E
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Which hep viruses are slow with onset?
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C & B
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What are the diagnostic tests for HCV?
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Anti HCV
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What are the prevention methods for HCV?
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there are no vaccines. need to avoid the transmissions
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If exposed to HCV, what is the immediate action that you can take?
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Interferon combined with ribavirin
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HCV has the joy of being the most common cause of ___________ __________.
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chronic hepatitis
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Of all of the hepatitis viruses, HCV is most likely to progress to.....
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liver failure and cirrhosis
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What is the source of HDV?
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blood, body fluids, STDs, needle sticks
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Although not spoke of much, HDV is pretty serious because....
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it can be asymptomatic for a long time and then becomes SEVERE. It is the hepatitis that leads to FULMINANT HEPATITIS
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Why is fulminant hepatitis so bad?
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b/c there is no recovery and death is caused by liver failure
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What are the diagnostic tests for HDV?
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Anti-HDV
HDV Ag |
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What is the source of HEV?
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contaminated water in Asia, Africa, and Central America
(fecal=oral) abrupt onset |
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HEV antigens are found in __________.
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stool
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HEV antibodies are found in __________.
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blood
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How fast does liver failure set in with HDV/HBV combo hepatitis?
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2-3 weeks after onset of symptoms
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Other than the antigen &antibody lab tests that determine which type of hepatitis a person has, there are other lab diagnostics that are performed. List them.
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CT scan of liver
LFTs Serum bilirubin Prothombin time |
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Why is the prothrombin time extended for a person with liver issues?
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b/c of decreased absorption of vitamin K and decreased production of prothrombin....so increased PT time and increased bleeding
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Liver function tests are elevated until _________ sets in. Then only alkaline phosphatase is elevated.
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jaundice
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Other than the vaccines that are available for certain hep viruses, what are the other pharamacotherapeutics?
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Interferon (B & C only)
Anti-emetics (no phenergen) Benadryl and Questran (for itching) Corticosteroids to reduce inflammation in severe cases |
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What is the name of an antiemetic that can be used for hepatitis?
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Torecan (it depresses the vomiting center)
**don't use phenergan |
