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81 Cards in this Set
- Front
- Back
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functions of the liver |
metabolizes glucose makes blood clotting factors cleanses blood drugs chemicals and bacteria synthesizes builliribin synthesis and store bile |
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bile is a |
digestive enzyme |
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jaundice/ lcterus |
caused by abnormally high levels of bilirubin in the blood |
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elevated bilirubin levels |
excessive destruction of RBC in the body the liver is diseased and cannot excrete bilirubin normally |
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2 types of bilirubin measured in the blood |
indirect and direct |
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indirect bilirubin |
normally found circulating in the blood when elevated the usual case is hemolysis ex newborn infants |
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direct bilirubin |
when this is elevated it's because of liver dysfunction or an obstruction somewhere btw the liver and small intestines
gallstones or cancerous tumor ex cirrhosis or the liver |
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cirrhosis |
degenerative lover disorder caused by damage to the liver cell liver cells are irreversibly damaged and replaced by nonfunctional scar tissue which causes the liver to malfunction |
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3 types of cirrhosis |
laennec postnecrotic billary |
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laennec |
most common type can be caused by chronic alcohol abuse, metal poisoning or acetaminophen overdose |
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postnecrotic |
caused by infections such as hepatitis |
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biliary |
obstruction or infection of Hillary tract |
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assessment for cirrhosis |
symptoms worsen as disease progress hepatomegaly jaundiced skin,sclera and mucous membranes ascites chronic fatigue and anemia clay colored stool upset GI tea colored urine pruritis |
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diagnosis for cirrhosis |
liver biopsy blood clotting studies lft direct and indirect bilirubin levels ammonia levels ammonia is produced by protein |
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ammonia is converted to |
urea |
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ammonia levels in the blood rise when? |
the liver is not able to convert ammonia to urea |
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urea is eliminated In the |
urine |
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ALT &AST |
when damaged or destroyed they will leak into the blood where they can be measured by blood test |
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if AST&ALT are found together in the blood the what is suspected |
liver damage |
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AST |
is found in muscles and many other tissues beside the liver |
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ALT |
is almost exclusively found in the liver |
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what does BUN stand for |
Blood Urea Nitrogen |
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medical management for cirrhosis |
vitamin K supplements (IV and IM) lactulaose laxative and ammonia detoxant diuretics, fluid and sodium restrictions blood transfusion to correct anemia consider liver transplant |
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nursing management for cirrhosis |
daily weight measure abdominal girth (ascites) good skin care |
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complications of cirrhosis |
portal hypertension esophageal varices ascities hepatic encephalopathy |
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portal hypertension is causes |
esophageal varices rectal hemmroids caput medusal |
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portal hypertension |
increased congestion and fluid pressure in the portal circulation this causes ascites affects esophagus rectum and abdomen |
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what needs treated that are caused by portal hypertension |
esophageal varices ascites hepatic encephalopathy |
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esophageal varices |
dilated bulging esophageal veins occurs as a result of portal hyper tension |
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esophageal varices may bleed from |
alcohol use,rough food, insertion of NG tube is contraindicated |
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diagnosis for esophageal varices |
barium swallow, esophagoscopy |
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treatment for esophageal varices |
injection sclerotherapy , variceal banding insertion of a sengesteken blakemore tube |
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sengstaken blakemore tube |
needs to be inflated and deflated at diffrent intervals KEEP scissors at bed side to cut the esophageal balloon and remove immediately |
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treatment for ascites |
sodium restrictions albumin replacement paracentesis spironolactone -diuretic potassium sparing diuretic denver shut |
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paracentesis |
have the pt sitting upright so they dont have there intestines punctured |
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denver shunt |
last resort high failure rate pt must lay flat for several hours when finished sit in semi fowler's to stop pump distributes fluid into cardiovascular circulation |
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hepatic encephalopathy |
neurological complications that often lead to coma and death caused by high ammonia levels can cause alteration and permanent damage to the CNS |
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assessment for hepatic encephalopathy |
disorientation, mental confusion, personality changes, memory loss, asterisxis- tremor of the hands percent neurological damage- kernicterus |
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treatment for hepatic encephalopathy |
low protein diet antibiotics to destroy bacteria that produce ammonia neomycin kantrex use of lactulose |
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hepatitis |
Inflammation of the liver most common is a viral infection viral or due to chronic alcohol abuse |
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hepatitis B |
infected by blood and sexual contact symptoms rash may be asymptomatic often fatal high risk of liver cancer, cirrhosis |
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assessment for hepatitis |
preicteric icteric posticteric |
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preicteric |
N,V anorexia, weight loss,RUQ pain, hepatomegaly, spleenomegaly, rash pruritus |
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Icteric |
symptoms as above + onset of jaundice, clay colored or whitish stools dark urine |
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posticteric |
liver enlargement, fatigue, malaise persist, all other symptoms start to subside |
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diagnosis for hepatitis |
serum testing for antibodies made against the hep virus elevated liver enzymes elevated bilirubin level liver biopsy |
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medical management for hepatitis |
bed rest, balanced diet liver transplant medications |
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hepatitis a |
fecal to oral raw sewage, sushi, sharing utensils, cigarettes flu like symptoms, malaise, anorexia full recovery |
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hepatitis c |
infected blood, sexual contact similar to hep b symptoms often chronic lead to liver cancer |
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meds for hepatitis |
Ribavarin, Introl A, Roferon Sofosbuvir- hep c 89% cure rate hep c comb drug lediposavir/sofobovir SE: weakness, HA, fatigue check LFT |
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tumors of the liver |
abnormal mass of cells in the liver may be malignant or benign metastalises from somewhere else tumor cells rapidly multiply causing jaundice liver failure portal hypertension ascites |
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assessment for tumors |
anorexia and weight loss abnormal bleeding |
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if the tumor is refined to only one lobe you can have a |
hepatic lobectomy |
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medical management of tumor |
may be considered for a liver transplant aggressive chemotherapy |
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gallbladder disorders |
billary system cholelithiasis choledoxhilithiasis cholecysitis |
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billary system |
gallbladder and bile ducts which carry common bile into duodenum |
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cholelithiasis |
formation of stones in the gallbladder |
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choledocholithiasis |
stones present in gallbladder and common bile duct |
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choleytitis |
inflammation or infection of the gallbladder |
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pathophysiology of gallbladder disorders |
linked to high fat, high cholesterol diet multiple pregnancies, diabetes, and obesity most often happens in middle age women |
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when do symptoms develop with gallstones |
when they partial or totally impair passage of bile from the gallbladder to the duodenum |
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a patient is eating fatty foods what hormone stimulates the gabaldder to contract and secrete bile into the duodenum |
CCK |
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this aides in digestion of fats |
bile |
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biliary colic |
pain that accompany with contraction |
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early gallbladder symptoms |
excessive belching RUQ pain may radiate to back and shoulder abd cramp after eating fatty foods |
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acute cholecystitis symptoms |
fever, nausea vomiting RUQ abd pain and back pain |
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diagnosis for gallbladder |
ultrasound ERCP elevated bilirubin levels leukocytosis elevated liver enzymes CCK |
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CCK |
most often ordered for gallbladder |
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CCK |
most often ordered for gallbladder |
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cholecystectomy |
removal of gallbladder |
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a pt just had there gallbladder removed and is still complaining of back, shoulder and abdominal pain. what might be a way to help relieve there pain. |
have the patient ambulate |
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chronic management for gallbladder |
low fat diet |
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acute cholecystitis |
NPO,IV fluids, angesics |
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3 digestive enzymes |
amylase,lipase,tripsin |
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if the digestive enzymes are trapped in the pancreas what begins to happen |
they begin to auto digest the pancreas |
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pancreatitis |
inflammation of the pancreas needs to be treated ASAP |
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causes of pancreatitis |
chronic alcohol use tumors unknown develops spontaneously |
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complication of pancreatitis |
hyperglycemia pain infection,necrosis and hemmorage of the gland |
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assessment of pancreatitis |
mild abdominal pain N,V flatulance steatorrhea jaundice absent or decreased bowel sounds ascites |
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diagnosis of pancreatitis |
election amylase elevated serum bilirubin levels CT MRI hyperglycemia |
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management of pancreatitis |
bed rest encourage pt to sit up or lean forward IV IV ATB analgesics DON NOT GIVE MORPHINE accuchecks |
