NUR 425 - Week 2 Digestive System Review

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Questions and Answers

What is the most common manifestation of chronic hepatitis?

Pruritis

RUQ tenderness

Weight loss

Palmar erythema (correct)

What is the primary process that converts unconjugated bilirubin to conjugated bilirubin?

Liver processing (correct)

Gallbladder synthesis

Kidney filtration

Spleen metabolism

Which condition results from a buildup of bilirubin in the liver?

Cholecystitis

Jaundice (correct)

Hepatitis A

Anemia

What is the main reason for the development of clay-colored stools?

Lack of bilirubin in stool Signup and view all the answers

What role do bile salts play in the skin when bilirubin levels are elevated?

They lead to pruritis Signup and view all the answers

If the liver fails to synthesize enough albumin, what can occur?

Buildup of bilirubin Signup and view all the answers

Where does bilirubin metabolism primarily occur?

Liver Signup and view all the answers

What effect does elevated bilirubin have on urine appearance?

Dark amber urine Signup and view all the answers

What condition can lead to splenomegaly due to blood backup in the spleen?

Cirrhosis Signup and view all the answers

Which of the following is a common complication of advanced cirrhosis affecting blood clotting?

Thrombocytopenia Signup and view all the answers

What is the primary purpose of performing paracentesis in patients with ascites?

To relieve symptoms temporarily Signup and view all the answers

Which clinical sign is associated with hepatic encephalopathy and involves irregular muscle jerking?

Asterixis Signup and view all the answers

In the management of hepatic encephalopathy, which medication is primarily used to decrease ammonia absorption?

Lactulose Signup and view all the answers

What is the most likely cause of renal failure in patients with cirrhosis?

Decreased blood volume to kidneys Signup and view all the answers

What is the primary mode of transmission for Hepatitis B?

Exposure to blood or blood products Signup and view all the answers

Which diagnostic test is considered the gold standard for identifying liver cell changes in cirrhosis?

Liver biopsy Signup and view all the answers

What is the significance of HBsAg in Hepatitis B diagnosis?

Confirms chronic infection if present after 6 months Signup and view all the answers

Which of the following symptoms can indicate increased bleeding due to liver dysfunction?

Gingival bleeding Signup and view all the answers

Which of the following antiviral agents is contraindicated in pregnancy for Hepatitis B treatment?

Entecavir Signup and view all the answers

What type of breath odor is associated with hepatic encephalopathy?

Fetor hepaticus Signup and view all the answers

Elevated levels of which laboratory test indicate liver dysfunction in cirrhosis?

Bilirubin Signup and view all the answers

What is the major distinguishing feature of Hepatitis D virus infection?

It requires Hepatitis B to be present for infection Signup and view all the answers

What characterizes the treatment for Hepatitis C using DAAs?

They directly target RNA replication in HCV Signup and view all the answers

What is the common side effect of ribavirin when used in treatment?

Hemolytic anemia Signup and view all the answers

What is the primary goal when treating patients with chronic Hepatitis C?

Cure the infection Signup and view all the answers

In which condition is the presence of Anti-HCV antibodies significant?

It indicates previous exposure or current infection with Hepatitis C Signup and view all the answers

Which Hepatitis virus is primarily associated with oral-fecal transmission?

Hepatitis A Signup and view all the answers

Which laboratory test is crucial for monitoring the effectiveness of Hepatitis C treatment?

HCV RNA at 12 weeks after therapy Signup and view all the answers

What is a characteristic symptom of cirrhosis?

Development of scar tissue in the liver Signup and view all the answers

What is the recommended vaccination schedule for Hepatitis B?

3 doses at 0, 1, and 6 months Signup and view all the answers

Which type of hepatitis typically leads to chronic disease in immunocompromised individuals?

Hepatitis E Signup and view all the answers

Which protein is primarily synthesized by the liver?

Albumin Signup and view all the answers

What provides the majority of the liver’s blood supply?

The hepatic portal vein provides most of the blood supply Signup and view all the answers

Which substance is primarily detoxified by the liver?

Ammonia Signup and view all the answers

What clinical manifestation is most characteristic of chronic hepatitis?

Palmar erythema Signup and view all the answers

Which class of medications is commonly used in the treatment of chronic hepatitis B?

Nucleoside analogs Signup and view all the answers

Which hepatitis viruses are preventable through vaccination in Canada?

Hep A, B and D Signup and view all the answers

Hepatic fat accumulation is most commonly seen in which form of cirrhosis?

Alcoholic cirrhosis Signup and view all the answers

The most common clinical manifestation of portal hypertension is ________ bleeding.

Esophageal Signup and view all the answers

What condition can arise from the accumulation of estrogen due to impaired liver function?

Gynecomastia Signup and view all the answers

Which clinical manifestation is a common result of portal hypertension?

Ascites Signup and view all the answers

What is the primary factor that leads to the development of ascites?

Hypoalbuminemia Signup and view all the answers

Which hormone accumulates due to the damaged hepatocytes in cirrhosis that can lead to fluid retention?

Aldosterone Signup and view all the answers

What treatment is commonly used to reduce bleeding from esophageal varices?

Beta-blockers Signup and view all the answers

What is hepatic encephalopathy characterized by?

Neuropsychiatric abnormalities Signup and view all the answers

Which complication is NOT associated with portal hypertension?

Gynecomastia Signup and view all the answers

How can sodium restriction help manage ascites?

It prevents fluid retention Signup and view all the answers

What is the goal of using sclerotherapy in the management of varices?

To induce clotting Signup and view all the answers

Which sign may indicate the presence of ascites?

Everted umbilicus Signup and view all the answers

What assessment is crucial in monitoring a patient with ascites?

Daily abdominal girth measurement Signup and view all the answers

What condition may occur as a late-stage complication involving acute kidney injury in liver patients?

Hepatorenal syndrome Signup and view all the answers

What is the primary cause of abdominal distension in patients with ascites?

Fluid accumulation Signup and view all the answers

What is a key function of the liver that, when impaired, can affect estrogen levels?

Metabolizing hormones Signup and view all the answers

Study Notes

Hepatitis B

Caused by the Hepatitis B Virus (HBV), transmitted through blood, sexual contact, and perinatal exposure.
Infectious before symptoms, may be asymptomatic.
Infants born to HBV-infected individuals should receive vaccination and immunoglobulins within 12 hours to prevent acute and chronic infection.
Management includes symptom relief and education; antiviral therapy may be necessary.
Key serologic tests include HBsAg (indicates infection), Anti-HBs (immunity), and HBV DNA (viral load).
Pharmacotherapy aims to reduce viral load and prevent complications like cirrhosis.
Two main classes of antiviral agents: nucleoside analogues (entecavir, tenofovir) and pegylated-interferon alfa.

Hepatitis C

Caused by the Hepatitis C Virus (HCV), with similar transmission routes as Hepatitis B.
Infectious 1-2 weeks before symptoms appear; most infections are asymptomatic initially.
Anti-HCV test indicates past or present infection; HCV RNA confirms active disease.
There are six genotypes, significant for treatment planning.
Direct-acting antivirals (DAAs) target steps in HCV replication and have a typical 12-week treatment course.
DAAs can cause fatigue and headaches; non-recommended in pregnancy.

Hepatitis D and E

Hepatitis D requires co-infection with Hepatitis B.
Treatment for Hepatitis D is primarily supportive; chronic cases may use pegylated interferon alfa.
Hepatitis E, transmitted via the oral-fecal route, is generally mild and self-limiting, with chronic cases primarily in immunocompromised individuals.

Cirrhosis

Chronic progressive disease resulting in fibrosis, impacting liver structure and function.
Diagnosis often involves biopsy, but can also be assessed through ultrasound.
Symptoms include fatigue, weight loss, pruritis, splenomegaly, and various endocrine disturbances.
Portal hypertension leads to complications such as esophageal varices, ascites, and hepatic encephalopathy.

Bilirubin Metabolism

Bilirubin results from the breakdown of old RBCs and is processed in the liver, converted from unconjugated to conjugated form for excretion.
Increased bilirubin levels can cause jaundice, pruritus, dark urine, and clay-colored stools.

Portal Hypertension

Caused by fibrosis and changes in liver blood vessels, leading to increased pressure in the portal venous system.
Complications include varices, ascites, and hepatic encephalopathy.
Management strategies focus on relieving pressure and managing symptoms.

Varices

Enlarged veins that may rupture and cause hematemesis or melena; require careful management to prevent bleeding.
Treatment options include beta-blockers, sclerotherapy, band ligation, and in severe cases, shunting procedures.

Ascites

Accumulation of fluid in the peritoneal cavity caused primarily by portal hypertension and hypoalbuminemia.
Symptoms include abdominal distension and discomfort; management involves sodium restriction and diuretics.
Paracentesis may be performed for symptomatic relief.

Hepatic Encephalopathy

Results from the accumulation of ammonia due to impaired liver function.
Early signs include mood changes, memory loss, and drowsiness; late signs can involve confusion, tremors, and distinct breath odor.
Lactulose and rifaximin are key treatments to reduce ammonia levels.

Hepatorenal Syndrome

Characterized by renal failure related to portal hypertension and fluid shifts.
Often seen after diuretic therapy or gastrointestinal bleeding; difficult to treat effectively.
Liver transplantation may reverse kidney failure.

Diagnostic Tests for Cirrhosis

Liver function tests reveal increased AST, ALT, and bilirubin levels.
Prolonged PT and INR indicate impaired liver function.
A CBC may show thrombocytopenia and anemia.### Cirrhosis: Management Overview
No specific medication for cirrhosis; treatment targets underlying causes (e.g., antivirals for hepatitis).
Manage symptoms with medications such as antacids for gastric discomfort and diuretics for ascites.
Lifestyle changes: avoid alcohol, adopt a healthy diet, and engage in regular exercise.
Vitamins and nutritional supplements may be necessary for nutritional support.
Recommended diet: high in calories and carbohydrates, moderate to low fat content.
Sodium restriction is advised in cases of ascites and peripheral edema.
Procedures such as paracentesis and Transjugular Intrahepatic Portosystemic Shunt (TIPS) may be performed.
Regular monitoring through blood tests, imaging studies, and endoscopies is crucial.
Liver transplantation may be necessary for advanced cirrhosis.

Key Review Questions

The liver primarily synthesizes Albumin.
Most of the liver's blood supply is provided by the hepatic portal vein.
The liver detoxifies Ammonia, converting it to urea.
The most characteristic clinical manifestation of chronic hepatitis is Jaundice.
Common medications for chronic hepatitis B include Nucleoside analogs and Nucleotide analogs.
Hepatitis A and B viruses are preventable through vaccination in Canada.
Hepatic fat accumulation is associated with Alcoholic cirrhosis.
The most common clinical manifestation of portal hypertension is Esophageal bleeding.
A key strategy in managing cirrhosis involves implementing lifestyle modifications and monitoring health conditions.

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Hepatitis Cirrhosis Ascites