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Questions and Answers
What is the primary role of the liver in glucose metabolism?
What is the primary role of the liver in glucose metabolism?
What is the consequence of increased ammonia levels in the body?
What is the consequence of increased ammonia levels in the body?
Which of the following substances is NOT stored in the liver?
Which of the following substances is NOT stored in the liver?
What main effect does the liver have on medications taken orally?
What main effect does the liver have on medications taken orally?
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What condition may result from high bilirubin levels in the body?
What condition may result from high bilirubin levels in the body?
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What are common factors to assess when diagnosing hepatic disorders?
What are common factors to assess when diagnosing hepatic disorders?
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Which of the following functions is NOT performed by the liver?
Which of the following functions is NOT performed by the liver?
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Which statement about liver and protein metabolism is true?
Which statement about liver and protein metabolism is true?
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What is considered the first line therapy for managing patients with low sodium levels?
What is considered the first line therapy for managing patients with low sodium levels?
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Which of the following is NOT recommended for a low-sodium diet?
Which of the following is NOT recommended for a low-sodium diet?
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What is the primary concern when a patient undergoes a large volume paracentesis?
What is the primary concern when a patient undergoes a large volume paracentesis?
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Which symptoms are indicative of shock in a patient with esophageal varices?
Which symptoms are indicative of shock in a patient with esophageal varices?
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During nursing management, which laboratory values should be monitored to assess electrolyte balance?
During nursing management, which laboratory values should be monitored to assess electrolyte balance?
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What is a key component of the home care checklist for patients with hepatic issues?
What is a key component of the home care checklist for patients with hepatic issues?
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Which diagnostic tool is primarily used to identify the bleeding site in esophageal varices?
Which diagnostic tool is primarily used to identify the bleeding site in esophageal varices?
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What is the recommended positioning for a patient during a paracentesis procedure?
What is the recommended positioning for a patient during a paracentesis procedure?
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What is the normal range for ammonia levels in mcg/dL?
What is the normal range for ammonia levels in mcg/dL?
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Which liver function test is primarily indicative of liver damage?
Which liver function test is primarily indicative of liver damage?
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What indicates an increased risk factor for cirrhosis in women?
What indicates an increased risk factor for cirrhosis in women?
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In hepatic dysfunction, what would a bilirubin level greater than 2.5 mg/dL indicate?
In hepatic dysfunction, what would a bilirubin level greater than 2.5 mg/dL indicate?
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In portal hypertension, what is a major complication associated with increased pressure in the portal venous system?
In portal hypertension, what is a major complication associated with increased pressure in the portal venous system?
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Which symptom is commonly associated with ascites?
Which symptom is commonly associated with ascites?
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What is indicated by an AST/ALT ratio greater than 2:1?
What is indicated by an AST/ALT ratio greater than 2:1?
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What condition can cause clay-colored stools?
What condition can cause clay-colored stools?
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What effect does liver dysfunction have on aldosterone metabolism?
What effect does liver dysfunction have on aldosterone metabolism?
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What physical sign is associated with liver failure and can be assessed for abnormalities in recall and memory?
What physical sign is associated with liver failure and can be assessed for abnormalities in recall and memory?
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What is a critical diagnostic test to perform for a patient suspected of hepatic encephalopathy?
What is a critical diagnostic test to perform for a patient suspected of hepatic encephalopathy?
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What is the purpose of administering lactulose to a patient with hepatic encephalopathy?
What is the purpose of administering lactulose to a patient with hepatic encephalopathy?
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Which of the following treatments should be avoided in a patient with hepatic encephalopathy?
Which of the following treatments should be avoided in a patient with hepatic encephalopathy?
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What dietary recommendation is appropriate for a patient with hepatic encephalopathy?
What dietary recommendation is appropriate for a patient with hepatic encephalopathy?
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What should be monitored closely in patients receiving lactulose to avoid overdose?
What should be monitored closely in patients receiving lactulose to avoid overdose?
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What is the primary purpose of Octreotide in the management of esophageal varices?
What is the primary purpose of Octreotide in the management of esophageal varices?
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Which preventative medication is commonly used alongside beta-blockers for the management of esophageal varices?
Which preventative medication is commonly used alongside beta-blockers for the management of esophageal varices?
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Which of the following is NOT a recommended nursing management practice for patients with esophageal varices?
Which of the following is NOT a recommended nursing management practice for patients with esophageal varices?
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What neurological condition is primarily related to the buildup of ammonia due to liver failure?
What neurological condition is primarily related to the buildup of ammonia due to liver failure?
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What is one of the initial symptoms of hepatic encephalopathy?
What is one of the initial symptoms of hepatic encephalopathy?
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What management strategy is utilized to control variceal bleeding immediately?
What management strategy is utilized to control variceal bleeding immediately?
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Which of the following symptoms is associated with hepatic encephalopathy?
Which of the following symptoms is associated with hepatic encephalopathy?
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Why is abdominal cramping a significant concern for patients receiving Octreotide?
Why is abdominal cramping a significant concern for patients receiving Octreotide?
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Study Notes
Hepatic Disorders
- Anatomy and physiology of the liver is not on the exam
- Liver role in glucose metabolism: regulates blood glucose, converts glycogen and glycogenolysis (breakdown of glucose)
- Liver converts ammonia to urea, excreted by kidneys
- Elevated ammonia levels cause neurological problems and coma
- Protein metabolism: produces albumin and clotting factors
- Fat metabolism: breaks down fatty acids for energy
- Vitamins and iron storage: stores significant amounts of vitamins A, D, B vitamins, and iron
- Bile formation and enterohepatic circulation
- Bilirubin excretion: breakdown of red blood cells (RBCs)
- Jaundice indicators: yellowing of skin and eyes, and urine/feces color changes
- Drug metabolism: bioavailablity & first-pass effect (PO meds)
Assessment
- Medical history: Exposure to hepatotoxic substances, infectious agents, lifestyle behaviors (occupational factors, sexual practices, alcohol use, medications, IV drug use)
- Questions: ETOH intake (men: 60-80 g/day, women: 40-60 g/day), history of IV drug use
- Liver function tests: ammonia levels (normal: 15-45 mcg/dL), direct/total bilirubin, total serum protein, serum albumin, LDH, PT/INR, AST/ALT (ratio 2:1 for possible damage), GGT, GGTP (elevated in ETOH abuse, biliary cholestasis)
Manifestations of hepatic dysfunction
- Jaundice (bilirubin > 2.5 mg/dL)
- Hemolytic (increased RBC destruction, low H/H)
- Hepatocellular (damaged liver cells, bilirubin not cleared from blood)
- Obstructive (extrahepatic or intrahepatic bile duct blockage)
Complications
- Ascites: increased abdominal girth, rapid weight gain, SOB, distended neck veins, fluid and electrolyte imbalances, and umbilical hernia
- Portal hypertension: increased pressure in portal venous system due to liver obstruction
- Esophageal varices: enlarged veins in the lower esophagus (or stomach) from blocked blood flow
- Hematemesis and melena result from esophageal varices
Hepatic Encephalopathy
- Ammonia buildup from profound liver failure
- Symptoms: altered mental status, motor disturbances, mood swings, asterxis, constructional apraxia, fector hepaticus
- Assessment/Diagnostic: labs, psychometric tests, EEG (brainwave slowing)
- Medical Management: Lactulose (stimulates stools), antibiotics
- Diet: maintain protein intake between 1.2-1.5 g/kg daily, small-frequent meals, no protein restriction (avoiding this can be helpful), snacks before bed
Hepatitis A
- Transmission: fecal-oral contamination, contaminated water or shellfish
- Manifestations: mild flu-like symptoms/fatigue, jaundice, dark urine, anorexia, nausea, and vomiting
Hepatitis B
- Risk Factors: close contact with carrier; frequent exposure to blood, personal at high risk for needlestick(e.g., health care workers, operating room staff, dentists), IV drug use, homosexual activity, recent history of STDs, mothers to children
- Manifestations: anorexia, dyspepsia, abdominal pain, aching, malaise, and weakness
- Prevention: screening of blood donors, no smoking or eating in areas exposed to blood, needleless devices
- Medical Management: alpha-interferon injections, lamivudine, adefovir
Hepatitis C
- Chronic is most common
- Risk factors: previous blood transfusions (before 1992), IV drug use
- Prevention: precautions to avoid exposure to blood
- Medical Management: (Treatment depends on case by case basis) IV treatments (protease inhibitors, peginterferon, ribavirin)
Hepatitis D
- Risk Factors: individuals with HBV
- Risk factors, similar to HBV; develops faster liver failure/carcirhoma
- Medical Management: alpha-interferon, (determine on case by case)
Hepatitis E
- Transmission: fecal-oral
- Jaundice frequently present
- Prevention/Management: Hand hygiene is important
Liver Cancer
- Primary Tumors: Benign or malignant (malignant most common)
- Metastases: spreads quickly due to vascularity from colon
- Manifestations: pain, weight loss, loss of strength/appetite, anemia, liver enlargement, jaundice, ascites
- Medical Management: radiation therapy, chemotherapy, percutaneous biliary drainage, lobectomy
- Liver transplant: most beneficial if able (success depends on immunosuppressive therapy to prevent rejection)
Liver Transplant
- Indications include chronic liver disease or without use of alcohol, fulminant hepatic failure, metabolic liver diseases, andsome malignancies.
- Higher the MELD score, the higher the need for liver donation
- Complications: bleeding, infection
Liver Abscesses
- Could happen after car accidents or IV drug use
- Types: pyogenic or amoebic
- Nursing Management: monitor vital signs, physical status, drain abscess, administer IV antibiotics
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Description
Test your knowledge on hepatic disorders, including the liver's role in glucose and protein metabolism, bile formation, and the impact of elevated ammonia levels. This quiz will also cover assessment strategies and potential risk factors associated with liver disease.
