Hepatic Disorders
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Questions and Answers

What is the primary role of the liver in glucose metabolism?

  • The liver stores glucose only.
  • The liver synthesizes glucose exclusively.
  • The liver breaks down glucose without regulation.
  • The liver regulates glucose metabolism and concentration. (correct)

What is the consequence of increased ammonia levels in the body?

  • Improved cognitive function.
  • Enhanced protein synthesis.
  • Neuro problems leading to coma. (correct)
  • Increased appetite and energy levels.

Which of the following substances is NOT stored in the liver?

  • Copper
  • Calcium (correct)
  • Vitamin D
  • Iron

What main effect does the liver have on medications taken orally?

<p>Metabolizes many medications impacting their bioavailability. (B)</p> Signup and view all the answers

What condition may result from high bilirubin levels in the body?

<p>Jaundice, affecting skin and eyes. (D)</p> Signup and view all the answers

What are common factors to assess when diagnosing hepatic disorders?

<p>Exposure to hepatotoxic substances and lifestyle behaviors. (A)</p> Signup and view all the answers

Which of the following functions is NOT performed by the liver?

<p>Production of red blood cells. (D)</p> Signup and view all the answers

Which statement about liver and protein metabolism is true?

<p>The liver synthesizes albumin and clotting factors essential for blood. (C)</p> Signup and view all the answers

What is considered the first line therapy for managing patients with low sodium levels?

<p>Diuretics (spironolactone) (B)</p> Signup and view all the answers

Which of the following is NOT recommended for a low-sodium diet?

<p>Fresh fruits (C)</p> Signup and view all the answers

What is the primary concern when a patient undergoes a large volume paracentesis?

<p>Fluid shift resulting in shock (D)</p> Signup and view all the answers

Which symptoms are indicative of shock in a patient with esophageal varices?

<p>Cool clammy skin and tachycardia (A)</p> Signup and view all the answers

During nursing management, which laboratory values should be monitored to assess electrolyte balance?

<p>Serum ammonia and creatinine levels (B)</p> Signup and view all the answers

What is a key component of the home care checklist for patients with hepatic issues?

<p>Educate on dietary restrictions and medications (D)</p> Signup and view all the answers

Which diagnostic tool is primarily used to identify the bleeding site in esophageal varices?

<p>Endoscopy (A)</p> Signup and view all the answers

What is the recommended positioning for a patient during a paracentesis procedure?

<p>Sitting in a high fowlers position (C)</p> Signup and view all the answers

What is the normal range for ammonia levels in mcg/dL?

<p>15-45 mcg/dL (A)</p> Signup and view all the answers

Which liver function test is primarily indicative of liver damage?

<p>ALT (B)</p> Signup and view all the answers

What indicates an increased risk factor for cirrhosis in women?

<p>ETOH intake of 40-60 g/day (A)</p> Signup and view all the answers

In hepatic dysfunction, what would a bilirubin level greater than 2.5 mg/dL indicate?

<p>Clinically evident jaundice (B)</p> Signup and view all the answers

In portal hypertension, what is a major complication associated with increased pressure in the portal venous system?

<p>Ascites (B)</p> Signup and view all the answers

Which symptom is commonly associated with ascites?

<p>Increased abdominal girth (C)</p> Signup and view all the answers

What is indicated by an AST/ALT ratio greater than 2:1?

<p>Alcoholic liver disease (B)</p> Signup and view all the answers

What condition can cause clay-colored stools?

<p>Obstructive jaundice (C)</p> Signup and view all the answers

What effect does liver dysfunction have on aldosterone metabolism?

<p>Increased Na and water retention (A)</p> Signup and view all the answers

What physical sign is associated with liver failure and can be assessed for abnormalities in recall and memory?

<p>Neuro changes (C)</p> Signup and view all the answers

What is a critical diagnostic test to perform for a patient suspected of hepatic encephalopathy?

<p>Serum ammonia levels (C)</p> Signup and view all the answers

What is the purpose of administering lactulose to a patient with hepatic encephalopathy?

<p>To trap ammonia in the stool (C)</p> Signup and view all the answers

Which of the following treatments should be avoided in a patient with hepatic encephalopathy?

<p>Sedatives and tranquilizers (D)</p> Signup and view all the answers

What dietary recommendation is appropriate for a patient with hepatic encephalopathy?

<p>Keep daily protein intake between 1.2 - 1.5 g/kg body weight (C)</p> Signup and view all the answers

What should be monitored closely in patients receiving lactulose to avoid overdose?

<p>Stool frequency (C)</p> Signup and view all the answers

What is the primary purpose of Octreotide in the management of esophageal varices?

<p>To decrease bleeding from esophageal varices (A)</p> Signup and view all the answers

Which preventative medication is commonly used alongside beta-blockers for the management of esophageal varices?

<p>Nitrates (C)</p> Signup and view all the answers

Which of the following is NOT a recommended nursing management practice for patients with esophageal varices?

<p>Encourage smoking to help with appetite (B)</p> Signup and view all the answers

What neurological condition is primarily related to the buildup of ammonia due to liver failure?

<p>Hepatic encephalopathy (A)</p> Signup and view all the answers

What is one of the initial symptoms of hepatic encephalopathy?

<p>Altered mental status (B)</p> Signup and view all the answers

What management strategy is utilized to control variceal bleeding immediately?

<p>Endoscopic sclerotherapy (C)</p> Signup and view all the answers

Which of the following symptoms is associated with hepatic encephalopathy?

<p>Chronic bad breath (B)</p> Signup and view all the answers

Why is abdominal cramping a significant concern for patients receiving Octreotide?

<p>It can lead to hypoglycemia (A)</p> Signup and view all the answers

Flashcards

Liver's glucose metabolism

The liver is crucial for maintaining blood glucose levels by storing and releasing glucose as needed.

Ammonia conversion

The liver converts ammonia into urea, which is then excreted by the kidneys to prevent dangerous buildup and neuro issues.

Liver's role in protein metabolism

The liver produces crucial proteins like albumin and clotting factors, essential for blood function.

Liver and fat metabolism

The liver is involved in breaking down fatty acids for energy and ketone body creation.

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Liver and vitamin storage

The liver stores large amounts of vitamins like A, B, and D, as well as iron and copper.

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Bilirubin excretion

The liver breaks down red blood cells, and the resulting bilirubin is processed and removed from the blood.

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Bioavailability (medication)

Bioavailability is the percentage of a medication reaching the bloodstream.

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Hepatotoxic substances

Substances that can damage the liver.

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Cirrhosis Risk Factors (Men)

Men with cirrhosis typically have an ethanol intake of 60-80 g/day.

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Cirrhosis Risk Factors (Women)

Women with cirrhosis typically have an alcohol intake of 40-60 g/day.

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High Ammonia Levels (Treatment)

If ammonia levels are high, lactulose is given to help excrete the excess ammonia.

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Normal Ammonia Level

Normal ammonia levels are between 15-45 mcg/dL.

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Liver Function Tests (LFTs)

LFTs assess the liver's ability to function by measuring various substances in the blood.

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Increased PT/INR in Liver Disease

Prolonged PT (Prothrombin Time) and INR (International Normalized Ratio) indicate the blood's thinning in liver conditions.

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AST/ALT Ratio in Liver Damage

A 2:1 ratio of AST to ALT suggests tissue damage when high. High levels of AST and ATL generally indicate liver disease.

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Ascites Symptoms

Ascites presents as abdominal swelling, rapid weight gain, shortness of breath, and fluid/electrolyte imbalance, sometimes with distended neck veins and umbilical hernia.

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Portal Hypertension Cause

Portal hypertension is increased pressure in the portal venous system due to liver damage obstructing blood flow.

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Jaundice Cause (Obstructive)

Obstructive jaundice is from extrahepatic or intrahepatic blockages of the bile duct. It prevents bile from flowing into the intestines.

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Low-Sodium Diet (2-g Na)

A diet restricting sodium intake to 2 grams per day, used to manage fluid retention and related issues.

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Paracentesis

Surgical procedure to remove fluid from the abdominal cavity.

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Post-Paracentesis Albumin

Administering albumin after a large paracentesis to prevent fluid shifts and circulatory/renal dysfunction.

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Hepatic Encephalopathy

A neurological complication of liver disease, characterized by changes in mental status.

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Esophageal Varices

Enlarged veins in the esophagus due to blocked blood flow to the liver.

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Hematemesis

Vomiting of blood.

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IV Volume Expanders

Fluids given intravenously to increase blood volume, often used to treat shock.

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Portal Hypertension

High blood pressure in the portal vein, often linked to liver disease and varices.

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Lactulose's Function

Lactulose is a medication used in hepatic encephalopathy. It traps ammonia in the stool, preventing its absorption into the bloodstream and reducing the risk of encephalopathy.

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Hepatic Encephalopathy Diet

While protein is essential for the body, patients with hepatic encephalopathy generally need a controlled protein diet. Aim for 1.2-1.5g protein per kg of body weight daily.

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Why Avoid Sedatives?

Sedatives, tranquilizers, and analgesics are metabolized by the liver. In hepatic encephalopathy, the liver is impaired, leading to accumulation of these drugs and worsening sedation.

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Monitoring for Complications

Closely monitor for neuro changes as constipation can worsen hepatic encephalopathy.

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Deep Breathing and Coughing

Encourage deep breathing and coughing exercises to improve lung function and prevent pneumonia in patients with hepatic encephalopathy.

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Octreotide's role in esophageal varices

Octreotide (Sandostatin) is a vasoactive drug that reduces bleeding from esophageal varices, unlike vasopressin, which is vasoconstrictive.

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Preferred treatment for variceal bleeds

Octreotide (Sandostatin) is the preferred initial treatment for controlling bleeding from esophageal varices.

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Hepatic encephalopathy cause

Hepatic encephalopathy results from ammonia buildup due to profound liver failure or damage.

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Ammonia & CNS Depression

Ammonia buildup in the brain excites astrocytes, which stimulate GABA, leading to central nervous system depression and hepatic encephalopathy symptoms.

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Hepatic encephalopathy S/sx

Symptoms of hepatic encephalopathy include altered mental status, motor disturbances, mood changes, asterixis, constructional apraxia, fector hepaticus (bad breath).

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Early signs of hepatic encephalopathy

Early signs of hepatic encephalopathy involve changes in mental status and motor function.

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Octreotide side effects

Monitor for mild hypoglycemia and abdominal cramping when using Octreotide.

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Esophageal varices care

Avoid activities that could irritate the esophagus (e.g., coughing, straws, smoking, alcohol); assess nutritional and neurological status; provide mouth care; and manage alcohol withdrawal.

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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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Hepatic Disorders PDF

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.

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