Liver Functions and Disorders: Hepatitis & Cirrhosis

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Questions and Answers

Which of the following is NOT a primary function of the liver?

Detoxing ammonia

Synthesizing insulin (correct)

Producing bile

Storing glycogen

What is the primary role of albumin in the blood?

Stores glycogen for energy

Produces clotting factors

Transports drugs and attracts water (correct)

Regulates bilirubin excretion

In hepatitis, which phase is characterized by vague body symptoms resembling flu?

Icteric

Preicteric (correct)

Posticteric

Convalescent

What can severe inflammation in the liver lead to?

Cirrhosis and liver cancer Signup and view all the answers

Which of the following best describes the hepatic portal vein's function?

Pumps nutrient-rich blood from the intestines to the liver Signup and view all the answers

What is the byproduct of protein breakdown that the liver detoxifies?

Ammonia Signup and view all the answers

Which form of hepatitis is NOT typically viral?

Alcohol-induced hepatitis Signup and view all the answers

How does bile function in the body?

Excretes bilirubin and cholesterol Signup and view all the answers

What is the primary mode of transmission for Hepatitis B, C, and D?

Blood and bodily fluids Signup and view all the answers

Which treatment is specifically indicated for Hepatitis C?

Peginterferon alfa 2-a & ribavirin combination therapy Signup and view all the answers

What characteristic describes the carrier state of Hepatitis B and C?

Asymptomatic but infectious Signup and view all the answers

How much more infectious is Hepatitis B compared to Hepatitis C?

10x Signup and view all the answers

Which is true regarding immunoglobulin therapy for new infants born to Hepatitis B positive parents?

Should be administered within 12 hours of birth Signup and view all the answers

What percentage of babies born to a Hepatitis B positive parent are likely to develop chronic Hepatitis B?

90% Signup and view all the answers

What is the significance of universal precautions in healthcare in relation to Hepatitis B and C?

They minimize the risk of exposure due to asymptomatic carriers. Signup and view all the answers

In 2021, how many cases of Hepatitis C were reported in Nova Scotia?

274 cases Signup and view all the answers

Which symptom is associated with liver dysfunction due to cirrhosis?

Left upper quadrant discomfort Signup and view all the answers

What mechanism primarily causes portal hypertension?

Narrowing of the portal vein due to scar tissue Signup and view all the answers

Which of the following methods is NOT a recognized transmission route for hepatitis B?

Eating food prepared by someone with hepatitis B Signup and view all the answers

What condition is characterized by fluid buildup in the peritoneal cavity due to portal hypertension?

Ascites Signup and view all the answers

What risk does an individual with esophageal varices face?

Hemorrhage from ruptured veins Signup and view all the answers

What is the consequence of the liver's inability to detoxify ammonia in hepatic encephalopathy?

Build-up of toxic ammonia levels Signup and view all the answers

Which option describes a distinguishing feature of cirrhosis?

Transition of healthy liver tissue to fibrotic tissue Signup and view all the answers

Which laboratory finding is commonly associated with ascites development due to portal hypertension?

Low albumin levels Signup and view all the answers

What is the primary reason for the difficulty in Hepatitis C treatment awareness among patients?

44% of individuals with Hepatitis C are unaware they have it. Signup and view all the answers

In which case is the Hepatitis D virus able to develop?

Only if Hepatitis B is also present. Signup and view all the answers

What is a significant indicator of acute Hepatitis as opposed to other forms?

Dark urine and clay stools. Signup and view all the answers

Which laboratory tests would most likely be monitored in cases of hepatitis?

Monitoring of AST, ALT, bilirubin, and antibodies. Signup and view all the answers

What dietary recommendations should be made for patients with liver conditions?

Low fat and protein with high calorie and carbohydrate intake. Signup and view all the answers

What is the primary purpose of a liver biopsy in hepatitis diagnosis?

To assess the extent of liver damage. Signup and view all the answers

What is the best prevention measure for Hepatitis B?

Vaccination against Hepatitis B. Signup and view all the answers

What symptom is commonly associated with fulminant hepatitis?

Rapid onset of severe liver failure. Signup and view all the answers

What is a key neurological finding associated with liver dysfunction?

Asterixis Signup and view all the answers

What are potential symptoms of increased estrogen due to liver impairment?

Gynecomastia and spider angiomas Signup and view all the answers

Which laboratory findings would be expected in a patient with late-stage cirrhosis?

High AST and ALT Signup and view all the answers

What is a common complication of hepatic failure affecting the kidneys?

Hepatorenal syndrome Signup and view all the answers

What dietary recommendation is crucial for managing cirrhosis?

Low sodium and low fat Signup and view all the answers

What observation suggests the presence of ascites in a cirrhosis patient?

Increased belly circumference Signup and view all the answers

Which of the following medications would be contraindicated in a patient with liver failure?

Alcohol Signup and view all the answers

What is the indication of elevated BUN and creatinine in a cirrhosis patient?

Acute kidney injury Signup and view all the answers

What is the primary purpose of creating a shunt in patients with varices?

To reduce pressure by allowing blood to bypass the liver Signup and view all the answers

What statement indicates a misunderstanding about home care management for a client with cirrhosis?

I will take ibuprofen for headaches. Signup and view all the answers

In the care plan for a client with cirrhosis and ascites, which nursing action is least appropriate?

Encourage the client to lie supine for comfort Signup and view all the answers

Which medication should be administered to a client with elevated ammonia levels due to liver dysfunction?

Lactulose to decrease ammonia levels Signup and view all the answers

What precaution must be taken prior to performing a paracentesis in a client with ascites?

Ensure the bladder is empty to prevent perforation Signup and view all the answers

What is the primary purpose of lactulose in the management of liver disease?

To decrease ammonia levels through stool Signup and view all the answers

Which nursing action is critical for a client undergoing paracentesis to prevent complications?

Ensure the patient's bladder is empty Signup and view all the answers

What disqualifies a patient from being a candidate for a liver transplant?

Severe respiratory disease Signup and view all the answers

Which of the following accurately describes the purpose of using beta blockers in portal hypertension management?

To decrease portal venous pressure Signup and view all the answers

In the care plan for a client with cirrhosis, which of the following actions should be avoided?

Encouraging high protein intake Signup and view all the answers

Which symptom is expected in a client suffering from hepatitis B infection?

Malaise Signup and view all the answers

How can hepatitis B be transmitted between individuals?

Intravenous drug use Signup and view all the answers

What is a significant consequence of portal hypertension related to liver dysfunction?

Fluid accumulation in the peritoneal cavity Signup and view all the answers

Which condition is characterized by the enlargement of veins in the esophagus due to severe pressure from portal hypertension?

Esophageal varices Signup and view all the answers

What leads to hepatic encephalopathy in a patient with liver dysfunction?

Ammonia build-up in the bloodstream Signup and view all the answers

Which factor contributes to the development of cirrhosis in individuals with chronic hepatitis?

Excessive alcohol consumption Signup and view all the answers

What is the primary risk associated with ruptured esophageal varices?

Shock and airway obstruction Signup and view all the answers

What primarily causes fluid to shift into the peritoneal cavity in ascites?

Venous congestion from portal hypertension Signup and view all the answers

Which function of the liver is mainly responsible for the detoxification of ammonia?

Conversion of ammonia into urea Signup and view all the answers

What is a primary result of moderate inflammation in the liver?

Obstruction of blood and bile flow Signup and view all the answers

Which type of hepatitis is characterized by an autoimmune response?

Hepatitis C Signup and view all the answers

How does the liver primarily handle bilirubin produced from old red blood cells?

Converts it into bile for excretion Signup and view all the answers

What symptom is typically seen in the icteric phase of hepatitis?

Yellowing of the skin and eyes Signup and view all the answers

Which of the following best describes the primary role of albumin in the blood?

Attracting water and transporting drugs Signup and view all the answers

What common misconception might someone have regarding the hepatic portal vein?

It carries oxygenated blood to the liver Signup and view all the answers

Which phase of hepatitis is primarily characterized by the absence of flu-like symptoms?

Posticteric phase Signup and view all the answers

What is the main reason for the high rate of Hepatitis C cases, given that 44% remain unaware of the infection?

Lack of symptoms early on Signup and view all the answers

Which of the following statements accurately describes the relationship between Hepatitis D and Hepatitis B?

Vaccination against Hepatitis B prevents Hepatitis D. Signup and view all the answers

What dietary adjustments are recommended for a patient with acute hepatitis?

High carbohydrate, low protein Signup and view all the answers

What is indicated by a positive HBsAg test result in a patient?

The patient has a chronic or active Hepatitis B infection. Signup and view all the answers

What is the main purpose of performing a liver biopsy in hepatitis cases?

To assess the severity of liver damage Signup and view all the answers

Which of these symptoms is most characteristic of acute hepatitis?

Flu-like symptoms with clay-colored stools Signup and view all the answers

What is a potential complication of fulminant hepatitis?

Acute kidney injury Signup and view all the answers

What is the key clinical finding associated with ammonia accumulation in the blood?

Asterixis Signup and view all the answers

Which laboratory finding is most closely monitored in patients with hepatitis?

Increased ALT and AST levels Signup and view all the answers

Elevated levels of what substance in the blood indicate liver or hepatic dysfunction?

Bilirubin Signup and view all the answers

What condition is associated with a sudden decrease in urine output and elevated blood urea nitrogen (BUN) in patients with liver failure?

Hepatorenal Syndrome Signup and view all the answers

Which symptom is NOT commonly associated with liver impairment secondary to high estrogen levels?

Tremors Signup and view all the answers

Which dietary recommendation is crucial for managing symptoms in patients with cirrhosis?

Low sodium and high carbohydrate intake Signup and view all the answers

What is a common clinical manifestation of late-stage cirrhosis related to liver failure?

Musty breath (Hepatic Foetor) Signup and view all the answers

What surgical procedure is minimally invasive for treating esophageal varices in patients with liver dysfunction?

Endoscopic variceal ligation Signup and view all the answers

Which laboratory findings would likely be present in a patient with late-stage cirrhosis?

Increased PT/PTT/INR and Decreased Platelets Signup and view all the answers

What are the two primary forms of hepatitis based on duration?

Chronic and acute Signup and view all the answers

Which viruses are classified as acute hepatitis infections that do not progress to chronic forms?

Hepatitis A and E Signup and view all the answers

Which of the following is a common risk factor associated with hepatitis A transmission?

Ingestion of contaminated food and water Signup and view all the answers

What is the primary cause of hepatocyte damage in acute hepatitis?

Liver inflammation leading to cell lysis Signup and view all the answers

Which antibiotic is commonly used for pre or post-exposure to Hepatitis A infection?

Immunoglobulin Signup and view all the answers

Study Notes

Infection & Inflammation: Hepatitis & Cirrhosis

Hepatitis is inflammation of the liver.
Cirrhosis is the end-stage of liver fibrosis.
Types of hepatitis include viral (A, B, C, D, E), idiopathic, drug toxicity, autoimmunity, and alcohol-induced.

About the Liver

The liver has four main functions:
- Storing glycogen
- Drug and fat metabolism
- Detoxifying ammonia
- Producing bile, coagulation factors, and albumin

Production (Liver Functions)

Albumin: Transports drugs, attracts water, and binds with Calcium for bone strength.
Bile: Scoops up bilirubin and cholesterol and excretes them through the GI system.
Clotting factors: Regulates PT, PTT, INR.

Ammonia & Bilirubin

Ammonia is a byproduct of protein breakdown.
The liver normally converts ammonia to urea for excretion by the kidneys.
Bilirubin is a byproduct of red blood cell (RBC) breakdown.
The liver normally converts old RBCs to bilirubin and excretes it via stool.

Hepatic Portal Vein & Artery

Hepatic Portal Vein: Pumps blood rich in nutrients from the GI system to the hepatocytes, filtering the blood.
Hepatic Artery: Pumps fresh oxygenated blood to the liver from the aorta.

Hepatitis

Hepatitis is inflammation of the liver.
One type is hepatitis infection.

Forms of Hepatitis

Hepatitis can take many forms, including virus from (A, B, C, D, and E), idiopathic, drug toxicity, autoimmunity, and alcoholism.

Inflammation Stages

Mild: Impairs hepatocyte function.
Moderate: May lead to obstruction of blood and bile, impairing overall liver function.
Severe: Contributes to cirrhosis, hepatocellular cancer, and liver failure.

Phases of Hepatitis

Preicteric (prodromal): Vague flu-like symptoms.
Icteric: Flu-like symptoms decrease, jaundice and dark urine appear from high bilirubin levels, clay stools, hepatomegaly, and pain.
Posticteric (convalescent): Jaundice and dark urine subside, stool normalizes, liver enzymes and bilirubin decrease and eventually normalize.

Acute vs. Chronic Hepatitis

Acute: Lasting less than 6 months, usually self-limiting.
Chronic: Lasting over 6 months, liver deteriorates over time leading to cirrhosis, liver cancer, or liver failure.

Hepatitis - Brief Overview

0 - 1: Hepatitis Infection
1 - 2: Targets the Liver
2 - 3: Hepatocytes become inflamed
3 - 4: Hepatocyte lysis
0 - 5: Contents of hepatocytes released into the blood
5 - 6: Increased ALT & AST

Hepatitis A and E

Acute only, not chronic.
Contracted through oral-fecal route.
Risk factors: Ingesting contaminated food/water (especially shellfish), contact with infected stool (poor hygiene), crowded conditions.
Medications: Hep A vaccine (pre or post-exposure), immunoglobulin within 2 weeks post-exposure.
Pathophysiology (Hep A & E): Ingested, travels through digestive system; absorbed through portal vein; binds to hepatocytes, enters through endocytosis.

Chronic Hepatitis B, C, and D

Hepatitis B, C, and D can become chronic.
Contracted via blood and bodily fluids.
- Risk Factors: unprotected sex, contact with blood, substance use disorder, birth, tattoos, hemodialysis, unscreened blood.
Medications: Interferons (Hep C), Hep B Immunoglobulin (within 24 hours of potential exposure)
Hepatitis D cannot occur without Hepatitis B.

Carrier State

Hepatitis B and C can exist in a carrier state, meaning the infected person is often asymptomatic.

Hep B

10x more infectious than Hep C.
100x more infectious than HIV.
Vaccine available.

Hep B & Birth

High risk of transmission from mother to baby.
Babies have a 90% chance of developing chronic Hep B.
Precaution: If mother is confirmed/suspected of having Hepatitis B, immunoglobulin given to the infant within 12 hours of birth.

Hepatitis C

Growing concern, Nova Scotia reported 274 cases in 2021.
27.6 cases per 100,000 people.
Curable with Direct-Acting Antivirals (DAAs).
44% of people with Hep C unaware they have it.

Fulminant Hepatitis

Rare, life-threatening complication.
Severe liver failure over hours to days.

Acute Hepatitis Symptoms

Malaise (flu-like): Nausea, vomiting, diarrhea, low appetite, low-grade fever.
Clay stools (lack of bilirubin).
Dark urine.
Jaundice.
RUQ tenderness.
Hepatomegaly.

Hepatitis Stages

Incubation (asymptomatic): Aperiodical time.
Acute Infection: 4-12 weeks of infection, malaise, fever, joint pain.
Preicteric/Prodromal: Vague flu-like symptoms.
Icteric: Jaundice, dark urine, clay stools, pain, hepatomegaly.
Posticteric/Convalescent: Jaundice subsides, stool normalizes, liver enzymes decrease, recovery.
Chronic Infection: Long-term infection potentially leading to complications like cirrhosis, liver failure, or hepatic cancer.
Fulminant Infection: Severe, life-threatening complication; liver failure occurs over hours or days.
Carrier State: Asymptomatic chronic infection.

Serology for Viral Hepatitis

Hep A: Anti-HAV IgM (active), Anti-HAV IgG (recovered).
Hep B: HBsAg (surface antigen, infectious), Anti-HBs IgG (recovered/immune).
Hep C: Anti-HCV (antibodies), HCV RNA (in active infection).
Hep D: HDAg (hepatitis D antigen), Anti-HDV.
Hep E: Anti-HEV.

Hep B Serology Table (Results)

Results for HBsAg, Anti-HBs and Anti-HBc.

Labs to Watch in Hepatitis

AST
ALT
Bilirubin
Antibodies

Liver Biopsy

Used to assess extent of liver damage.
A small piece of liver tissue is removed and examined.
Teach right-side lying to prevent post-procedure bleeding.

Diet

High carbohydrates, high calories, low protein, low fat.

Patient Teaching

Handwashing, personal hygiene products, activity restrictions, avoiding toxins, individual bathroom, testing, interferon, small, frequent meals.

Cirrhosis

End-stage liver fibrosis.
Caused by chronic hepatitis (specifically B and C).

Cirrhosis Stages

Healthy liver, fatty liver, liver fibrosis, cirrhosis, and potential complications such as hepatocellular carcinoma.

Portal Hypertension

Portal vein narrows due to scar tissue.
Increased pressure, fluid shifts to peritoneal spaces, splenomegaly, varices.

Esophageal Varices

Enlarged, thinned esophageal veins due to portal hypertension.
Risk of rupture, leading to fatal shock.

Ascites

Fluid buildup in peritoneal cavity caused by portal hypertension and low albumin.

Hepatic Encephalopathy

Liver cannot detoxify.
Ammonia buildup; ammonia crosses blood-brain barrier.
Alerted level of consciousness (LOC), asterixis (involuntary hand-flapping).

Liver and Estrogen

Liver produces small amounts of estrogen; estrogen is fat-soluble.
Impaired liver functions can lead to high estrogen levels.
High estrogen levels can cause gynecomastia, spider angiomas, and palmar erythema.

Hepatorenal Syndrome

Progressive renal failure associated with hepatic failure.
Sudden decrease in urine output, elevated BUN and creatinine (think AKI).

Late Stage Cirrhosis Symptoms

Tremors, musty breath (Foetor), yellowing of eyes and skin, loss of appetite, increased bilirubin, varices, edema, reduced platelets, itchy skin, spider angiomas, splenomegaly, confusion/coma, ascites, palmar erythema, renal failure, and enlarged breasts (in men).

Monitor Diet & Lifestyle (Cirrhosis)

Same as hepatitis diet (low protein, low fat, high carb, high calories).
Vitamin & mineral supplements (multivitamins, folate, thiamine).
Monitor glucose closely to assess for hypo/hyperglycemia
Low sodium (edema).
Avoid alcohol.

Labs to Watch in Cirrhosis

High AST
High ALT
High Bilirubin
Low Albumin & Calcium
Low Platelets (thrombocytopenia).
High PT, PTT, INR

Treatment Options (Cirrhosis)

Shunting Surgery (TIPS): Minimally invasive shunt creates a new channel to bypass the liver and reduce portal pressure.
Endoscopic Variceal Ligation: Varices are sclerosed or banded with small rubber bands to prevent bleeding and shrinkage.

Liver Transplant

Very strict protocols.
Living or deceased donor.
Not a candidate if severe cardiac/resp disease, metastatic cancer, or ETOH/substance abuse.
Acute graft rejection within 4-10 days after surgery.

Paracentesis

Draining fluid from ascites.
Prior to procedure: Ensure bladder is empty.
Take vital signs; monitor blood pressure.
Measure abdominal circumference, daily weight.
Drain according to orders (usually no more than 1L/day).
Maintain high fowlers position to promote fluid drainage and breathing.

Pharmacology (Cirrhosis)

Beta blockers & nitrates: Portal HTN and varices.
Vitamin K: Clotting factors.
Lactulose: Decreases ammonia levels through stool. Monitor for hypokalemia.
Diuretics: Decrease fluid buildup.
Albumin: Helps with ascites and edema.

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Description

This quiz explores essential aspects of liver functions, focusing on conditions like hepatitis and cirrhosis. Delve into the roles of the liver in metabolism, detoxification, and the production of critical substances like albumin and bile.