Hepatic disorders (Jaundice/Hepatitis)
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How is the liver's blood supply unique?
- Blood suppy
- – Hepatic artery
- – Portal vein
- – Portal circulation
- – Cardiac output (receives entire volume of cardiac output.)
What is the functional cell of the liver?
- cuffer's cells
- --last two create the blood filtration system
funcitons of liver?
- fat metabolism
- glycogen-->glucose (gluconeogenesis)
- glucose-->glycogen (glycogenolysis)
Hepatic A & P review for liver function
- Folks with hepatic encephalopathy will not respond to narcan.
- Urea cannot be broken down--> ^ in ammonia levels-->v loc. Use laculose instead to absorb ammonia.
How does liver change with age?
- Decreased liver weight and size
- Decreased ability to detoxify drugs
- Increased risk of toxic levels in elderly
Tylenol: very toxic to liver. Max dose =4000mg/day.
What are some liver fxn tests?
- • LiverEnzymes
- • Bilirubin (conjugated and unconjugated: makes stuff yellow (urine, skin, poo, bruises). RBCs get broken down and recycled. Hemogobin is recycled, unconjugated Bilirub (not water soluable) is a byproduct which will bind to albumin. Anything watersoluable can be broken down by bacteria. High levels of unconjugated will result in jaundice. Bilirubin is a problem because it will hemolocize healthy RBCs (rabdoanemia)-->poor filtration in kidneys-->renal damage.
- • Ammonia
- • PT/INR
- • Liver Biopsy: bleeding is a problem. Positioning can help. Look it up in book.
- • Ultrasound
- • CT
- • MRI: if fluid pouching.
What are some etiologies of jaundice?
What are some nursing interventions for jaundice?
- – Determine cause
- – Pruritis early sign
- – Check sclerae, skin
- Impaired skin integrity
- – Control itching (benadryl, but only low doses if liver failure)
- Body image disturbance
- – Reassure temporary
- – Express feelings
- • Altered health maintenance
- – Educate
- • Evaluation
- – Resolves 4-6wks with tx
Make a chart to compare/contrast hep types.
general pathophys about hep viral types.
- Similar changes for all causes of viral hepatitis
- Hepatocytes affected by immune response
- Specific antigen-antibody responses to different types of viral hepatitis
- Liver inflammation and necrosis lead to altered function
- Healing occurs in 3 to 4 months
What are the preicteric SnSs of viral hep
- Precedes jaundice
- Lasts 1-21 days
- GI symptoms: Anorexia, nausea, abd pain, vomiting, diarrhea
- Other symptoms: Malaise, HA, fever, arthralgias
- PE: hepatomegaly
What are snss of icteric phase of viral hep?
- Jaundice: Lasts 2-4 weeks
- – Urine dark
- – Light or clay colored stools
- – Pruritus: caused by secreting toxins through skin.
- – GI symptoms, fever
- – Liver enlarged and tender
What can you expect during posticteric phase?
- Begins as jaundice subsides
- – Average 2-4 months
- – Malaise and tires easily
- – Hepatomegaly
- – Relapses may occur
what are some complications of viral hep?
- Fulminant hepatitis: Ful=most/worst
- • Chronic hepatitis
- • Cirrhosis: hardening/scarring of liver.
- • Hepatocellular carcinoma
What are some diagnostic studies for viral hep?
- Blood tests for specific types of viral hepatitis
- • Liver function tests
- • Prothrombin time
- • Serum proteins
- • Liver biopsy for chronic hepatitis
Collaborative care for viral hep?
- Reduce fatigue
- • Maintain nutritional and fluid balance
- • Avoid alcohol
- • Avoid drugs detoxified by liver
- • Drug therapy for chronic B & C
What kidney responses can occur after nfxn
Pyleonephritis and glomerionephritis
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