1750: Hepatic disorders

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1750: Hepatic disorders
2015-05-18 21:14:09

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  1. The Liver:

    Where does 80% of the circulation come from?

    Where does 20% of the circulation come from?
    š80% of circulation comes from portal vein (brings in nutrients)

    š20% of circulation comes from hepatic artery

    šCapable of regeneration
  2. The Liver functions:

    What does it metabolize?

    What does it produce & excrete, and store?

    *What does it convert?
    šSteroid, CHO, protein & fat metabolism.


    šBile production and excretion


    šPhagocyte system

    šConverts ammonia to urea 

    šMetabolize & eliminate bilirubin
  3. What are some Dx studies for the liver?
    šSerum protein studies -albumin

    šDirect & indirect serum bilirubin, urine bilirubin & urobilinogen

    šCBC with platelets

    šCoagulation studies

  4. Hepatic Dysfunction

    What is the most common cause?

    What else may be the cause of dysfunction (disorders/deficiencies)?
    malnutrition RT alcoholism

    šAcute or chronic cirrhosis of liver




    šMetabolic disorders

    šNutritional deficiencies
  5. What are some "manifestations"? (PCs)
    šJaundice (yellow discoloration of the skin d/t build up of bilirubin)

    šPortal HTN (increased pressure in the capillaries) results in ascites, and varices

    šHepatic encephalopathy (build up of toxins in the brain d/t dysfunction of the liver to clear toxins leading to toxic circulation) or coma

    šNutritional deficiencies (malnourished d/t liver's impairment of processing nutrients)
  6. What is "jaundice"?

    Which are associated w/ liver disease?
    šYellow- or green-tinged sclera and skin caused by increased serum bilirubin levels

    šHemolytic, *hepatocellular, *obstructive

    šHereditary hyperbilirubinemia

    Hepatocellular and obstructive jaundice are most associated with liver d
  7. What are some s/sx associated w/ "hepatocellular"?
    šMild or severely ill

    šLack of appetite, N/V, weight loss

    šMalaise, fatigue, weakness

    šHeadache, chills, fever, infection
  8. What are some s/sx associated w/ "obstructive"?

    stool color?
    šDark, orange-brown urine, clay-colored stools

    šDyspepsia and intolerance of fats, impaired digestion

  9. What is "portal HTN"?

    What does it cause and what may it lead to?
    šObstructed blood flow through the liver results in increased pressure throughout the portal venous system

    Cirrhosis slows the normal blood flow through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.

    šAffects veins in esophagus causing esophageal varices (enlarged veins), rectum and abdomen

    šCauses fluids to be pushed out of capillaries leading to third spacing (ascites)
  10. Ascites: Fluid in Peritoneal Cavity

    What are some causes?
    šPortal HTN resulting in increased capillary pressure and obstruction of venous blood flow

    šVasodilatation of the major abdominal organs

    šChanges in the ability to metabolize aldosterone, increasing fluid retention

    šDecreased synthesis of albumin, decreasing serum osmotic pressure

    šMovement of albumin into the peritoneal cavity
  11. What are the Tx for Ascites?
    šLow-sodium diet


    šBed rest


    šAdministration of salt-poor albumin

    • šTransjugular intrahepatic portosystemic
    • shunt (TIPS)
  12. Which is the drug of choice for Ascites?
    Spironolatone (Aldactone)
  13. Bleeding of Esophageal Varices (enlarged veins)

    When does this usually occur?
    šOccurs in about 1/3 of patients with cirrhosis and varices

    šFirst bleeding episode has a mortality rate of 30% - 50%

    šManifestations: hematemesis, melena, general deterioration, and shock

    šPts w/ cirrhosis should undergo screening endoscopy q2 years
  14. Tx of bleeding varices.

    How should you treat a Pt w/ bleeding varices (similar as you would treat someone w/...)?
    šTreat for shock; administer oxygen

    šIV fluids, electrolytes, volume expanders, blood and blood products

    • šVasopressin, somatostatin, octreotide to
    • decease bleeding

    šNitroglycerin in combination with vasopressin to reduce coronary vasoconstriction

    šPropranolol and nadolol to decrease portal pressure; used in combination with other treatment
  15. What is Hepatitis?

    How are they transmitted?
    • šViral hepatitis: a systemic viral infection that causes necrosis and inflammation of
    • liver cells with characteristic sx and cellular and biochemical changes.

    šA and E: fecal–oral route; contaminated food (E is not chronic)

    šB and C: bloodborne

    šD: only people with hepatitis B are at risk

    šHepatitis G and GB virus-C
  16. Hep A.

    How's it spread?

    What is the incubation period?

    Mortality rate & Manifestations?
    šSpread by poor hand hygiene; fecal–oral

    šIncubation: 15 to 50 days

    šIllness may last 4 to 8 weeks

    šMortality rate is 0.5% for those younger than age 40 years and 1% to 2% for those >40 yo

    • šManifestations: mild flu-like sx, low-grade fever, anorexia, later jaundice and dark
    • urine, indigestion and epigastric distress, enlargement of liver and spleen
  17. How can you prevent/manage Hep A?

    Is there a vaccine?
    šGood handwashing, clean water, & proper sewage disposal

    šVaccine available.

    šImmunoglobulinn for contacts to provide passive immunity

    šBed rest during acute stage

    šNutritional support
  18. Hep B.

    How is Hep B transmitted?

    What are the tx for Hep B (pharm)?

    Is there a vaccine?

    What type of precautions?
    Bloodborne (like Hep C)

    šinterferon & antiviral agents: lamivudine (Epivir), adefovir (Hepsera)

    Vaccine available

    Precautions: standard & infection control measures
  19. Hep C.

    How is it transmitted?

    *Most common bloodborne infection; šcauses 1/3 of cases of liver cancer and the most common reason for
    liver transplant

    How do you manage Hep C (pharm tx)?

    šAntiviral medications: interferon, ribavirin (Rebetol)
  20. Splenomegaly.

    What is the cause?

    What happens to RBCs & WBCs as a result?

    What might this lead to?
    Caused by Portal HTN.

    Blood is shunted into splenic vein.

    Increased removal & destruction of RBCs & WBCs, & platelets.

    • šMay lead to anemia, leukopenia, &
    • thrombocytopenia