Patho 3 2

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Author:
jld15
ID:
305744
Filename:
Patho 3 2
Updated:
2015-07-26 21:17:19
Tags:
Patho
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Description:
Patho 3 2
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  1. Hepatic Encephalopathy
    • Build up of NH4 to the brain
    • Hepatic coma
    • Diagnosis
    • ----Ammonia levels in blood: <75 Is normal
    • Treatment
    • ----Underlying cause
    • ----Lactulose (Promote diarrhea getting rid of bacteria that produces NH4)
    • Prognosis
    • ----Depends on cause
    • Therapist Considerations
    • ----Gait abnormalities (tremors)
    • Mental status changes
    • Electrolyte imbalances (Due to diarrhea)
    • Fatigue
  2. Ascites cause mechanism s/s
    • Abnormal accumulation of serous fluid
    • Causes
    • ----Cirrhosis 85%
    • Mechanism
    • ----Portal hypertension (Cause back up fluid)
    • ----Hypoalbuminemia (Fluid shift info tissues instead of bv)
    • Hyperaldosteronism (Cause Na and fluid retention)
    • S/S
    • ----Weight gain
    • ----Abdominal distension
    • ----Dyspnea
    • ----Too much fluid
    • ----Peritonitis
  3. Ascites dx, tx, prognosis, therapist consideration
    • Dx
    • ----Lab values
    • ----paracentesis
    • Treatment
    • ----Paracentesis
    • ----Watch Na/ fluid intake
    • Prognosis
    • ----Severity of underlying cause
    • ----Worst prognosis if caused by cancer
    • Therapist Considerations
    • ----Positioning (Cant lay flat- Positioned in high fallers: head of bed up)
    • ----Breathing techniques (Rely on accessory muscles bc diaphragm cant come down bc fluid)
    • ----Edema/ skin tears
  4. Hepatorenal syndrome
    • Renal dysfunction due to portal HTN in advanced liver disease
    • Associated with poor prognosis (Seen at end stage liver disease)
    • Treatment
    • ----Liver transplant (But may not be able to tolerate it)
  5. Hepatitis
    • Inflammation caused by virus, chemical, drug reaction, or alcohol abuse
    • Viral
    • Chronic: Usually follows hep b/c
    • Fulminant: Very severe
    • Toxic
  6. HAV
    • Contaminated water or food
    • Acute illness
    • Vaccine avail
    • Incubation days is 15-45 days
  7. HBV
    • Percutaneous transmission- needles
    • Bloodborne
    • Common cause of chronic hepatitis
    • Vaccine avail
    • Common cause but only 6-10% become chronic cause
    • Incubation day: 45-160 days
  8. HCV
    • IV drug use
    • Bloodborne
    • Causes chronic hepatitis in 50-70% of time
    • No vaccine avail
    • Incubation day: 2 w- 6 mo
  9. HDV
    • Same transmission form as hep B
    • Only occur if have hep B
  10. HEV
    • Similar to hep A
    • Seen mostly in Asia
    • Contaminated water/food sources
  11. HGV
    • Most recently discovered
    • Similar to Hep C
  12. Hepatitis 2
    • Classic symptoms
    • ----Many acute cases asymptomatic
    • ----Malaise, fatigue, mild fever, nausea, vomiting, anorexia, RUQ discomfort
    • Prevention
    • ----Primary immunization/Passive immunization (if exposed but didn’t get immunization, get immunization before end of incubation day)
    • ----Education
    • Diagnosis
    • ---Serology (Look for elevated enzymes)
    • Treatment
    • ---Anti-viral agents for symptomatic cases
  13. Hepatitis Prognosis
    • HAV- self limiting
    • ---Supportive measures
    • ---Runs course and never turns into chronic
    • HBV- good with normal immune system
    • ---Cirrhosis if not healthy
    • HCV- 20-30% lead to cirrhosis
    • ---Most likely to turn into chronic
  14. Chronic Hepatitis
    • >6 months
    • Causes
    • ----Hep B/C
    • Medication
    • ----Metabolic abnormality
    • ----Autoimmune
    • Symptoms
    • ---Asymptomatic
    • ---Vague
    • Diagnosis
    • ---Liver biopsy
    • Prognosis
    • ---Depends on cause and stage

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