NUR 213 Exam 6 - 2. Liver function Answer Metabolism of proteins...

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NUR 213 Exam 6

• Metabolism

Answer Bio chemical reaction necessary to produce energy, repair cells and maintain life

• Liver function

Answer Metabolism of proteins, carbs, fats Stores minerals and fat-soluble vitamins Stores glycogen Metabolism of medication (narcotics/sedatives/Tylenol) Metabolism of steroids Produces albumin and clotting factors - albumin affects oncontic pressure Detoxifies drugs and alcohol

• What is a toxic by product of protein metabolism , converted to urea in the liver for

elimination by the kidneys.

Answer Ammonia

• what does bile do?

Answer Bile- produced in the liver, stored in the gallbladder, absorbs fat, eliminates bilirubin from the body

• Fat soluble vitamins

Answer ADEK iron and copper Vit K is necessary for clotting

• What side is your liver on?

Answer Right side

• Liver blood supply

Answer Sees 75% of venous blood from stomach, intestines, spleen, to the liver Liver detoxify blood 1 / 4

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• Impaired liver function

Answer Low albumin = edema in peripheral tissue and as cities Impaired clotting factors = risk for bleeding Impaired glucose metabolism = alterations in blood glucose levels Impaired bile production= decreased absorption of lipids and fats-soluble vitamins Decreased vit k= increased bleeding Impaired metabolism or steroid hormones= feminization in men and change in menses in women

• Cirrhosis

Answer Caused by necrotic injury or chronic reaction to inflammation over a prolonged period of time.

Develops over years and is irreversible Normal tissue is replaced with non-functioning fibrotic tissue Developers slowly, progressive, irreversible, liver no longer able to regenerate itself Fibrous tissue disrupts bile and blood flow through liver Liver enlarges and becomes hard then shrinks as function is lost

• Cirrhosis types

Answer Alcoholic- chronic ETOH use Hepatitis, medication, or toxins. (Tylenol OD can cause acute cirrhosis) Chorionic biliary obstruction

• Cirrhosis risk factors

Answer Alcohol use Fatty liver Hepatitis Hepatotoxic medications Severe right sided heart failure

• Early Signs and symptoms of cirrhosis

Answer Early-vague 2 / 4

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Dull, achy, pain RUQ Loss of appetite Indigestion N/V Constipation/diarrhea Jaundice (more advanced) Fatigue Weight loss

• Progressive signs and symptoms of cirrhosis

Answer Later signs-loss of cell func- tion Pruitis Altered mental status Personality change Esophageal varicose Splenomegaly Profound weakness Bleeding Ascites

Palmar erythema (red palms) Spider angiomas (spider veins on upper extremities due to increased estrogen) Peripheral edema Asterixis (hand flapping) Gynecomastia Anemia Thrombocytopenia

• Hepatic encephalopathy

Answer Results from cerebral edem and Neurotoxin accu- mulation in the blood (ammonia) -confusion -Asterixix is the early sign *monitor mental status* Risk factors of people who have cirrhosis to get encephalopathy

Answer (think of blood like a protein) GI bleed Blood transfusion Hypoxia High protein diet

• Early signs of hepatic encephalopathy

Answer Agitation Restlessness Impaired judgment Slurred speach

• Progression of hepatic encephalopathy

Answer Confusion Disorientation Incoherence 3 / 4

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*the more sleep they get the worse it is*

• What is the leading cause of death in encephalopathy?

Answer Increased cerebral edema and cerebral hypoxia

• What is the treatment for hepatic encephalopathy?

Answer Lactulose - binds to the ammonia and helps the patient poop it out -monitor for signs and symptoms of dehydration Antibiotic is given (neomycin) to kill the the bacteria in the gut that produces ammonia

• What is portal hypertension

Answer Impaired circulation through the liver Increases hydrostatic pressure (increases pressure in the portal vein) -Shunts it into the lower pressure veins in the esophagus, stomach and rectum

Ascites, peripheral edema- primary cause portal hypertension, plus decreased albumin ( decreased colloidal osmotic pressure) and increased aldosterone(RAAS activation)- Na and water retention Splenomegaly(due to backflow of blood to the spleen) -Anemia-decrease RBC/WBC/PLT *PTs are at a huge risk for bleeding* Hepatorenal syndrome (kidney failure secondary to cirrhosis) Spontaneous bacterial peritonitis

• Esophageal varices

Answer Engorged veins that are super fragile *Medical Emergency if they start to bleed* Vessels are hypertensive Blood in vomit/stool No NG tubes Prevent bleeding

TEACH PATIENTS

-no heavy lifting/straining -no bending at waist -use stool softener -stop drinking -chew food completely

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