Term
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Definition
Lipoprotein formation
Synthesis of cholesterol
Formation or urea (ammonia)
Formation of plasma proteins (albumin)
Biotransformation of hormones, drugs, etc.
Conjugation of substances (more water soluble)
Formation of clotting factors |
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Term
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Definition
Gives bile its color
RBC role
Free bilirubin
Attaches to albumin and then released in liver
Conjugated & secreted into bile
Intestinal conversion to urobilinogen
Absorbed or excreted
Bilirubin = 0.1 to1.2 mg/dL |
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Term
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Definition
Accum of bilirubin in blood
Serum bile > 2-2.5 mg/dL
Dark skinned individuals hard to see
sclera
4 major causes
Excessive destruction of RBC: hemolysis
Impaired uptake of bilirubin: neonatal, drugs
Decr. Conjugation of bilirubin: neonatal jaundice, hepatocellular disease, drug inhibition
Obstruction of bile : gallstones, tumors that block flow or strictures of biliary circulation
Categories
Prehepatic
Intrahepatic
Posthepatic |
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Term
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Definition
Causative agent initiates:
Inflammation
Infiltration
Obstruction of hepatocytes
Fibrous tissue deposits
Necrosis of hepatocytes |
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Term
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Definition
End stage chronic liver disease
Functional tissue replaced with fibers
Vascular flow and duct system disrupted
Predisposition to portal hypertension |
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Term
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Definition
Laennecs/alcoholic—liver enlarged and hard early, small and nodular late
Postnecrotic—hepatitis or toxins cause massive hepatocyte necrosis
Biliary—chronic biliary obstruction causes inflammation, fibrosis, and destruction
Cardiac—CHF causes enlargement, congestion, anoxia, and necrosis |
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Term
| Complications of Hepatic failure/inflammation |
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Definition
Portal hypertension and esophageal varices
Portal-systemic encephalopathy (PSE), aka hepatic encephalopathy and hepatic coma
Hepatorenal syndrome |
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Term
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Definition
Blood backs up in spleen
Spleenomegaly
Incr. breakdown of WBC, RBC, platelets
Development of collateral circulation
Stomach, rectum & esophagus
varices
Varices irritated/aggravated and rupture
Bleeding, melana, hematemises |
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Term
| Liver Failure Diagnositics |
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Definition
History and physical for clues
Hepatic enzymes AST, ALT, LDH (damage)
↑ direct (conjugated) and indirect (unconjugated) bilirubin, urine bilirubin (function)
↓ total serum protein and albumin (function)
↑ PT (function)
↑ ammonia (function)
↓ Na+, K+, Ca++
↓ CBC
↓ WBC
X-ray, CT, MRI, EGD, nuclear med scans, biopsy |
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Term
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Definition
Liver enzymes
Assess
injury to cells
Ability to synthesize proteins
Excretory functions
Elevated enzymes = liver injury
Key enzymes
AST
ALT |
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Term
| Liver Failure Medical Treatments |
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Definition
Manage complications
Ascites, bleeding, infection
Surgery—liver transplant, peritoneovenous (LaVeen) shunt, or Denver shunt
OP procedures—paracentesis
Pre girth assessment, empty bladder, allergies, VS
Position upright
Apply dressing, VS q 15”, record amount and type of drainage, send to lab, monitor site/shock
Drug therapy
Diuretics
Lactulose (Cephulac), Neomycin sulfate (Mycifradin)
Vitamin K
Liver dialysis
Esophageal varices
Gastric intubation with norepinephrine
Balloon tamponade (Sengstaken-Blakemore)
Stop hemorrhage
Secretions
24 hours
Blood products
Propranolol (Inderal), Vasopressin (Pitressin)
Decr. HR = Decr BP
Decr portal Htn.
Petression direct infusion
NTG
Injection sclerotherapy with EGD
Endoscopic ligation
Transjugular intrahepatic portal-systemic shunt (TIPS) |
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Term
| Liver Failure Nursing Diagnoses |
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Definition
Fluid Volume overload due to protein/albumin disturbances and pleural effusion
Risk for decreased CO
Impaired gas exchange r/t pleural effusions and ascites
Altered tissue perfusion/activity r/t low RBC
Risk for injury r/t confusion for uremia
Altered nutrition
Discomfort/Risk for Altered skin integrity--itching r/t jaundice and bile salt accumulation |
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Term
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Definition
Viral infection
Types A through G have been identified
Not typically fatal, but have long lasting effects |
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Term
| Hepatitis Pathophysiology |
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Definition
Infection causes inflammation
Inflammation causes hepatocyte congestion, and necrosis
Further necrosis stimulates hepatocellular regeneration causing increase portal pressure and edema
Edema creates intrahepatic obstructive jaundice
Can result in liver failure
Phases—preicteric, icteric, posticteric |
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Term
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Definition
Preicteric
Malaise, GI, enlarged liver, lyte imbal., pain
Icteric
Preicteric plus
Jaundice, puritis, pale stools, brown urine
Posticteric
Decr. Fatigue, appetite returns, labs improve |
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Term
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Definition
HAV—fecal/oral (water, shellfish, food, oral/anal sexual activity)
HBV—skin/mucous membrane, blood
HCV—skin/mucous membrane, blood
HDV—co-infects with HBV, percutaneous
HEV—fecal/oral (water) |
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Term
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Definition
Phase dependent
Abdominal pain—over liver
Joint/muscle pain
Diarrhea/constipation
Fever
Lethargy
Malaise
Jaundice
Dark urine, clay-colored stools
Rashes |
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Term
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Definition
↑ liver enzymes
Presences of antibodies/serologic markers
Liver biopsy |
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Term
| Hepatitis Medical interventions |
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Definition
Diet therapy
High CHO
Small, frequent meals
Drugs
Antiemetics
Ribvirin (Virazole), Lamivudine (Ipivir)
Liver transplant |
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Term
| Hepatitis Nursing Diagnoses |
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Definition
Activity Intolerance
Altered Nutrition
Risk for Impaired Skin Integrity
Knowledge Deficit
Behavioral modification with personal items, hygiene, sexual practices
Drug rehab
Do not donate blood
Avoid acetaminophen (Tylenol) |
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Term
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Definition
Liver cancer
Symptomology consistent with cirrhosis
Treatments include surgery, radiation and chemotherapy
Low survival rate |
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