- liver enzymes: ALT, AST, GGT, ALP

- cholesterol (made in liver, often low with liver disease)

- serum proteins: total, albumin, globulin, A/G ratio

- serum ammonia

- PT/PTT (often prolonged in liver disease)

- position pt

- have patient exhale and hold breath while biopsy is taken

- offte psychological support

- position on R side

- VS q 15 minutes x 1 hour, q 30 minutes until stable

- assess for complications

- RBCs are composed of globin and heme

- glob in re-used

- heme becomes biliverdin

- biliverdin becomes bilirubin, which is unconjuguated, indirect, not water-soluble, and bound to albumin)

- in liver, joined with glucuronic acid, becomes conjugated, direct, and water soluble

- conjugated bilirubin excreted in bile via bile ducts

- bile empties into small intestine

- bacteria in gut convert bilirubin to urobilinogen

- most urobilinogen excreted in feces

- some excreted in urine

- bilirubin: serum direct, serum indirect, serum total

- urine bilirubin

- fecal urobilinogen

- a condition in which the bilirubin concentration in the blood increases (3x normal levels)

- icterus

- all body tissues become yellow tinged: skin, sclera, mucous membranes

- a symptom, not a disease

- hemolytic: increased destruction of RBCs, increased unconjugated bilirubin, liver cannot handle all of it

- examples: hemolytic anemia, blood toxicity reaction, Rh incompatiblity, physiologic jaundice of newborn

- hepatocellular: inability of diseased liver to clear normal amounts of bilirubin

causes: cirrhosis, hepatitis, cancer, chemical toxicity, trauma

- obstructive: obstruciton of bile flow, bile dammed in liver

- causes: liver tumors, hepatitis, cirrhosis, bile duct stones, cancer head of pancreas

- viral: A, B, C, D, E, G

- drugs

- chemicals

- viral invasion

- inflammation and destruction

- enzymes released

- decreased liver function

- liver may regenerate

- starts with infection

- last 1-3 weeks

- flu- like symptoms: a/n/v, fatigue, malaise, fever, h/a, arthralgias

- dull pain RUQ

- increased liver size

- lymphadenopathy

- starts with onset of jaundice

- lasts 2-6 weeks

- GI symptoms remain

- juandice

- liver increased in size, tender

- dark urine, clay stool with biliary obstruction

- pruritis

- convalescence

- lasts 2-4 months

- jaundice disappears

- fatigue remains

- liver size decreases

- appetite returns

- may have relapse

- complete recovery by 6 months

- fecal-oral transmission

- crowded conditions, poor sanitation

- contaminated food or water

- 37% of hepatitis cases in USA

- is an acute disease

- fecal-oral transmission

- seen in Asia, Africa, and Mexico

- pareneteral transmission: contaminated needles

- sexual transmission: sex with infected partners

- perinatal transmission

- 6 % become chronic

- parenteral and sexual transmission

- co-infection with HIV is increasing

- 75% of patients develop chronic form

- transmitted same as HBV

- can only infect in presence of HBV

- collateral veins that form to try and decrease portal hypertension

- occur in: distal espohagus, upper stomach, peri-umbilical, rectum

- occur in 2/3 pts with cirrhosis

- bleeding varices are most life threatening complicatino of cirrhosis

- bleeding r/t irritatino, ulceration

- 30-50% mortality with first bleed

- melena

- hematemesis

- oozing vs. hemorrhage

- increased encephalopathy

- barium swallow

- EGD

- ligation/banding of varices

-sclerotherapy

-shunt therapy: Tips/Surgical shunting

- maintain airway; deflate esophageal balloon

- stabilize pt

- fluid resuscitation

- balloon tamponade

- edema: excess fluid in interstitial spaces, in peritoneal space

- not a disease

- increased capillary hydrostatic pressure

- increased capillary permeability

- decreased colloid osmotic pressure

- increased ADH and increased aldosterone r/t circulating volume

- abdominal distention

- everted umbilicus

- abdominal striae

- + fluid wave

- looks dehydrated

- decreased urine output

- abdominal pain

- dyspnea

- empty of ascites

- have pt empty bladder

- possibly 7-8 L of fluid

- bedrest

- sodium restricted diet

- possible fluid restriction

- diuretics: aldactone

- salt poor albumin

- neuropsychiatrtic manifestation of liver failure

- protein digestion produces ammonia, liver converts ammonia to urea

- diseased liver cannot convert, ammonia builds up

- promdromal: personality changes, blank stares

- impending: lethargic, flapping tremors, muscle twitching, electrolyte imbalance

- stupourous: verbally abuse, may try to get out of bed

- comatose: coma

- goal: decrease ammonia formation

- treat causes

- restrict dietary protein

- administer neomycin PO

- administer lactulose

- assess: neurologic status, vital signs

- monitor ammonia levels

- monitor fluid/electrolyte status

- keep pt safe

- avoid sedatives, narcotics

acute: normal as tolerated

maintenance: increased if malnourished

- acute: none to low with encephalopathy

- maintenace: normal to increased

acute: restricted with steatorrhea

maintenance: normal as tolerated

acute: not restricted

maintenace: increased

acute: limit if ascites, FVE

maintenance: limit if ascites, FVE

- chronic viral hepatitis

- congenital biliary atresia

- cancer confined to liver

- fulminant liver failure

- chronic end-stage liver disease

- severe pulmonary hypertension

- morbin obesity

- gallstones

- long term alcohol use

- other: trauma, infection, drugs, post-op GI surgery

- pain

- n/v

- change in VS

- respiratory distress

- Grey-Turner's sign

- Cullen's sign

- fever

- jaundice

- serum amylase

- serum lipase

- urine amylase

- CBC: WBC, H&H

- Chest x-ray

- CT, Ultrasound of abdomen

- MRCP

- pain control

- fluid resuscitation

- decrease pancreatic secretions

- prevent/treat infection

- bedrest

- inflammatory disease characterized by progressive destruction of pancrease

- cells replaced by fibrous tissue

- increased pressure in pancreas leads obstruction

- organ is digested by own enzymes

- long term ETOH consumption

- biliary disease

- cancer

- pain

- n/v, weight loss

- jaundice, dark urine, steatorrhea

- diabetes

- psudeocyst formation

- as acute pancreatitis

- ERCP

- as for acute pancreatitis

- prevention

- medications

- surgery

- analgesics: morphine, Dilaudid

- pancreatic enzymes: Viokase

- insulin/oral hypoglycemics

- GI prophylaxis: H2 block, PPI

- hormone: Sandostatin