liver functions

congestion of bile ducts in liver (increase bile in intestine, increase bilirubin in blood, increase bile salts in blood)

what happens when the liver doesn’t form and excrete bile properly?

fat intolerance: nausea and bloating, clay colored stool, jaundice, dark urine, pruritus

signs and symptoms when liver doesn’t form and excrete bile?

decreased absorption of vitamin K leads to decreased prothrombin, decreased clotting factors

what happens when liver doesn’t make clotting factors and prothrombin?

bleeding, bruising

signs and symptoms when liver doesn’t make clotting factors and prothrombin

decreased serum albumin with decreased colloidal osmotic pressure and increased fluid tends to leave vascular space

what happens when the liver doesn’t make plasma proteins (albumin)

edema, ascites, hypotension

signs and symptoms when liver doesn’t make plasma proteins (albumin)

increase serum ammonia (doesn’t turn into urea)

what happens when the liver doesn’t deaminate proteins (remove ammonia and converts it to urea)?

hepatic encephalopathy, mental status changes, asterixis

signs and symptoms of when the liver doesn’t deaminate proteins (removes ammonia and converts it to urea)

decreased effectiveness of kupffer cells (macrophages in liver)

what happens when the liver doesn’t have effective kupffer cells (macrophages in liver) removes bacteria and toxins

increased risk of infection, increased drug toxicities

signs and symptoms when the liver doesn’t have effective kupffer cells (macrophages in liver) remove bacteria and toxins

effects of the hormones stay in the system longer (increased ADH = water retention, increased aldosterone = retention of Na and H20 and excretion of K+)

what happens when the liver doesn’t metabolize and excrete hormones (ADH, aldosterone, estrogen)

edema, ascites, hypotension, decreased serum potassium, gyecomastia

signs and symptoms of when liver doesn’t metabolize and excrete hormones?

decreased conversion of glycogen to glucose, decreased gluconeogensis

what happens to glucose metabolism during liver failure?

decreased serum glucose

signs and symptoms of liver failure glucose metabolsim

liver functions

• produces bile

• eliminates bilirubin

• makes albumin (plasma protein)

• makes clotting factors including prothrombin (proteins)

• deaminates proteins (removes ammonia)

• metabolizes and excretes: ADH, aldosterone and other hormones and drugs

• glucose metabolism

• kupffer cells help filter blood and remove bacteria and toxins

• stores vitamins and minerals

synthesizes

to make something (chemicals)

hepatocytes

functioning cell of the liver

kupffer cells

macrophages in the liver, remove bacteria, toxins

deamination of protein

process of removing ammonia from amino acids

hepatic encephalopathy

change in mental status due to increased ammonia

asterixis

“liver flap” a tremor caused by accumulation of ammonia

ascites

collection of fluid in peritoneal space

esophageal varices

abnormal and enlarged veins in esophagus

hepatomegaly and splenomegaly

enlarged liver and spleen

fector hepaticus

ammonia odor to breath

jaundice

yellow of sclera and skin due to increased bilirubin in the blood

intraheptic jaundice

which type of jaundice is associated with cirrhosis?

increased destruction of RBC

what causes prehepatic jaundice?

obstruction of the CBD due to gallstones or cancer in the head of the pancreas

what causes post hepatic jaundice?

ascites is the collection of fluid in the peritoneal space

what is ascites?

is not making clotting factors such as prothrombin

patients with liver disease are at risk for bleeding because the liver:

• is not making plasma proteins such as albumin

• is unable to convert glycogen to glucose

• is not converting ammonia to urea

• is not synthesizing clotting factors

it can be reversible if treated properly

all of the following are true about cirrhosis except:

• it is the end stage of chronic liver disease

• functional liver tissue is replaced by fibrous tissue

• it is accompanied by portal hypertension

• it can be reversible if treated properly

esophageal varices (veins are thin and can easily bleed)

a person with portal hypertension is most at risk for:

• gastric ulcers

• esophageal varices

• bleeding in the large intestine

• general hypertension

edema (decreased synthesis of plasma proteins, especially albumin leads to edema and hypotension)

which of the following problems occur in liver failure because of a deceased synthesis of plasma proteins?

• bleeding

• edema

• thrombocytopenia

• leukopenia

the patient is likely to be hypotensive

what effect might a decreased serum albumin have on blood pressure?

congestion of bile ducts within the liver preventing excretion of bile and reabsorption of bilirubin into the blood stream

in liver disease, jaundice develops because

increased bile salts in tissue

pruritus is caused by:

pruritus

itching of the skin

reduced bile in the intestine decreases the body’s ability to breakdown fat

why do people with liver disease develop intolerance to fat in the diet?

manifestations of portal hypertension

ascites, hemorrhoids, esophageal varices, hepatic encephalopathy, anemia, leukopenia, thrombocytopenia, bleeding

hypokalemia

patients with liver failure have decreased metabolism of ADH and aldosterone. what electrolyte abnormality is likely?

• hypernatremia

• iron deficiency

• hypocalcemia

• hypokalemia

confusion

which of the following is an indication of hepatic encephalopathy?

• confusion

• grey turner sign

• jaundice

• trousseau’s sign

vague symptoms such as myalgia and anorexia

what happens during prodromal phase of acute hepatitis?

prodromal, icterus, covalescent

what are the 3 phases of acute hepatitis?

prodromal

period between initial symptoms and full blown disease (malaise, myalgia, anorexia)

icterus

occurs 5 - 10 days after prodromal, marked by appearance of jaundice

covalescent

long period of recovery

hepatitis A

• DOES NOT cause chronic hepatitis

• transmission: fecal-oral, sexual

• incubation: 14-28 days

• symptoms:

  • fever

  • nausea

  • malaise

  • ABD

  • discomfort

  • dark urine jaundice

• treatment:

  • hepatitis A vaccine post exposure

fecal-oral, sexual

how is hepatitis A transmitted?

14 - 28 days

what is the incubation period of hepatitis A?

fever, nausea, malaise, discomfort, ABD, discomfort, dark urine, jaundice

what are the symptoms of hepatitis A?

hepatitis B

• CAUSES chronic hepatitis

• transmission: blood - sex

• incubation: 6- 8 weeks

• symptoms:

  • ½ asymptomatic

  • fever

  • nausea

  • malaise

  • ABD

  • discomfort

  • dark urine

  • jaundice

• treatment: hepatitis B vaccine

blood-sex

what is the transmission for hepatitis B?

6 - 8 weeks

what is the incubation period for hepatitis B?

hepatitis b vaccine

what is the treatment for hepatitis B?

hepatitis C

• CAUSES chronic hepatitis

• treatment: blood - sex

• incubation: 2- 26 weeks

• symptoms: usually asymptomatic

• treatment: no vaccine

blood - sex

transmission of hepatitis c?

2 - 26 weeks

what is the incubation period for hepatitis c?

usually asymptomatic

what are the symptoms of hepatitis c?

no treatment

what is the treatment for hepatitis c?

hepatitis a

what does not cause chronic hepatitis?