Chapter 31: Disorders of the Liver

The registered nurse is teaching a group of nursing students about hyperbilirubinemia. Which statements made by a student nurse indicates effective learning? Select all that apply.

"Bile duct obstruction can cause hyperbilirubinemia." "Hepatocellular injury can cause hyperbilirubinemia." "Excessive RBC hemolysis can cause hyperbilirubinemia."

After explaining about viral hepatitis to a group of nursing students, the registered nurse asks, "What are the common changes observed in this condition?" Which responses made by the student nurse indicates effective learning? Select all that apply. "There will be an infiltration of white blood cells." "The liver becomes infiltrated with fibrotic tissue." "Acetaminophen use can cause viral hepatitis." "Activation of stellate cells takes place in viral hepatitis." "Serological tests are used to diagnose hepatitis."

"There will be an infiltration of white blood cells." "Serological tests are used to diagnose hepatitis."

A nurse is caring for a patient diagnosed with portal hypertension. What development should the nurse be concerned about?

Increased risk for esophageal varices

Which of the following are liver enzymes? Select all that apply.

AST ALT

Hepatitis A

Anti-HAV antibodies Hepatomegaly RUQ tenderness Fecal-oral transmission

Which of the following may cause hyperbilirubinemia? Select all that apply.

Bile duct obstruction Increased red blood cell breakdown Injury to hepatocytes

The physical examination findings of a patient who has liver disease show dilated veins over the umbilical area of the abdomen. What is this finding called?

Caput medusa

Hepatitis B

Does not directly destroy hepatocytes Positive HBc Ig Range of symptoms Vaccine available Positive HBsAg, HBcAg

Hemochromatosis

Elevated serum iron Elevated serum ferritin High serum transferrin Hereditary forms

Crigler-Najjar Syndrome

Elevated unconjugated bilirubin Elevated total bilirubin Genetic defect affecting bilirubin processing

Which form of hepatitis is primarily transmitted through the blood, often through IV drug use?

Hepatitis C

Biliary Cirrhosis

Increased IgM Increased ESR Xanthelasma Antimicrobial antibodies (AMAs)

Cirrhosis and Liver Failure

Liver scarring Silent, gradual disease Portal hypertension Widespread decrease in liver function parameters

Wilson's disease

Low ceruloplasmin levels Kayser-Fleisher rings of the cornea High urinary copper Copper accumulation Masklike facies

Which of the following statements are true? Select all that apply -Portal hypertension may lead to esophageal varices. -If the liver is unable to detoxify the blood, ammonia levels may increase. -Decreased bile production by the liver may lead to reduce absorption of water-soluble vitamins. -Decreased albumin synthesis by the liver may lead to jaundice. -Hepatitis may be transmitted by fecal-oral route..

Portal hypertension may lead to esophageal varices. If the liver is unable to detoxify the blood, ammonia levels may increase. Hepatitis may be transmitted by fecal-oral route.

Hepatitis C

Positive HCV RNA assay anti-HCV antibody Six different genotypes Dormant infection; asymptomatic initially

Alcoholic Liver Disease

Steatosis AST and ALT 2-7 times higher than normal Elevated triglycerides and cholesterol Hepatic encephalopathy

Which substance is responsible for the yellow color of urine?

Urobilinogen

Which of the following are common signs of liver disorders? Select all that apply.

increased liver enzyme in the blood Jaundice hepatomegaly