Liver chapter 49

slowly

ALT levels are normal or slightly elevated in myocardial necrosis. ALT levels return more_______ to normal range than AST levels in liver conditions.

radioisotope liver scan

A__________ assesses liver size and hepatic blood flow and obstruction.

decreased

Age-related changes of the hepatobiliary system include_______ blood flow,_______ drug clearance capability, increased presence of gallstones, and a steady_______ in size and weight of the liver

EEG

An______ is used to detect abnormalities that occur with hepatic coma.

MRI

An______ is used to identify normal structures and abnormalities of the liver and biliary tree.

Esophagus, lower rectum and stomach

Cirrhosis results in shunting of portal system blood into collateral blood vessels in the gastrointestinal tract. What are the most com- mon sites of engorged collateral blood vessels?

Decompensated cirrhosis

Clubbing of fingers, Hypotension, Sparse body hair

Thiamine

Beriberi and polyneuritis

Compensated cirrhosis

Flatulent, dyspepsia, Abdominal pain, Firm enlarged liver

Hepatic encephalopothy

The patient appears confused and unkempt and has alterations in mood and sleep patterns. The patient tends to sleep during the day and has restlessness and insomnia at night.

cirrhosis, hepatic failure

The patient should identify foods high in carbohydrates and within protein requirements (moderate to high protein in______ hepatitis, low protein in_________).

Alcoholic cirrhosis

There are three main types of cirrhosis: alcoholic postnecrotic, and biliary.________ is the most common type most frequently caused by chronic alcoholism and leads to malnutrition.

Rejection

________is a primary concern. A transplanted liver is perceived by the immune system as a foreign antigen. This triggers an immune response, leading to the activation of T lymphocytes that attack and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver. These agents inhibit the activation of immunocompetent T lymphocytes to prevent the production of effector T cells. Although the 1- and 5-year survival rates have increased dramatically with the use of new immunosuppressive therapies, these advances are not without major side effects.

Asterixis

________is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

Colchicine

________is primarily used prophylactically for gout and to treat acute attacks. It has an unlabeled use for hepatic cirrhosis. Preliminary studies show increased survival rates for cirrhosis clients.

Angiography

________is used to visualize hepatic circulation and detect the presence and nature of hepatic masses.

Hepatocellular

________jaundice is the result of liver disease.

Obstructive

________jaundice is the result of liver disease.

Hemolytic

________jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in patients with hemolytic transfusion reactions and other hemolytic disorders.

Silymarin

_______from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notif)y your primary care provider of any herbal remedies being used so drug interactions can be evaluated.

Nitroglycerin

_______has been used to prevent the side effects of vasopressin.

Hepatic cirrhosis

_______is a chronic liver disease characterized by widespread destruction of hepatic cells which are replaced by fibrous cells, chronic injury to the liver, and nodular tissue growth.

Prothrombin

______is synthesized by the liver and is an inactive precursor in the clotting process._________ is converted to thrombin, which is needed to form a blood clot. Prothrombin time measures clotting ability.

advanced

Three signs of________ liver disease is ascites jaundice and portal hypertension.

Hepatic encephalopothy

To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns. For:

Alcoholic

________cirrhosis, in which the scar tissue characteristically surrounds the portal areas, is most frequently caused by chronic alcoholism and is the most common type of cirrhosis.

Cirrhosis

________is a chronic liver disorder characterized by fibrotic changes, the formation of dense connective tissue within the liver, subsequent degenerative changes, and loss of functional liver tissue.

low-sodium

ascites indicates that a_______ diet is needed

Decompensated cirrhosis

results from failure of the liver to synthesize proteins, and clotting factors.

Decompensated cirrhosis

results from failure of the liver to synthesize proteins, and clotting factors. Other symptoms of cirrhosis that may be seen in both compensated and decompensated cirrhosis is mild fever and easy bruising.

Biliary cirrhosis

results from prolonged bile duct obstruction, inflammation, and infection. Twice as many men as women are affected by cirrhosis of the liver.

lver biopsy, ultrasonography, CT scans, MRI.

underwent a physical with routine blood work due to his complaint of fatigue and occasional right upper quadrant abdominal discomfort His lver transaminases are found to be elevated. Identify what further diagnostic studies the urse should canticipate

Compensated cirrhosis

which presents often times with vague symptoms, may be discovered secondary to a routine physical examination.

carbohydrates

Teach patients to select a diet high in_______ with protein intake consistent with liver function.

phosphorous

The chemicals most commonly implicated in toxic hepatitis are chloroform, gold compounds, and______.

hepatic cirrhosis

The client with________ has an increased risk of bleeding because of decreased production of prothrombin and decreased ability of the synthesize the necessary substances for blood coagulation.

Hepatic encephalopothy

The earliest symptoms of________ include both mental status changes and motor disturbances.

hepatic cirrhosis

The iver is initially enlarged, but late in the disease is decreased in size as scar tissue contracts the liver tissue with:

Infection

The leading cause of death after liver trans- plantation is________

Vit K

The liver synthesizes prothrombin only if there is enough_______

Portal vein

The majority of blood supply to the liver, which is rich in nutrients from the gastrointestinal tract, comes from the_______

10%

The mortality rate for hepatitis B can be as high as______

Hep C

The most common reason for liver transplan- tation is exposure to_______

SAM-e

The natural compound_______ (s-adenosylmethionine) may improve outcomes in liver disease by improving liver function, possibly through enhancing antioxidant function. Herbal supplements are used in conjunction with medical treatment and medications. Herbal supplements are not approved by the FDA. Their usage should be discussed with the primary care provider to evaluate their effectiveness and interactions with other treatment regimens.

Heart Liver

The nurse educates the client that AST is an enzyme found mainly in what organs of the body?

Alterations in mood, Insomnia, Agitation

The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor?

hold breath

The nurse should instruct the patient to do this immediately before needle insertion for a liver biopsy. Inhale and exhale deeply several times, finally to exhale, and to_________ at the end of expiration.

Postnecrotic cirrhosis

is a late result of viral hepatitis.

Hepatocellular jaundice

is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood.

AST (a lab value)

is found mainly in the heart muscle and liver. Moderate amounts may also be found in the pancreas, skeletal muscle, and kidneys.

Hemolytic jaundice

is the result of an increased destruction of red blood cells that overload the plasma with bilirubin so quickly that the liver can- not excrete the bilirubin as fast as it is formed.

Laparoscopy

is used to examine the liver and other pelvic structures. It is also used to perform guided liver biopsy

Obstructive jaundice

is usually caused by occlusion of the bile duct by a gallstone from an inflammatory process, a tumor, or pressure an enlarged organ.

radioisotope liver scan

may be performed to assess liver size, blood flow, and obstruction.

postnecrotic

In__________ cirrhosis, there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis.

Decompensated cirrhosis

Ascites, Jaundice, Muscle wasting, Weight loss

Vitamin C

Hemorrhagic lesions of scurvy

90

Hepatic lobectomy for cancer can be successful when the primary site is localized. Because of the regenerative capacity of the liver, a surgeon can remove up to- __________- % of liver tissue .

Chronic liver disease, hep B, hep C, and cirrhosis

Hepatocellular carcinoma is caused by 4 things

Vitamin K

Hypoprothrombinemia

Hepatic cirrhosis

In __________These changes are irreversible and result from liver cell death, collapse of the liver's supporting structure, distortion of the vascular bed, and nodular regeneration of remaining liver tissue.

biliary

In_______ cirrhosis, scarring occurs in the liver around the bile ducts.

70

Liver function tests are not abnormal until _______% of the liver is revealed damaged.

Folic acid

Macrocytic anemia

airway

Maintaining the_______ is the highest priority because oxygenation is essential for life. The airway is compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

jaundice

Many patients who have end-stage liver disease (ESLD) with cirrhosis use the herb milk (Silybum marianum) to treat______ and other symptoms. This herb has been used for centuries its healing regenerative properties for liver disease. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.

Riboflavin

Mucous membrane lesions

Vitamin A

Night blindness

10 to 13 seconds

Normal prothrombin time is

10 to 35

Normal serum ALT is

8 to 38

Normal serum AST

hepatic cirrhosis

Nursing management for the client with_______ includes promoting rest, improving nutritional status, providing skin care, reducing risk of injury and monitoring and managing potential complications. Potential complications include bleeding and hemorrhage hepatic encephalopathy, and fluid volume excess.

Bruising

Other symptoms of cirrhosis that may be seen in both compensated and decompensated cirrhosis is mild fever and easy ________.

esophageal varices

Patients diagnosed with_________ are at risk for hemorrhagic shock leading to hypovolemia. Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased BP, and decreased urine output.

hepatic cirrhosis

Peritonitis, edema, gastrointestinal varices, vitamin deficiency and anemia, and mental deterioration may also result from________

hepatic cirrhosis

Peritonitis, edema, gastrointestinal varices, vitamin deficiency and anemia, and mental deterioration may also result from_________. The liver is initially enlarged, but late in the disease is decreased in size as scar tissue contracts the liver tissue.

liver

Serum ALT is increased more markedly than serum AST in______ disease, whereas AST is more increased in myocardial necrosis.

True

Serum ALT is increased more markedly than serum AST with liver disease. Identify the statement as true or false.

Pyridoxine

Skin and neurologic changes

acute hepatic

The patient with__________ encephalopathy is placed on a low decrease ammonia levels.

Cholesterol

The substance necessary for the manufacture of bile salts by hepatocytes is_______

Bleeding and bile peritonitis

The two major complications of liver biopsy are ________and_____

Compensated cirrhosis

Vascular spiders Reddened palms Morning indigestion

Vasopressin

_________may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension.

Hep C

________caused by contaminated needles shared by drug users, is also the most common reason for liver transplantation.

blood, coagulation

Veronica, age 46, is scheduled for a liver biopsy to determine if she has cirrhosis of the liver. The nurse assigned to care for Veronica is to accompany her to the treatment room. What preparation is required by the nurse prior to beginning the procedure? Making sure that informed consent has been obtained and the permit is signed, compatible donor_______ is obtained, vital signs are obtained and recorded, and______ studies are reviewed.

hepatitis B

What are the indications for post exposure vaccination with_______ immunoglobulins? Accidental exposure to HBAg-positive blood, Perinatal exposure, sexual contact with those who are positive for HBAg.

Fat

What is the main function of bile salts? ______ imulsification in the intestines.

GluconeoGenesis

What role does the liver play in glucose metabolism? Produces ketone bodies, synthesizing albumin, and participating in _______

Recumbent (with right upper abd exposed)

While preparing a patient for a liver biopsy the position the nurse will place the patient in to ensure adequate access to the biopsy site is______.

albumin

With the movement of_______ from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

Ruptured esophageal varices

_______ is the most common single cause of death in patients with cirrhosis.

Hepatic encephalopathy

_________ is a central nervous system dysfunction resulting from liver disease. It is frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma.

Asterixis

_________, an involuntary flapping of the hands, may be seen in stage Il encephalopathy. It indicates that the patient has hepatic encephalopathy and, if untreated, hepatic coma may occur, which is more concerning than a 2 kg wt gain.

Esophageal varices

__________ are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged iver.

Compensated

__________cirrhosis is a general term given to the state of liver disease in which the liver continues to be able to function effectively.

Portal hypertension

__________is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver.

Nonobstructive

__________jaundice occurs with hepatitis.