DISORDERS OF THE LIVER CH 31

Question 1 of 5 A 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. "Steatosis can cause hyperbilirubinemia." "Excessive RBC hemolysis can cause hyperbilirubinemia." "Hepatocellular injury can cause hyperbilirubinemia." "Hemochromatosis can cause hyperbilirubinemia." "Bile duct obstruction can cause hyperbilirubinemia."

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

Question 4 of 5 A Which of the following are liver enzymes? Select all that apply. Albumin ALT Lipase AST Bilirubin

ALT AST

Question 5 of 5 A 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 response made by the student nurse indicates effective learning? Select all that apply. "The liver becomes infiltrated with fibrotic tissue." "Serological tests are used to diagnose hepatitis." "Viral hepatitis causes caput medusa." "Acetaminophen use can cause viral hepatitis."

"The liver becomes infiltrated with fibrotic tissue." "Serological tests are used to diagnose hepatitis." Viral hepatitis causes Caput Medusa

One of the most common liver disorders in the United States is nonalcoholic fatty liver disease. Hepatocytes exhibit an accumulation of triglycerides, and the condition is associated with metabolic syndrome.

Alcohol usage can also damage the liver. Alcoholic hepatitis may present as an acute, reversible condition, or develop into alcoholic cirrhosis, which results in scarring and decreased functioning.

Liver damage can also lead to enlargement of the liver, called hepatomegaly, and right upper quadrant (RUQ) tenderness.

Because the liver synthesizes coagulation factors, clotting disorders and prolonged prothrombin time may be present as well. And if the liver cannot detoxify the blood, elevated ammonia levels may lead to hepatic encephalopathy.

Question 2 of 5 C Which of the following may cause hyperbilirubinemia? Select all that apply. Bile duct obstruction Increased red blood cell breakdown Injury to hepatocytes Lack of albumin synthesis Lack of prothrombin synthesis

Bile duct obstruction Increased red blood cell breakdown Injury to hepatocytes

Question 2 of 5 A Which substance is responsible for the yellow color of urine? Biliverdin Bilirubin Stercobilinogen Urobilinogen

Bilirubin

Question 3 of 5 C A nurse is caring for a pt. diagnosed w/ portal hypertension. What development should the nurse be concerned about? Increased risk for esophageal varices Decreased detoxification of the blood Increased blood clotting time Decreased bile production

Increased risk for esophageal varices

Question 1 of 5 C The physical examination findings of a pt. who has liver disease show dilated veins over the umbilical area of the abdomen. What is this finding called? Caput medusa Jaundice Ascites Icterus

Caput medusa

Hyperbilirubinemia

Causes: Increased R.B.C.'s Hemolysis Hepatocellular Injury Bile Duct Obstructions S&S: Yellowing of the skin Jaundice Sclera Urine darkens in color

Q 9 of 9 B Can you select the correct characteristics for each of the following disorders? HEMOCHROMATOSIS Elevated serum iron Elevated serum ferritin Hereditary forms Increased IgM Low ceruloplasmin Primary and secondary forms Silent, gradual disease

Elevated serum iron Elevated serum ferritin Hereditary forms Primary and secondary forms CORRECT: HIGH SERUM TRANSFERRIN TOO Hemochromatosis develops when too much iron is present in the blood. Most frequently, this is due to an inheritable genetic defect. The elevation in iron causes higher than normal ferritin and transferrin levels. Ceruloplasmin levels are related to copper levels, thus are not affected by hemochromatosis.

Q 8 of 9 B Can you select the correct characteristics for each of the following disorders? CRIGLER-NAJJAR SYNDROME Elevated unconjugated bilirubin Genetic defect affecting bilirubin processing Elevated total bilirubin Liver scarring Steatosis RUQ tenderness Positive HCV RNA assay

Elevated unconjugated bilirubin Genetic defect affecting bilirubin processing Elevated total bilirubin CORRECT. Crigler-Najjar syndrome is a rare genetic disorder in which the breakdown of bilirubin is compromised. Bilirubin builds up in the body leading to elevated levels of unconjugated bilirubin. Non-hemolytic jaundice develops.

Q 7 of 9 B Can you select the correct characteristics for each of the following disorders? HEPATITUS A Fecal-oral transmission Anti-HAV antibodies Hepatomegaly RUQ tenderness Six different genotypes Antimicrobial antibodies (AMAs)

Fecal-oral transmission Anti-HAV antibodies Hepatomegaly RUQ tenderness CORRECT. Hepatitis A is a viral form of hepatitis transmitted through the fecal-oral route. It can lead to typical signs of liver problems, including enlargement of the liver and tenderness in the right upper quadrant (RUQ) area. Infection with hepatitis A results in the formation of anti-HAV antibodies, which can be detected with a blood test.

Although there are many causes of liver disorders, many present with the signs and symptoms we have just outlined: jaundice, hyperbilirubinemia, elevated liver enzymes, and prolonged PT. To differentiate the cause of liver dysfunction, additional tests may be needed.

For example, hepatitis is inflammation of the liver; it may be caused by viruses, autoimmune disease, or toxic injury. Viral forms of hepatitis include Hepatitis A, B, C, D, and E. Each form shows specific antigens and antibodies in serological tests. Each of the forms of hepatitis have their own transmission routes. Hepatitis A and hepatitis E are transmitted by the fecal-oral route. Hepatitis B is spread by blood products, body fluids, and sexual contact. Hepatitis C is primarily transmitted via blood through IV drug use, and acute forms may progress to chronic hepatitis.

Question 5 of 5 C Which form of hepatitis is primarily transmitted through the blood, often through IV drug use? Hepatitis C Hepatitis A Hepatitis D Hepatitis B

Hepatitis C

Although known as "liver function tests," these are not direct measurements of liver function; instead, they indicate hepatic injury.

Hepatocellular injury can be detected by measuring the presence of liver enzymes in the blood, such as aspartate aminotransferase, abbreviated AST, and alanine aminotransferase, abbreviated ALT.

Question 4 of 5 C Which of the following are common signs of liver disorders? Select all that apply. Hepatomegaly Jaundice Increased liver enzyme levels in blood Skin rash Fever

Hepatomegaly Jaundice Increased liver enzyme levels in blood

Disorders of the Liver. Because of its central role in a number of bodily processes, liver disorders may present in a diverse and systemic manner. The liver, in effect, acts as the body's processing plant. It aids in digestion; aids in fat, protein, and carbohydrate metabolism; and filters and detoxifies the blood, among other responsibilities. One of the liver's functions is converting bilirubin, a product of red blood cell breakdown, into bile.

Hyperbilirubinemia is elevated bilirubin levels in the blood, which may occur because of increased red blood cell hemolysis, hepatocellular injury, or bile duct obstruction. Elevated bilirubin causes one of the primary signs of liver damage—the yellowing of the skin and sclera known as jaundice. Bilirubin backup may also cause urine to appear dark in color. If the liver is unable to produce bile, fat digestion and absorption of fat-soluble vitamins may be compromised.

Q 6 of 9 B Can you select the correct characteristics for each of the following disorders? BILIARLY CIRRHOSIS Increased IgM Increased ESR Xanthelasma Antimicrobial antibodies (AMAs) Elevated serum ferritin Medical emergency Hepatic encephalopath

Increased IgM Increased ESR Xanthelasma Antimicrobial antibodies (AMAs) CORRECT. Destruction of the bile ducts occurs in biliary cirrhosis. The primary form of biliary cirrhosis is considered an autoimmune disease. Thus, inflammatory mediators, such as ESR, and antibodies, such as IgM and AMAs, are elevated. Xanthelasma, which are yellow patches of cholesterol that develop near the eyes, may be present.

Q 3 of 9 B Can you select the correct characteristics for each of the following disorders? WILSON'S DISEASE Masklike facies Kayser-Fleischer rings of the cornea Low ceruloplasmin levels High urinary copper Positive HCV RNA assay Elevated unconjugated bilirubin Copper accumulation

Masklike facies Kayser-Fleischer rings of the cornea Low ceruloplasmin levels High urinary copper Copper accumulation CORRECT. Wilson's disease is a rare genetic disorder that causes copper to accumulate in some tissues. Copper may begin to be excreted in the urine at a high level. Golden, brown discoloring of the eyes (Kayser-Fleischer rings) may be apparent and result from copper deposition. Ceruloplasmin levels are low, as copper incorporation onto this transport protein is abnormal. Neurological manifestations may develop in Wilson's disease. One such example is masklike facies, in which the facial expression is flat, almost masklike.

The liver also synthesizes the plasma protein, albumin. Liver damage may reduce albumin production, leading to ascites.

Portal hypertension increases the risk of esophageal varices and upper GI bleed, as blood from the GI tract, which normally goes to the liver, begins to backup. Dilated, superficial veins known as caput medusa become visible around the umbilicus.

Q 2 of 9 B HEPATITIS B Positive HBc Ig Positive HBcAg Range of symptoms Vaccine available High urinary copper Transmitted by fecal-oral route Dormant subclinical infection

Positive HBc Ig Range of symptoms Vaccine available Positive HBsAg, HBcAg CORRECT: Does not directly destroy hepatocytes ALSO CORRECT. Diagnosis of hepatitis B results from positive serology results for the antigen, including HBcAg, as well hepatitis B antibodies, HBc Ig. Hepatitis B presents with a range of symptoms. It is transmitted by blood and body fluids, not the fecal-oral route. A vaccine against hepatitis B is available.

Q 5 of 9 B Can you select the correct characteristics for each of the following disorders? HEPATITIS C Positive HCV RNA assay Anti-HCV antibody Dormant infection; asymptomatic initially Genotyping should be completed Positive HBsAg Fecal-oral transmission Vaccine is available Low ceruloplasmin

Positive HCV RNA assay Anti-HCV antibody Dormant infection; asymptomatic initially Genotyping should be completed CORRECT. Hepatitis C is sometimes referred to as a "silent infection," as few signs and symptoms may be present initially. Diagnosis is based on positive RNA assay results for the virus, as well as positive antibody results. Several genotypes exist for hepatitis C, and there is no vaccine currently available.

Q 1 of 9 B CIRRHOSIS & LIVER FAILURE Silent gradual disease Liver scarring Widespread decrease in liver function parameters Portal hypertension Elevated triglycerides and cholesterol Develops from hepatitis a infection Kayser-Fleischer rings of the cornea

Silent gradual disease Liver scarring Wide spread decrease in liver function parameters Portal hypertension Correct: Cirrhosis is fibrotic scarring of the liver. The scarring manifests as a result of damage to the liver liver function becomes impaired as indicated by laboratory results. The disease is not rapid in onset and does not present with acute symptoms in the early stages. Portal hypertension often develops in response to cirrhosis, as the veins become blocked by the damaged liver. Hepatitis C, not hepatitis A is more likely to cause cirrhosis.

Question 3 of 5 A Which of the following statements are true? Select all that apply. Portal hypertension may lead to esophageal varices. Decreased bile production by the liver may lead to reduce absorption of water-soluble vitamins. Some forms of hepatitis may be transmitted by fecal-oral route. Decreased albumin synthesis by the liver may lead to jaundice. If the liver is unable to detoxify the blood, ammonia levels may increase.

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

Q 4 of 9 B Can you select the correct characteristics for each of the following disorders? ALCOHOLIC LIVER DISEASE Steatosis AST and ALT 2-7 times higher than normal Elevated triglycerides and cholesterol Hepatic encephalopathy Hyperpigmentation Elevated HBsAg Portal hypertension

Steatosis AST and ALT 2-7 times higher than normal Elevated triglycerides and cholesterol Hepatic encephalopathy CORRECT. Alcoholic liver disease develops as a result of excessive alcohol consumption. As the liver processes alcohol, excessive consumption may lead to damage to the liver cells. Liver enzymes, such as AST and ALT may elevate in the serum, indicating damage to hepatocytes. Liver processing of lipids may be impaired resulting in elevated triglycerides and cholesterol. Steatosis, the accumulation of fat in liver cells, may also occur. With severe damage, the liver is no longer able to detoxify the blood. For example, ammonia levels may increase to the point that damage to the nervous system, including the brain, results. This is known as hepatic encephalopathy.