Med Surg 2 - Liver Problems
How long is icteric phase?
1-4 months
how long is post icteric phase?
2-4 months
How long is incubation phase?
28-96 days, happens before jaundice
What is unconjugated (indirect) billirubin?
Circulates in blood attached to albumin, insoluble in water, keeps circulating, unable to excrete in urine
How is billirubin formed?
In the breakdown of HGb in liver
s/s incubation phase
anorexia, taste change, nausea, weight loss
what do you get when you have the HBV vaccine?
anti HBV post immunization
examples of hemolytic jaundice
blood transfusion reactions, sickle cell crisis, hemolytic anemia
what if tested negative for viral hepatitis?
consider OTC drugs like tylenol
What is conjugated (direct) billirubin?
converted to water soluble in liver, secreted into bile and flows into biliary duct system, excreted in small intestine
how can you get hepatitis?
drugs, chemicals, virus, alcohol, inflammation
what are intrahepatic obstructions?
due to swelling/fibrosis of livers canaliculi and bile ducts
name the three types of jaundice
hemolytic, hepatocellular, obstructive
examples of hepatocellular jaundice
hepatitis, carcinoma, cirrhosis
physical findings of incubation phase
hepatomegaly, lymphadenopathy, splenomegaly
what is hemolytic jaundice?
increased breakdown of RBC, too much unconjugated billirubin in blood
what is hepatitis?
inflammed liver cells become necrotic and cause interruption of flow of bile, liver cells CAN regenerate
where do you check jaundice in blacks?
inner canthus or eye, soft palate
s/s post icteric phase
jaundice improves, fatigued
s/s icteric phase
jaundice, clay stool, hapatomegaly, dark urine, pruritis
what is hepatocellular jaundice?
liver cant take up billirubin from blood and conjugate it to be excreted
Examples of intrahepatic obstruction
liver tumor, cirrhosis, hepatitis
what is poop floats?
not digesting fat
what is obstructive jaundice?
obstructed flow of bile through the liver/biliary duct system
what are extrahepatic obstructions?
stone, strictures, sclerosing cholangitis, pancreatic cancer
what if antigens are present in blood?
then the virus is present
what will you see with complete intestinal obstruction?
white, clay colored stool: no bile
what happens if you dont have jaundice with icteric phase?
youre considered non icteric
what if antibodies are present in blood?
youve been exposed in the past and have some immunity, can have with A and B but NOT C
