Hepatic

Question 1

List the functions of the Hepatic System

Answer 1

1. Conversion and excretion of bilirubin ammonia
2. Sole source of albumin and other plasma proteins
3. Produces bile (500 - 1500 mls/day)
4. Synthesizes clotting factors
5. Absorbs and processes nutrients from the gut
6. Detoxification (drugs, ETOH and toxins)
7. Storage (glycogen, vitamins, iron)
8. Synthesizes cholesterol

Question 2

List S/S of Hepatic Disease

Answer 2

1. GI symtpoms
   
   • N/V, diarrhea, constipation, heartburn, abdominal pain, GI bleeding
2. Edema/Ascites
3. Dark urine (bilirubin)
4. Light/clay colored stools
5. Right upper quadrant abdominal pain
6. Neuro involvement
   
   • confusion, muscle tremors, sleep disturbances
7. Hepatic Osteodystrophy
8. Osteoporosis
9. Skin changes: Juandice, increased burising

Question 3

What is juandice?

Answer 3

a symptom not a disease

• bilirubin break down product of RBC macophages
• yellow discoloration of the skin, sclerae, and mucous membranes
• increased bilirubin production. Decreased processing bilirubin
• Hepatocyte dysfunction leading to bilirubin accumulation
• impaired bile flow

Question 4

how is jaundice treated?

Answer 4

treat underlying disease

return to normal color suggests resolution

activity and exercise can be resumed after resolution

Question 5

what causes neuro symptoms in hepatic disease?

Answer 5

ammonia accumulation in blood

• ammonia converted into urea in liver
• ammonia comes from degradation of amino acids
• ammonia is then catabolized by liver generating urea
• decreased urea leads to ammonia accumulation in blood

Question 6

what is a flapping tremor?

Answer 6

tremor elicted by attempted wrist extension while forearm is fixed

most common neuro abnormality w/liver failure

Question 7

what musculoskeletal pain is associated with liver and biliary system?

Answer 7

posterior thoracic pain (inter scapular, R shoulder, R upper trap, R subscapular)

Question 8

what is hepatic osteodystrophy?

Answer 8

abnormal development of bone/osteoporosis in individuals with chronic liver disease

leads to osteopenia and osteoporosis

Question 9

what is cirrhosis?

Answer 9

a late scarring (fibrosis) of the liver caused by many forms of liver disease

typically a result of alcoholism or hepatitis

Progressive, patterened loss of healthy tissue which is replaced with fibrotic tissue

Question 10

describe the process that results in liver scarring

Answer 10

1. liver inflammation causes tissue damage necrosis
2. liver repairs itself
3. liver is reinjured leading to more tissue damage and necrosis
4. this cycle of inflammation and healing leads to the replacement of liver tissue with bands of CT

Question 11

what are the practice implications for cirrhosis?

Answer 11

1. Osteoporosis
2. Impaired posture
3. Impaired muscle performance/weakness
4. Loss of balance
5. Deconditioning
6. Ascites/bilateral edema of feet and ankles
7. Blood loss: bruising/bleeding
8. Rest to reduce metabolic demand on the heart is recommended; rest during treatment sessions and avoid unnecessary fatigue

Question 12

what is portal hypertension?

Answer 12

defined as an increase in hepatic sinusoidal BP > 6 mm

fibrosis, and abnormal liver architecture combine to form mechanical barriers to blood flow in the liver increasing the resistance and BP in the hepatic portal system

Question 13

what is the effect of portal hypertension on blood flow?

Answer 13

increased portal pressure causes a retrograde flow of blood back into the stomach, spleen, large and small intestine, rectum and esophagus

result is varices back upstream

Question 14

what is are varices?

Answer 14

an abnormally dilated vessel with a tortuous course

an ex is varicose veins in LE

these can leak blood/bleed

serious bleeding can quickly result in hypovolemia, shock, and death

Question 15

List some consequences of portal hypertension

Answer 15

1. ascites → from increased hydrostatic venous pressure
2. spleenomegally → enlargement of the spleen caused by venous congestion in spleen
3. Hemorrhoids → from venous congestion in the bowel
4. Varices → esophagus, stomach, rectum or umbilical area
5. May rupture and bleed

Question 16

what is hepatic encephalopathy

Answer 16

potentially irreversible, decreased level of consciousness in people with severe liver disease

thought to be caused by elevated blood ammonia and altered NT status in the brain

Insidious onset, progressively worsening os symptoms as disease progresses

Question 17

List symptoms of hepatic encephalopathy

Answer 17

1. depression, personality changes, impaired attention
2. drowsines, sleep disorders, ataxia, asterixis (rapid extension-flexion motion of head and extremities), slurred speech, hyperreflexia
3. marked confusion, incoherent speech, muscle rigidity
4. stupor, decerebrate posturing, positive Babinskis, dialted pupils

Question 18

T/F: symptoms of hepatic encephalopathy are reversible

Answer 18

TRUE

if cause is determined

Question 19

list some PT implications for hepatic encaphalopathy

Answer 19

1. patient safety
2. impaired motor and sensory integrity ie. impaired mobility, balance
3. impaired arousal
4. risk for pressure ulcers 2º to malnutrition, immobility, edema

Question 20

what is ascities associated with?

Answer 20

mostly with cirrohosis and accompanying portal hypertension resulting in congestion and varices and loss of blood into the abdomen

Question 21

management of ascites includes what?

Answer 21

1. Paracentesis
2. albumin consumption
3. diuretics
4. sodium and fluid restriction

Question 22

list implications for ascites

Answer 22

1. accompanying impaired cardiac and respiratory function
2. lymphedema
3. integumentary disorders (peripheral edema, reduced blood flow, lymphedema)
4. malnutrition
5. muscle degradation

Question 23

what is viral hepatitis?

Answer 23

inflammatory condition of the liver

result of an infection by one of several viruses with specific affinity for the liver (A, B, C, D, E)

Question 24

list some causes of chronic hepatitis

Answer 24

1. viruses
2. medications
3. metabolic abnormalities
4. autoimmune disorders
5. idiopathic

Question 25

T/F: most people with chronic hepatitis are asymptomatic

Answer 25

TRUE when symptoms appear they are nonspecific

Question 26

list diagnostic criteria for chronic hepatitis

Answer 26

1. symptoms 2. physical exam 3. blood test * specific Ab, liver function tests * liver biopsy (chronic inflammation, necrosis)

Question 27

list symptoms for viral hepatitis?

Answer 27

1. N/V 2. poor appetite, Wt. loss 3. weakness 4. Jaundice, dark urine 5. pale or clay-colored stool (defect in bilirubin homeostasis) 6. Fatigue 7. Most people have vague or no symptoms at all

Question 28

Describe Hepatitis A

Answer 28

* formerly known as infectious hepatitis * spread by close personal contact or oral-fecal contamination of water and food, poor hand hygiene, shared use of oral utensils * Benign and self-limiting disease * most persons w/acute disease recover with no lasting liver damage; rarely fatal * highly contagious * preventable w/vaccine

Question 29

how is hepatitis B spread?

Answer 29

1. blood transfusions 2. needle sticks 3. IV drug use/shared needles 4. dialysis 5. sexual contact 6. exchange of bodily fluids

Question 30

T/F: Hepatitis B is considered an STD

Answer 30

TRUE

Question 31

who is at most risk for hepatitis B?

Answer 31

healthcare workers who come into contact with blood

Question 32

what is the leading cause of chronic liver disease?

Answer 32

Hepatitis C transmitted by contact w/blood or an infected person, primarily through contaminated needles, sexual contact, needle sticks

Question 33

T/F: Hepatitis C has a vaccine

Answer 33

FALSE treated w/interferon, ribavirin and direct acting antiviral agents

Question 34

who should be tested for Hepatitis C?

Answer 34

1. ppl who recieved an organ transplant before 1992 2. if you have ever injected drugs 3. if you received blood product used to treat clotting problems that was made before 1987 4. those born between 1945-1965 5. on long term kidney dialysis 6. children born to HCV+ mothers

Question 35

List some other causes of Hepatitis

Answer 35

1. autoimmune 2. other viral causes: * CMV * Epstein-Barr (mono) * Yellow fever 3. drug and toxin induced liver disease 4. fatty liver 5. alcoholism

Question 36

how can a fatty liver lead to liver damage?

Answer 36

fat accumulates → inflammation → scarring (cirrhosis)

Question 37

how can alcoholism result in chronic liver damage?

Answer 37

cirrhosis can occur along with the following: 1. mitochondrial damage 2. excessive fat content in liver leads to inflammation with degeneration of hepatocytes 3. degenerated hepatocytes can stimulate an autoimmune reaction that causes further damage * \*\*alcoholic hepatitis\*\* 4. nutritional deficit → occurs b/c most alcoholics don't eat right