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NURS 5463 Test 5 Exam Study Guide
Cirrhotic - answer✔liver has all the nodularities that cause the fibrosis
Cirrhosis - answer✔Abnormal LFT/Transaminitis (elevated LFT)
Transaminitis - answer✔Elevated LFT
Acute or chronic liver disease - answer✔alanime transaminase (ALT) & Aspartate transaminase (AST),
Alk Phos, Total Bilirubin, Direct Bilirubin, occurs in acute or chronic liver disease
H&P for transaminitis - answer✔Helps to determine acute or chronic
Cirrhosis risk factors - answer✔IV drug use: Intranasal cocaine - the straws used when using intranasal
cocaine causes breakdown in the nasal mucosa and that is how the viruses are transmitted, Needle
sticks such in health care providers,
HD patients - answer✔higher risk for contracting Hep B
Blood transfusion prior to 1991/1992 - answer✔pt could have contracted hep C before we knew to test
for hep C
Acute liver Failure Work up for Transaminitis - answer✔Viral Serologies (hep ABC), Autoimmune marker
Doppler US of liver want to look at the plumbing of the liver - answer✔hepatic veins and arteries
MRI/MRCP - answer✔MR that focuses on the biliary tree and bile ducts, intrahepatic and extrahepatic
ductal dilatation) Liver biopsy
↑↑Aminotransferases (AST/ALT), +/- ↑ in Bilirubin, AK - answer✔Labs for Severe viral Hepatitis,
Acetaminophen overdose, Ischemia, Wilson's disease, AIH; related to liver injury
↑↑ Alkaline Phosphate, GGT, Bilirubin, +/- ↑ AST/ALT - answer✔Labs for Biliary Obstruction,
Choledocholithiasis, cholangiocarcinoma, pancreatic cancer, Intrahepatic cholestatis, Sepsis, PBC, Sex
Horm., Biliary Epitheleal Damage; related to cholestatic injury
Synthetic Function/Hepatic Function - answer✔how well is the liver working. INR, albumin (low albumin
can represent chronic problems were as normal albumin problem is more acute), and total bilirubin
Hepatitis A, B, C Full serologic work up - answer✔Hep A IgM, Hep A total, Hep B surface antigen, Hep B
surface antibody, Hep B core IgM, Hep B core total, and Hep C antibody. ANA, smooth muscle antibody
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(one or both can be elevated), Serum gamma globulins - can also be elevated, ANCA can be present,
Anti-LKM1
Hepatotoxic Drugs - answer✔Dilantin, Tylenol Accutane, Allopurinol, HAART, Statin, Methotrexate, INH
(TB med), Risperidone, Zoloft, Valproic acid, psych meds, Estrogen, Augmentin, Sulfonamides
Hepatotoxic Herbs - answer✔Noni juice, Chinese remedies & teas, Valerian, Mistletoe, Herbalife.
Hepatoxic Toxins - answer✔, , ETOH
Acute Liver injury AST/ALT ratio - answer✔2:1
Acute Liver Injury abdomen ultrasound shows - answer✔steatosis, cirrhosis, or focal lesions, Result in
alcoholic fatty liver disease
Vascular Liver Disorders - answer✔Budd-Chiari Syndrome, Obstruction of hepatic vein (thrombus)
Vascular Liver Disorders Work up - answer✔US of liver & hypercoagulable work up
Congestive Hepatopathy - answer✔Related to right sided HF; Echo to look at heart function
Causes of Congestive Hepatopathy - answer✔Ischemic (hypotension) (e.g. OR prolonged hypotensive)
Shocked liver (suspected from prolonged Hypotensive Episodes)
Alpha 1 antitrypsin - answer✔inherited disorder (rare) that affect lung, liver and skin.
Alpha antitrypsin Labs - answer✔antitrypsin phenotype (send out to Mayo Clinic)
Primary Biliary Cirrhosis - answer✔Autoimmune disorder that affect middle aged women
Primary Biliary Cirrhosis Labs - answer✔Alk phos or Total bilirubin, anti-mitochondrial antibody and IgM
(all
elevated) - answer✔
Hemochromatosis - answer✔Autosomal recessive disease; Caucasians & Western European decent,
resulting in very elevated Iron saturation or ferritin
Hemochromatosis - answer✔Autosomal recessive Labs: Iron, Ferritin, TIBC, Retic count (If iron studies
elevated, send HFE gene mutation)
Wilson's disease - answer✔Often has psych related problem growing up
Patho of Wilson's - answer✔Excessive deposits of cooper both in liver & brain
Wilson's Labs - answer✔serum Ceruloplasmin, If Serum Ceruloplasmin + get 24 hr urine for cooper
Evaluate for thrombosis - answer✔need doppler US of liver
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Rhabdo - answer✔seen extreme excises, strained muscle or working construction in the heat; increased
LFTs)
Hep A - answer✔Fecal Oral Route
Hep A Incubation - answer✔2-6 weeks
Hep A S/S - answer✔↓ appetite, malaise, fever, NV, RUQ pain
Hep A labs - answer✔Hep A IgM, Hep A antibody total (IgG)
If IgM is positive and the IgG is negative - answer✔acute hepatitis A
IgM - answer✔immediate disease
IgG - answer✔Long gone" prior exposure nt now gone
Hep A Prevention - answer✔vaccination, children are vaccinated to hepatitis A and are immune. People
that didn't get vaccinated as children can get the series and get immunity.
Hepatitis B Transmission - answer✔Blood transfusion or contact, sexual activity, perinatal
Hep B Incubation - answer✔6 wks-6 months
Hep B Labs - answer✔Hep B surface antibody/antigen & Hep B core antibody total (IgG), IgM.
IgM - answer✔Immediate
IgG - answer✔Long gone
Hep B prevention - answer✔Newborns vaccinated
Hi incidence of hep B - answer✔in Asian countries, remember recent travel/immigrant; + transaminitis
Ck Hep B and Hep D.
Hep B Therapy Goal - answer✔improve & suppress the Hep B (HBV DNA) to loss the HBeAG and to loss
the HBsAg
Hep B treatment - answer✔Interferon (SQ) for healthy liver and short term: main role is to treat young
patients with well
Interferon treatment - answer✔16-32 weeks or 12 to 24 months
Hep B treatment Entecavir 0.5 mg to 10 mg daily - answer✔If pt has had Lamivudine resistant HBV then
Entecavir should not be used but rather Tenofavir should be used
Tenofovir - answer✔300 mg daily (Hep B first line therapy)
Lamivudine - answer✔100 mg daily (cheap) Hep B
