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