RNSG 2539 UNIT 2- METABOLISM:
LIVER FAILURE
lactulose-suppresses-the-metabolism-of-ammonia-
and-aids-in-its-elimination-through-feces."---ans-✔✔When-explaining-the-rationale-for-
the-use-of-
lactulose-syrup-for-the-patient-with-chronic-
cirrhosis,-the-nurse-would-choose-which-of-the-
following-statements?
Largest-organ.-Metabolism-of-Glucose,-Protein,-Fatty-Acids,-
Cholesterol.-Bile-formation-and-secretion--Hepatocytes.-Mononuclear-phagocyte-
system--Kupffer-cells-Phagocytic-activity---ans-✔✔Liver-Functions
Blood-storage,-Plasma-protein-synthesis.-Clotting.-Storage-of-vitamins-and-minerals.-
Waste-products-of-hemoglobin,-Steroids-and-hormones,-Ammonia,-Drugs,-ETOH,-
toxin-metabolism---ans-✔✔Other-Liver-Functions
Viral-Hepatitis---ans-✔✔Inflammation-of-liver-caused-by-infectious-
mononucleosis,-cirrhosis,-toxic-chemicals,-
viral-infection
Hepatitis-A---ans-✔✔Transmitted-by-oral-fecal-route;-often-caused-by-
poor-hand-washing-and/or-stool-precautions;-
common-in-areas-of-poor-sanitation.-Vaccine-recommended-for-people-at-risk.-Rapid-
onset-4-6-weeks.-Adequate-diet-without-alcohol-recommended
Hepatitis-B---ans-✔✔Transmitted-through-contaminated-blood-and-
sexual-contact;-also-
perinatally.-Routine-vaccination-of-children-and-at-risk-groups.-Slow-onset-12-weeks.-
Adequate-diet-without-alcohol-recommended.
Hepatitis-C---ans-✔✔Transmitted-through-blood,-saliva,-or-semen.-Slow-onset-8-
weeks.-Progression-from-hepatitis-C-virus-(HCV)-to-cirrhosis-
may-take-10-40-years.-No-dietary-recommendations.
, Hepatitis-E---ans-✔✔Transmission-by-oral-fecal-route.-Endemic-areas:-South,-
Southeast,-and-Central-Asia;-
Africa;-Mexico;-India.-tropical-climates,-inadequate-sanitation,-
poor-personal-hygiene.-Onset-15-60-days.-avoid-drinking-water-or-other-
potentially-contaminated-beverages;-avoid-raw-
fruits-or-vegetables.-Requires-adequate-hydration-and-electrolyte-
repletion
Post-necrotic--Hepatitis.
Alcoholic-Cirrhosis--Laennec's-or-metabolic-changes-in-liver-(fat).-
Biliary--obstructive.
Cardiac--Right-side-heart-failure.
Drugs--INH,-Rifampin,-APAP---ans-✔✔Types-of-Cirrhosis-
Classified-by-risk-factors-*****
Caused-by-destruction-of-liver-cells,-fibrosis-and-
nodule-formation-restricting-blood-and-bile-flow.-Normal-hepatic-blood-pressure-is-
near-zero.-Restriction-of-blood-flow-in-liver-dysfunction-
causes-hypertension,-and-blood-will-attempt-to-
find-other-pathways,-bypass-liver.-Results-in-significant-impairment-of-liver-function.-
80%-destroyed-before-signs-and-symptoms.-Liver-can-regenerate-itself-if-good-
nutrition,-rest,-
and-no-alcohol.---ans-✔✔Pathophysiology
Early-stages:-Liver-enlarged,-may-be-tender,-dull-pain-RUQ.-Weight-loss,-weakness,-
anorexia.-Skin,-sclera.
As-it-progresses:-Manifestations-related-to-liver-cell-failure,-Portal-hypertension.
Treatment-supportive:-slow-progress---ans-✔✔Clinical-Manifestations-*****
Portal-hypertension:-bloods-rerouted-to-adjoining-veins.
Splenomegaly:-blood-shunted-to-splenic-vein,-greater-destruction-of-RBCs,-WBCs,-
platelets.
Ascites:-Plasma-rich-fluid-in-abdominal-cavity.-Hypoalbuminemia
and-hyperaldosteronism.---ans-✔✔Clinical-Manifestations-continued-*****
Esophageal-varices:-Enlarged,-thin-walled-veins-form-in-submucosa-of-esophagus-
from-portal-hypertension.-Rupture-leads-to-hemorrhage.
Portal-systemic-encephalopathy:-Hepatic-encephalopathy,-Asterixis,-Changes-in-
personality,-mentation.---ans-✔✔Clinical-Manifestations-continued-*****
Hepatorenal-syndrome:-Renal-failure-with-azotemia,-sodium-restriction,-oliguria,-
hypotension.-Result-of-imbalanced-blood-flow.-
Spontaneous-bacterial-peritonitis:-inflammatory-response-to-peritonitis.---ans-
✔✔Clinical-Manifestations-continued-*****
Excess-bilirubin-caused-by
LIVER FAILURE
lactulose-suppresses-the-metabolism-of-ammonia-
and-aids-in-its-elimination-through-feces."---ans-✔✔When-explaining-the-rationale-for-
the-use-of-
lactulose-syrup-for-the-patient-with-chronic-
cirrhosis,-the-nurse-would-choose-which-of-the-
following-statements?
Largest-organ.-Metabolism-of-Glucose,-Protein,-Fatty-Acids,-
Cholesterol.-Bile-formation-and-secretion--Hepatocytes.-Mononuclear-phagocyte-
system--Kupffer-cells-Phagocytic-activity---ans-✔✔Liver-Functions
Blood-storage,-Plasma-protein-synthesis.-Clotting.-Storage-of-vitamins-and-minerals.-
Waste-products-of-hemoglobin,-Steroids-and-hormones,-Ammonia,-Drugs,-ETOH,-
toxin-metabolism---ans-✔✔Other-Liver-Functions
Viral-Hepatitis---ans-✔✔Inflammation-of-liver-caused-by-infectious-
mononucleosis,-cirrhosis,-toxic-chemicals,-
viral-infection
Hepatitis-A---ans-✔✔Transmitted-by-oral-fecal-route;-often-caused-by-
poor-hand-washing-and/or-stool-precautions;-
common-in-areas-of-poor-sanitation.-Vaccine-recommended-for-people-at-risk.-Rapid-
onset-4-6-weeks.-Adequate-diet-without-alcohol-recommended
Hepatitis-B---ans-✔✔Transmitted-through-contaminated-blood-and-
sexual-contact;-also-
perinatally.-Routine-vaccination-of-children-and-at-risk-groups.-Slow-onset-12-weeks.-
Adequate-diet-without-alcohol-recommended.
Hepatitis-C---ans-✔✔Transmitted-through-blood,-saliva,-or-semen.-Slow-onset-8-
weeks.-Progression-from-hepatitis-C-virus-(HCV)-to-cirrhosis-
may-take-10-40-years.-No-dietary-recommendations.
, Hepatitis-E---ans-✔✔Transmission-by-oral-fecal-route.-Endemic-areas:-South,-
Southeast,-and-Central-Asia;-
Africa;-Mexico;-India.-tropical-climates,-inadequate-sanitation,-
poor-personal-hygiene.-Onset-15-60-days.-avoid-drinking-water-or-other-
potentially-contaminated-beverages;-avoid-raw-
fruits-or-vegetables.-Requires-adequate-hydration-and-electrolyte-
repletion
Post-necrotic--Hepatitis.
Alcoholic-Cirrhosis--Laennec's-or-metabolic-changes-in-liver-(fat).-
Biliary--obstructive.
Cardiac--Right-side-heart-failure.
Drugs--INH,-Rifampin,-APAP---ans-✔✔Types-of-Cirrhosis-
Classified-by-risk-factors-*****
Caused-by-destruction-of-liver-cells,-fibrosis-and-
nodule-formation-restricting-blood-and-bile-flow.-Normal-hepatic-blood-pressure-is-
near-zero.-Restriction-of-blood-flow-in-liver-dysfunction-
causes-hypertension,-and-blood-will-attempt-to-
find-other-pathways,-bypass-liver.-Results-in-significant-impairment-of-liver-function.-
80%-destroyed-before-signs-and-symptoms.-Liver-can-regenerate-itself-if-good-
nutrition,-rest,-
and-no-alcohol.---ans-✔✔Pathophysiology
Early-stages:-Liver-enlarged,-may-be-tender,-dull-pain-RUQ.-Weight-loss,-weakness,-
anorexia.-Skin,-sclera.
As-it-progresses:-Manifestations-related-to-liver-cell-failure,-Portal-hypertension.
Treatment-supportive:-slow-progress---ans-✔✔Clinical-Manifestations-*****
Portal-hypertension:-bloods-rerouted-to-adjoining-veins.
Splenomegaly:-blood-shunted-to-splenic-vein,-greater-destruction-of-RBCs,-WBCs,-
platelets.
Ascites:-Plasma-rich-fluid-in-abdominal-cavity.-Hypoalbuminemia
and-hyperaldosteronism.---ans-✔✔Clinical-Manifestations-continued-*****
Esophageal-varices:-Enlarged,-thin-walled-veins-form-in-submucosa-of-esophagus-
from-portal-hypertension.-Rupture-leads-to-hemorrhage.
Portal-systemic-encephalopathy:-Hepatic-encephalopathy,-Asterixis,-Changes-in-
personality,-mentation.---ans-✔✔Clinical-Manifestations-continued-*****
Hepatorenal-syndrome:-Renal-failure-with-azotemia,-sodium-restriction,-oliguria,-
hypotension.-Result-of-imbalanced-blood-flow.-
Spontaneous-bacterial-peritonitis:-inflammatory-response-to-peritonitis.---ans-
✔✔Clinical-Manifestations-continued-*****
Excess-bilirubin-caused-by
