-
Lactulose use, route
- d/c ammonia levels
- Route: PO, NGT, enema
- *treats/prevents hepatic encephalopathy
-
Kayexalate use, route
- Use: d/c K+ levels
- Route: PO, NGT, enema
-
Protonix/Nexium use
Prophylaxis of PUD
-
Vitamin K use, alternative
- I/c ability to clot
- *coumadin pts with i/c PT, end stage renal disease
- Alternative: fresh frozen plasma
-
Sandostatin (octreotide): use, route
- Use: esophageal varices, GI bleed (vasoconstrictor specific GI system)
- Route: IV
-
Ammonia
- 15-49
- ^ indicates hepatocyte damage (liver ocnverts NH3 to urea)
- i/c --> hepatic emvephalopathy
- s/s: change in LOC, neuromuscular disturbances, impaired thinking
- tx: lactulose
-
-
ALK Phos
- 20-90
- LFT
- ^ obstructive jaundice, intrahepatic cholestasis, liver metastasis, or granulomas
- *liver issues (shock, cirrosis)
-
Albumin
- 35-55
- d/c: cirrhosis, chronic hepatitis
- Low levels show evidence of ascites
- *acts by drawing fluid from the interstitial ot he intravascular spaces
-
Total bilirubin
- 0.2-1.3
- Direct: Abnormal in biliary and liver disease; causes clinical jaundice
- Indirect: bnormal in hemolysis and in functional disorders of uptake or conjugation
- (liver not changing unconjugated bili to conjugated bili/liver holding on to RBC due to failure--jaundice)
-
-
amylase
- 25-125
- ^ Peak with acute pancreatitis, then fall to normal with 48-72 hrs.
- Low indicates pancreatic insufficiency
-
lipase
- 10-40
- ^ only in pancreatitis, markedly in acute pancreatitis an dpancreatic duct obstruction
- -remains elevted after amylase returns to baseline
-
-
PT
- 11-14 sec
- Prolonged in liver disease (will not return to normal with vitamin K administration)
-
PTT
- 25-36
- Increased with severe liver disease or therapy with anticoagulants
-
9 functions of the LIVER
- 1. carbohydrate metabolism
- 2. protein metabolism
- 3. fat metabolism
- 4. bile production and excretion
- 5. metabolism of steroid hormones
- 6. vitamin storage
- 7. drug metabolism
- 8. synthesis of clotting factors
- 9. blood filtration
-
3 types of carbohydrate metabolism
- glycogenesis
- glycogenolysis
- gluconeogenesis
-
glycogenesis
- Glucose to glycogen
- conversion of excess carbs to glycogen as reserve
-
glycogenolysis
- Breakdown of glycogen to glucose
- converts large stores of glycogen in muscle and liver to glucose
-
Gluconeogenesis
- Formation of glucose from amino acids or fatty acids
- Formation of glucose from non-carb substrates (fat, muscles--amino acids, glycerol).
- -When the body changes from aerobic to anaertobig metabolism and lactic acid is produced
-
3 types of cirrhosis
- 1. Alcoholic (most common)
- 2. post-necrotic
- 3. biliary
- 4. cardiac
-
Treatment of GI bleed
- IVG (colloids/crystalloids)
- Labs: H&H
- Endoscopy
-
Pancreatitis s/s
- Abdominal pain, N/V, fever, jaundice, elevatd amlase, lipase, WBC
- Hypokalemia, hypocalcemia
-
Treatment of pancreatitis
NPO, TPN, IVF, NGT, PUD drugs
-
Risks with pancreatitis
- ETOH use
- I/C risk for ARDs
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