My Hepatic Notes

I'll add the rest later, this is just the beginning...

Liver Anatomy

Blood Supply

Hepatic Artery (25% of blood supply)
Portal Vein - direct from GI system
Sinusoids - capillary beds where arterial & venous blood mix
Kupffer's Cells - cleans the blood
Hepatic Vein - purified blood leaves the liver and flows into the inferior vena cava

Liver Function

Cleaning - bacteria removal & detoxification/excretion of ETOH & drugs
Storage - fat soluable vitamins (A, D, E, K), water soluable vitamins (B12), iron, copper, and glycogen for energy
Manufacturing - Bile (Bile salts & conjugated bilirubin), Albumin (oncotic pressure), and most coagulation factors

Liver Failure

Categories

Hepatocellular - viral hepatitis, ETOH, drugs
Cholestatic - destructive (gallstones)

Classifications

Acute - fullminant liver failure (within 8 weeks)
Chronic - ETOH & Viral
Acute on Chronic - Chronic failure w/ acute decline

S/S Liver Failure

Neuro - ranges from monotonous speech and drowsiness to coma

Hepatic Encephalopathy - liver's inability to break down ammonia (by-product of protein breakdown)
Asterixis - nonrhythmic flexion of hands and fingers when arms are extended

CV - dilated peripheral blood vessels

Increased cardiac output
Flushed extremities
Tachycardia
Bounding pulses
Hypotension

Hematologic - deficiency of coagulation factors

Petechiae
Occult Bleeding
Impaired Vitamin K absorption
Prolonged PT & INR
Anemia - blood loss, impaired RBC formation and increased destruction
Increased infections - resulting from poorly functioning Kupffers cells
Fluid Retention - decreased albumin

GI

Portal HTN - normal 5-10 mm Hg (HTN >10 mm Hg)

Collateral vessels form throughout the body leading to varices (esp esophagus, rectum, abdomen)

Can rupture - EMERGENCY!!!!

bright red blood from GI tract
Hypotention
Tachycardia
Cold, clammy skin
Bloody or black, tarry stools (melena)

Ascites - accumulation of fluid in peritoneal cavity caused by portal HTN, Sodium retention, and low albumin

Tight, shiny skin
Dyspnea
Percussion may yield a fluid wave

Fever - may indicate bacterial peritonitis

Clay-colored stools - caused by inability to conjugate bilirubin in GI tract
Fatty Stools - steatorrhea
Fetor hepaticus - sweet, fecal odor on breath

GU - excess bilirubin excreted by kidneys - urine turns a reddish-brown color

Low urine output
High BUN
High Serum Creatinine
Acute renal failure (hepatorenal syndrome)

Endocrine - endogenous steroids and sex hormones are not metabolized.

Men - breast enlargement, testicular atrophy, loss of body hair, decreased libido
Women - increased facial hair, smaller breasts, amenorrhea, decreased libido

Skin
Jaundice - yellow skin tone from unconjugated bilirubin
Pruritis - itching caused by accumulation of bile salts under the skin
Spider angiomas - vascular spider veins
Xanthomas - white fatty deposits around eyes

To my readers who want something to read

So it's been quite an adventurous couple of weeks here in our little Georgia household. Lots has happened without really alot going on (LOL) and at the end of each day I'm just amazed at the life God has given me.

Cody had his wisdom teeth cut out and he just had his follow-up appointment with his oral surgeon and he gave him two thumbs up! I'm so happy that things are going better for Cody with regards to his mouth pain. Seems like that was the cause of the whole thing - wisdom teeth!

We also welcomed a new member into our family, a kitten named Sara. We adopted her from a shelter in Walton county. We actually went there to look at another kitten, but this other kitten still had two of her brothers with her and we didn't want to split them up. Especially seeing as they were all super-active little boogers LOL! Sara is only 7 months old and has a very mellow personality, but a feisty side that comes out when it wants to. Works perfectly with me LOL She's UTD on her shots and tests and she's fixed. So no worries about unexpected baby kittens. Besides, I'm all about spaying and neutering animals.

Of course, Colin is on cloud nine with his little kitty. I think right now he's a little too much for her, I have to settle him down every so often and he learned today why it's not nice to pull the kitty's tail LOL But he's been good with playing "mouse" with her and not mixing her food and water together. I'm very proud of him.

Sara loves to lay and cuddle with me and I love it myself. She's so soft and lovable. Unfortunately, I've been fighting bronchitis since the day before we got her. I started out with a 103 fever for 3 days and had to be excused from Clinical Simulations in Dunwoody last week. I went to the doctor fearing I had pneumonia again but fortunately my xrays were clear. But I had to get a steroid shot, breathing treatments, antibiotics, and a real strong cough syrup that doesn't quite get the job done. But I finished the antibiotic tonight. Thank God!!!

It was rough going to lecture on Friday though. I ended up sleeping in my car for some of lecture and then requested to be excused so I could come home and rest up for my hard 12 the next day. Fortunately the instructor allowed me to. Well, I could have left regardless, but I wanted her to understand why I was leaving.

Saturday, my "Hard 12", was hell on Earth. I just felt like everything that could have been physically difficult was thrown at me. And my 02 sats never went above 95%! LOL I was lower than my patients. When I got home I had a good breathing treatment that helped ALOT. Marty and the boys ordered some Chinese food in for Valentines Day and they gave me some cookies (which I think were really for them LOL) and a pampering kit from Bath & Body Works. It smells SO nice. It's actually something Marty and I can use for each other. We love quiet nights with a good backrub to candlelight and soft music. Ahhhh...

Unfortunately for now Marty is recovering from a sinus infection, me from bronchitis, Colin with a croupy cough, and Cody is having a blast taking the week off from school. But we're all a kick ass family and I love every minute of it hehe...

(Oh! I passed my first exam of Advanced Nursing and got really high marks on my Advanced Nursing clinical evaluation! Only like 2 months until I graduate!!!)