Download Liver Function and Diseases: Pathophysiology & Pharmacology and more Exams Nursing in PDF only on Docsity!
California State University San Marcos
NURS 316B Exam 3 LATEST 2025 SPRING
SUMMER SEMESTER California State
University San Marcos COMPLETE EXAM
GRADED A
Explain how unconjugated bilirubin eventually gets excreted in the urine In liver, unconjugated bilirubin converted to water-soluble conjugated form → Conjugated bilirubin excreted in bile → Bile is later excrete in urine = Yellow color Why is some bilirubin excreted in bowel? Some conjugated bilirubin in colon is converted to urobilinogen by bacteria and excreted in bowel In a lab test, what is conjugated bilirubin called? Direct bilirubin
California State University San Marcos When the function of the liver is altered and there is a decrease in clotting factor synthesis, what problem(s) can you expect? Problem with coagulation When the function of the liver is altered and there is a decrease in albumin, what problem(s) and resulting signs/symptoms can you expect? ↓ Albumin (problems with protein) → Third spacing → Edema, ascites When the function of the liver is altered and there is a decrease in detoxification activity, what problem(s) can you expect? ↓ Detoxification activity → Excess accumulation of drugs, hormones & metabolites When the function of the liver is altered and there is a decrease in the storage of nutrients, what problem(s) can you expect? Muscle wasting
California State University San Marcos Summarize what happens with acute liver inflammation/infection? WBCs, ↑ Permeability of cell membranes of hepatocytes → Swelling liver → Beginning hepatomegaly signs What does chronic viral liver infection increase the risk for? Liver cancer List 3 viruses that can cause liver inflammation (1) Hepatitis viruses: A, B, C, D or G (2) Cytomegalovirus (CMV) (Can cause chickenpox, herpes simplex and mononucleosis) (3) Epstein-Barr virus (Causes infectious mononucleosis [mono]) Which drug, taken in excess, can cause liver inflammation? Acetaminophen
California State University San Marcos Explain how enzymes can cause liver inflammation Enzymes can be activated by medications → Oxidative stress in liver → Specific cells will trigger fats in the liver What is the end result of liver inflammation? Scarring → Collagen formation → Fibrous tissue that is nonfunctiona What can non-alcoholic fatty liver disease (NAFLD) lead to? Cirrhosis What is the etiology of NAFLD? Etiology of NAFLD is unknown, but highly correlated with obesity, HLD, DM and metabolic syndromes What is non-alcoholic steatosis (NASH)?
California State University San Marcos What was the cause of post-hepatic jaundice provided in class? Gallstones What was the cause of intrahepatic jaundice provided in class? Hepatocyte injury (inside of the liver) What is the most likely cause of biliary obstruction? Gallstones Why does pruritis occur in advanced liver disease? Bile salts deposit in skin → Pruritus What are spider angiomas? Fine capillaries that fan out
California State University San Marcos Why do spider angiomas occur with liver disease? Liver's ability to metabolize hormones (particularly estrogen) is decreased/impaired → Elevated levels of estrogen (liver unable to process) → Vasodilation What is caput medusa? Dilated veins in umbilical area List 3 liver enzymes tested for liver disorders (1) Alanine transaminase (ALT) (2) Aspartate transaminase (AST) (3) Alkaline phosphatase Where is the liver located? Right upper quadrant of abdomen List the 2 main blood vessels supplying the liver
California State University San Marcos Which liver enzyme tested is the most specific to liver disease? Alanine transaminase (ALT) What are 2 conditions that could results in elevated ALT? (1) Liver disease (2) Bile duct obstruction What is an elevated AST/ALT ratio indicative of? Alcoholic liver disease Other than liver enzymes, list 4 other lab tests that will be used for liver disease? (1) Albumin level
California State University San Marcos (2) Prothrombin time (PTT) (3) Blood ammonia (NH3) (4) Hepatitis serology: HAV, HBV, HCV In a patient with liver disease, what would be seen in their liver biopsy? Mallory bodies What is the most common cause of chronic liver disease in the U.S.? Non-alcoholic fatty liver disease (NAFLD) What is steatosis? Greater than 5% of liver contains fat What happens to the hepatocytes in NAFLD?
California State University San Marcos Obvious signs of liver impairment including edema, jaundice, fatigue What can NASH lead to? hepatocellular carcinoma (HCC) What is the treatment for NAFLD? Treat the metabolic syndrome and/or lifestyle changes (i.e. low fructose diet, weight loss) Why is gynecomastia in males a symptom of alcoholic liver disease? Impaired estrogen metabolism What condition is carbohydrate-deficient transferring (CDT) levels highly sensitive for? Alcohol use disorder
California State University San Marcos What condition is gamma-glutamyl transferase (GGT) levels highly sensitive for? Alcohol use disorder What is ethyl glucuronide? Biomarker alcohol usage (present in body for 3-4 days after consumption of alcohol) Why might a patient be tested for ethyl glucuronide? A patient who is qualifying for a liver transplant may be tested for ethyl glucronide, to confirm alcohol abstinence List 3 causes of cirrhosis (1) Hepatitis C Virus (HCV) infection (2) Alcoholic liver disease (3) NAFLD
California State University San Marcos What is the liver failure complication that has the 3 following characteristics?: (1) ↓ Fat digestion (2) Steatorrhea (3) ↓ Fat-soluble vitamin absorption Decreased bile synthesis List 2 characteristics of ↓ coagulation factors (Thrombocytopenia) (1) Bleeding (2) Bruising What is the term for the liver failure complication that results in progressive fibrosis of the palmar fascia? Dupuytren contracture
California State University San Marcos Describe the pathophysiology of dupuytren contracture as it relates to liver failure Connective tissue under the skin of the palm starts to shorten and tighten → Alcohol can directly stimulate the proliferation of collagen What is Fetor hepaticus? Sweet odor of breath due to dimethyl sulfide What is the pathophysiology behind fetor hepaticus? Different volatile acids building up in the bloodstream, due to not being processed by the liver What condition can folate deficiency caused by liver disease lead to? Anemia
California State University San Marcos What does a decrease in thrombopoietin due to liver failure result in? Low platelets What sign/symptom does a decrease in bilirubin conjugation due to liver failure result in? Jaundice What does a decrease in detoxification due to liver failure result in? High drug/hormone levels What does a decrease in deamination due to liver failure result in? High nitrogen levels
California State University San Marcos What does s healthy liver convert ammonia into? Urea What are 2 potential results of hepatic encephalopathy due to liver failure? (1) Confusion seizure (2) Uncal herniation Explain the pathophysiology behind the development of uncal herniation due to liver failure. In liver disease, nitrogenous wastes as build up (including NH3) → Hepatic encephalopathy → ↑ ICP → Uncal herniation Why does liver failure lead to osteoporosis? Vitamin D malabsorption. Liver stores A, D, E & K.
