Transcript: (cc) photo by Metro Centric on Flickr doodles the circulatory system interacts with the lungs in the repatory system. the two systems interact through the aveoli and the viens. lungs notes Budapest San Francisco Notes Stockholm Our Project (cc) photo by jimmyharris on Flickr (cc) photo by Franco Folini on Flickr Double click to crop it if necessary the organ ososiated with the lungs is the heart because the heart transfirs oxegen filled blood throgh the body. the lungs are located on the back bone and are on ether side of the heart. Research outlook the lungs are used to exchange gases. the lungs are apart of the respetory system. photo frame Place your own picture behind this frame! the tisse of the lungs are called squamous eithelial. (cc) photo by Metro Centric on Flickr details map Assets heath risks of the respatory system are, lung cancer and broncituos. lung cancer is caused by smoking. broncitous is caused from flooids filling the lungs. Important Details
Transcript: Examined Thompsons Micromedex Drugdex System and the Swedish Adverse Drug Advisory Committee databases Statistically significant relationship found between daily dose and poor outcome (death or liver transplant) in Swedish DILI cases. Non-significant trend in relationship between daily dose and ALTx3 and jaundice. 77% of all serious DILI cases belonged to the 50mg/day or greater group Antibacterials and nonsteroidal anti-inflammatory drugs were overrepresented in the 50mg/day+ group Could be these kinds of drugs, rather than the higher doses that cause the significant differences Ball, K., Kowdley, K. V. (2005). A Review of Silybum marianum (Milk Thistle) as a Treatment for Alcoholic Liver Disease. Journal of Clinical Gastroenterology. Vol. 39 (6) p 520-528. Retreived from http://ovidsp.tx.ovid.com.ezproxy.kwantlen.ca:2080/sp- 3 3.9.0b/ovidweb.cgi?&S= NKAMFPMCJMDDAADCNCOKLGFBHEBEAA00&Abstract=S.sh.22%7c1%7c1 Canadian Liver Foundation. (2013). Liver Disease. Retrieved July 20, 2013 from http://www.liver.ca/liver-disease/ Hackett, E. S., Twedt, D. C., & Gustafson, D. L., (2013). Milk Thistle and its Derivative Compounds: A Review of Opportunities for Treatment of Liver Disease. Journal of Veterinary Internal Medicine. Vlume 27(1) . Retreived from http://onlinelibrary.wiley.com.ezproxy.kwantlen.ca:2080/doi/10.1111/jvim.12002/pdf Hood, B. & Nowicki, M. J. (2010). Eosinophilic Hepatitis in an Adolescent During Lisdexamfetamin Dimesylate Treatment for ADHD. Pediatrics. 2010(125) 1510-1513. doi:10.1542/peds.2009-1835 Lammert, C., Einarsson, S., saha, C., Niklasson, A., Bjornsson, E., Chalasani, N. (2009). Relationship between daily dose of Oral Medications and Idiosyncratic drug-induced liver injury: Search for signals. Hepatology, Vol. 2008 (47), 2003-2009. doi.10.1002/hep.22272 Loguercio, C., and Festi, D. (2011). Silybin and the liver: From basic research to clinical practice. World Journal of Gastroenterology 12(18)2288-2301. doi:10.3748/wjg.v17.i18.2288 Szabo, G., & Pranoti, M. (2010). Focus on: Alcohol and the liver. Alcohol research & health Vol. 33(1) 87-96. Retrieved from http://ezproxy.kwantlen.ca:2048/login?url=http://search.proquest.com.ezproxy.kwantlen.ca:2080/docview/745600472?accountid=35875 Vanga, R. R., Bal, B., & Olden, K. W. (2013). Adderall Induced Acute Liver Injury: A Rare Case and Review of the Literature. Case Reports in Gastrointestinal Medicine, 2013 . Retreived from http.//dx.doi.org/10 .1155/2013/902892 11-49mg/day 32%* References Your Liver on Drugs Alcohol disrupts the intestines healthy microbial flora acetalydehyde (alcohol metabolite) disrupts proteins in cell walls in the gut degrades gut barrier causes leaky gut Too much endotoxin bacteria makes it to the liver Endotoxin interacts with Kupffer cells Causes secretion of cytokines and chemokines promoting inflammatory responses Chronic inflammation leads to hepatitis, fibrosis, cirrhosis Apoptosis (programmed cell death) Eliminates unneeded hepatocytes and damaged DNA Stop drinking!!! Alcohol Alcoholic liver disease (ALD) One of the leading causes of alcohol-related death 12th leading cause of death in USA your poor liver... Whilst you are sporting a happy drunk glow on the outside... Oxidative Stress Immune Response 11% Pemoline (Cylert) removed from the market due to liver-injury fatalities Hood & Nowicki (2010) case study Atomoxetine (SNRI) treats ADHD in children 14 yr old 2010, eosinophilic hepatitis via lisdexamfetamine dimesylate (D-amphetamine) taking regular dose for five months no family history of liver problems Venga, Bal, & Olden (2013) case study Adderall induced acute liver injury 55 yr old Took 2x prescribed amount of Adderall for 5 days, took with other drugs including aspirin 12% 50mg/day + Gut-Liver Axis 14%* 11-49mg/day “Chemical Factory” Contains molecules called enzymes Eg: alcohol dehydrogenase First pass metabolism Enzymes change other molecules Metabolism (detoxification) Metabolites (less harmful, more useful) Amount of enzyme available determines this process Cirrhosis Liver Review One of the most frequent causes of acute liver failure in the US Generally thought to be unpredictable and not dose-dependent Hypersensitivity, metabolic idiosyncracy HowEVER: Most drugs withdrawn from the market or have warnings for hepatoxicity have prescribed daily doses of more than 50mg Which drugs are harder on your liver: antidepressants, anxiolytics, anti-inflammatories or antibiotics? AHDH medicines are known to cause hepatic injury Rare cause of idiosyncratic drug reactions in US 13% of toxin induced liver injury In Spain, Amphetamine (and Ecstasy) are the 2nd most common cause of acute hepatitis under 25 years Mechanism Decreased clearance of metabolites Idiopathic hypersensitivity Neoantigen-induced autoimune hepatitis (CYP2D6– isoenzyme) Anti-liver/kidney antibodies Impaired metabolism Genetic mutations of CYP2D6 5-9% of Caucasians, 1-2% of Americans and Asians lack CYP2D6 cannot clear the drug causes liver damage
Transcript: Liver The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion. The liver is necessary for survival; there is currently no way to compensate for the absence of liver function long term, although liver dialysis can be used short term. This organ plays a major role in metabolism and has a number of functions in the body, including glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification. It lies below the diaphragm in the abdominal-pelvic region of the abdomen. It produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The liver's highly specialized tissues regulate a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions. Medical terms related to the liver often start in hepato- or hepatic from the Greek word for liver The liver is a reddish brown organ with four lobes of unequal size and shape. A human liver normally weighs 1.4–1.6 kg (3.1–3.5 lb), and is a soft, pinkish-brown, triangular organ It is located in the right upper quadrant of the abdominal cavity, resting just below the diaphragm. The liver lies to the right of the stomach and overlies the gallbladder. It is connected to two large blood vessels, one called the hepatic artery and one called the portal vein hepatic artery carries blood from the aorta By: Jennifer sunderland
Transcript: huddle Mrs. Rossi huddle to crowd together crowd huddle separate
Transcript: Liver - An Accessory Organ • More than 500 vital functions have been identified with the liver. Some of the more well-known functions include the following: • Excretes bile, which helps carry away waste products from the liver and break down fats in the small intestine during digestion • Produces cholesterol and special proteins to help carry fats through the body • Converts excess glucose into glycogen for storage (which can be later used for energy) • Regulated blood levels of amino acids, which form the building blocks for proteins • Processing of hemoglobin for use of its iron content (the liver stores iron) • Conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine) • Clearing the blood of drugs and other poisonous substances • Regulating blood clotting • Resisting infections by producing immune factors and removing bacteria from the bloodstream The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. Common Liver Diseases When the liver has broken down harmful substances, its by-products are excreted into the bile or blood. Bile by-products enter the intestine and ultimately leave the body in the form of feces. Blood by-products are filtered out by the kidneys, and leave the body in the form of urine. Functions: • The liver regulates most chemical levels in the blood • All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down the nutrients and drugs into forms that are easier to use for the rest of the body. Did you know? The liver can lose three-quarters of its cells before it stops functioning. In addition, the liver is the only organ in the body that can regenerate itself. The liver is located in the upper right-hand portion of the abdominal cavity Large meaty organ is shaped like a cone the liver is a dark reddish-brown organ weighs about 3 pounds Rubbery to the touch Two sources that supply blood to the liver, including: Oxygenated blood flows in from the hepatic artery Nutrient-rich blood flows in from the hepatic portal vein The liver holds about one pint (13 percent) of the body's blood supply at any given moment. The liver consists of two main lobes, both of which are made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct, which transports the bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine). Hepatitis: Swelling and inflammation of the liver Cholestasis: a condition in which the flow of bile from the liver is blocked Jaundice: if the liver doesn't break down enough of the bilibrubin, which is formed by old red blood cells, it builds up and causes jaundice.
Transcript: Social support and community services need to be identified (finances are frequently a problem): The American Liver Foundation (www.liverfoundation.org) 75 Maiden Lane. Suite 603 NewYorK NY 10038 [800) 465-4837 or (888) 443-7872 [24 hours/seven days a week] From: National Resources for Specific Disabilities. (2012). Exceptional Parent, 42(1), 8-41. American Gastroenterological Association (www.gastro.org) Home Care Management The patient is provided with a home care referral In collaboration with the patient, family, and case manager, the nurse assesses physical adaptation needed to prepare the patient's home for recovery The patient is provided with referral for physical therapy, nutrition therapy, and transportation for follow-up The patient's rest area is close to bathroom (increased frequency of urination and stools) Serum Electrolyte Levels Sodium-122 Potassium-2.7 Calcium-7.2 Chloride-73 Phosphorus-1.7 CO2-24 HCO3-19 Case Study Health Teaching The patient is discharged with an individualized teaching plan (nutrition therapy, drug therapy, and alcohol abstinence). Drug Therapy The patient will take diuretics and/or preventive beta blocker. He needs to contact his physician, if he experience muscle weakness, irregular heartbeat, or light-headedness (The side effects of diuretics are hypokalemia. The patient may need to take a potassium-sparing diuretics or potassium supplements) He will take medication to prevent gastrointestinal bleeding He will take lactulose syrup to maintain two or three bowel movements every day The patient will not take any other medications unless specifically prescribed (he will avoid over-the-counter drugs, especially NSAIDs and hepatic toxic herbs, vitamins, and minerals) The patient will keep appointments for follow-up medical care. He will notify his physician if any GI bleeding occur Day 1: Patient becomes hemodynamically stable. Find source of bleeding and control via EGD with Epi and cauterization. Day 2: Balance electrolytes and decrease ammonia levels. Ultrasound guided Paracentesis to remove excess fluid collection from abdomen. Day 3: Day 4: Alcohol Abstinence Important aspects of the need to avoid alcohol and illicit drugs: Prevent further fibrosis of the liver from scarring Allow the liver to heal and regenerate Prevent gastric and esophageal irritation Reduce the incidence of bleeding Prevent other life-threatening complications History 53 year old married Hispanic American Male who is a truck driver presented to the ED. He is currently experiencing alcohol induced cirrhosis, DMII and portal hypertension. He is fairly educated including some college. He has been married for 20 years and has been binge drinking for years, but quit 3 years ago. Physical Assessment Neurological Initially pt presented with behavioral changes noted by his wife, she also mentions he is extremely agitated at times Lethargy is noted Pt is AOX2 Loss of sensation of legs bilaterially Fluids and electrolytes monitoring: obtain laboratories specimens for monitoring of altered fluids and electrolyte levels e.g. bun ,protein, hematocrit, sodium, and potassium level as appropriate keep an accurate record of intake and output weight patient daily and monitor trends monitor for signs and symptoms of fluid retention administer prescribed supplemental electrolytes as appropriate. Bleeding precautions: monitor patient closely for hemorrhage monitor for signs and symptoms of persistent bleeding(for flank or occult bleeding) monitor orthostatic vital signs including blood pressure use electric razor instead of straight edge for shaving use soft toothbrush for oral care avoid injections as appropriate protect patient from trauma which may cause bleeding Nutrition therapy The patient should consume a diet that adheres to the guidelines set by the patient's physician, nurse, or nutritionist (keeping with his financial, cultural, and personal food preferences) Because the patient has excessive fluid in his abdomen, he should follows the low-sodium diet He should eats small, frequent meals that are nutritionally balanced He will includes in his diet daily supplemental liquids (e.g., Ensure or Ensure Plus) and a multivitamin (don't overdose vitamin A) Assessment Cost of Intensive Care Unit; Liver disease is a major source of morbidity and mortality in the intensive care unit (ICU). Cirrhotic patients admitted to the medical ICU have increased mortality (40 to 90%) and a poor prognosis. The Centers for Medicare and Medicaid Services (CMS) estimates that it will pay $41.1 billion in 2012 to hospitals, Intensive Care Unit (ICU), and outpatient services provided to Medicare beneficiaries diagnosed with liver disease. The cost of a night stay in the ICU is US$1783 to US$78 4351. These differences have been attributed to a number of different factors Price of Packed Red Blood Cell and a Unit of Fresh Frozen Plasma The patient with cirrhosis has many medical problems. An optimal physical state is described before
Transcript: Liver cancer is a Malignant Neoplastic disease that occurs in the Liver at a metastasis from another cancer Liver Cancer Condalitions Prevalence 41,000 people have Liver Cancer Symptoms The causes are growing older,Tobacco,sunlight,certain Hormones ,alcohal Causes This is liver cancer Feeling sick,loose of appetite,Feeling worn out,Loose of weight,Itchy skin
Transcript: Organs Discovering the "Digestive System" The Liver is one of the largest organs in the body and it has over 300 functions in the human digestive system. Liver The liver has many different jobs, some of which include; storing glycogen, breaking down unwanted amino acids, regulating vitamin levels, removes iron, produces bile, filters poisons, germs and drugs and makes fibrinogen. The liver is positioned just below the diaphragm in the upper right of the abdomen, with most of it behind the lower right ribcage. The liver is divided into a large right lobe and smaller left lobe by a sheet like ligament. Did you know that the everyone's Liver has between 50,000 and 100,000 Lobules The liver breaks down harmful substances into harmless ones.
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