Liver Labs & Assessment
Which liver enzyme is most specific for hepatocellular injury and is used to monitor for liver damage?
ALT (Alanine Aminotransferase )
What is jaundice, and what physical signs should a nurse assess for?
What is yellow discoloration of body tissues, especially the sclera and palate, due to elevated bilirubin?
How is Hepatitis A transmitted, and is it vaccine-preventable?
What is fecal-oral transmission (contaminated food/water), and yes, it's vaccine preventable (2-shot series)?
What is portal hypertension, and what causes it in cirrhosis?
: What is increased pressure in the portal vein caused by fibrosis and scarring of liver tissue that obstructs blood flow?
What is cholelithiasis, and what are the common risk factors remembered by the “5 Fs”?
What is the presence of gallstones, with risk factors:
Female, Fertile, Forty, Fat, Fair
What does an elevated PT/INR indicate in a patient with liver disease?
What is decreased synthesis of clotting factors, indicating worsening liver dysfunction?
Normal INR is 0.9–1.1.
In hemolytic jaundice, which type of bilirubin is elevated?
unconjugated (indirect) bilirubin?
Which viral hepatitis types can lead to chronic hepatitis and are bloodborne?
What are Hepatitis B and Hepatitis C?
What are two physical signs of ascites you might see in a patient with cirrhosis?
What are abdominal distension, weight gain, fluid wave, or shortness of breath from diaphragm pressure?
What is the classic pain pattern in biliary colic caused by a gallstone?
What is sharp RUQ pain, often after fatty meals,
Low albumin levels in liver disease contribute to what major complication?
What is edema or ascites, due to loss of oncotic pressure?
What are the common causes of hepatocellular jaundice, and what lab pattern would you expect?
What are hepatitis, cirrhosis, or liver cancer, with elevated both conjugated and unconjugated bilirubin?
A patient has elevated levels of both conjugated and unconjugated bilirubin, with a history of hepatitis. What type of jaundice is this, and what is the underlying pathophysiology?
What is hepatocellular jaundice?
when damaged liver cells leak conjugated bilirubin into the bloodstream and also fail to properly conjugate all the unconjugated bilirubin, leading to elevation of both forms.
What causes esophageal varices in cirrhosis, and why is bleeding dangerous?
bonus: what should you avoid in esophageal varices
What is increased portal pressure leading to dilated veins in the esophagus — they can rupture easily and cause life-threatening hemorrhage?
What is Murphy’s sign, and what does it suggest?
What is pain with deep palpation of the RUQ during inspiration, suggesting cholecystitis?
Why does thrombocytopenia occur in cirrhosis?
What is splenomegaly, which sequesters platelets and lowers circulating levels?
In hemolytic jaundice, which type of bilirubin is elevated?
What is unconjugated (indirect) bilirubin?
What are the common symptoms during the icteric phase of viral hepatitis?
What are:
Jaundice
Dark urine
Clay-colored stools
Pruritus
Nausea
Hepatomegaly
What is the appropriate dietary recommendation for a patient with both ascites and hepatic encephalopathy?
A: What is a low sodium, controlled protein diet?
Which laboratory values may be elevated if a gallstone is obstructing the common bile duct, and what other organ might be affected?
What are AST, ALT, and bilirubin, which may be elevated due to bile backing up into the liver — and amylase/lipase if the pancreas is also involved
In what clinical situation should ammonia levels be monitored in a liver patient?
What is hepatic encephalopathy — to evaluate mental status changes caused by ammonia buildup?
What are the key lab findings in cholestatic jaundice?
What are:
Elevated conjugated (direct) bilirubin
Positive urine bilirubin
Absent urobilinogen (due to bile flow blockage)
What are the three phases of illness in both Hepatitis A and B, and what happens in each?
A:
Pre-icteric – Malaise, headache, fever, arthralgias
Icteric – Jaundice, dark urine, clay stools, hepatomegaly
Post-icteric – Jaundice resolves, fatigue and hepatomegaly slowly improve
A patient with cirrhosis presents with 4+ pitting edema, massive ascites, and low serum albumin. What hormonal imbalance contributes to this fluid retention, and why?
What is hyperaldosteronism, caused by the liver’s decreased ability to break down aldosterone, leading to sodium and water retention?
A patient with suspected cholecystitis is scheduled for an ERCP. What is the purpose of this procedure, and what are two complications the nurse should monitor for after?
ERCP (Endoscopic Retrograde Cholangiopancreatography) is used to visualize the biliary tree and remove stones from the common bile duct
The nurse should monitor for pancreatitis and infection (especially cholangitis or sepsis)