10.1 Liver cirrhosis

Question 1

Two main blood supply of liver

Answer 1

Portal vein
Hepatic artery

Question 2

Function of liver

Answer 2

Ammonia conversion
Bile formation
Bilirubin excretion
Cholesterol synthesis
Detoxification
Emulsification of fats
Fat metabolism
Glucose metabolism
Protein synthesis
Storage of vitamin, fat and iron

Question 3

Haemoglobin die -> __-soluble ____ bilirubin -> liver -> __-soluble ____ bilirubin -> excreted in bile

Answer 3

Fat soluble unconjugated
Water soluble conjugated

Question 4

Symptom related to bilirubin

Answer 4

Jaundice
Pruritus
Clay stool
Tea colored urines

Question 5

Symptom related to albumin

Answer 5

Edema
Ascites
Increase abdominal girth
Weight gain

Question 6

Symptom related to ammonia

Answer 6

Change of mental status
Sleep disturbances

Question 7

Symptom related to blood clotting factors

Answer 7

Easy bruising
Melena

Question 8

眼白

Answer 8

Sclera

Question 9

palmar erythema

Answer 9

掌面紅斑

Question 10

Spider angiomas

Answer 10

蜘蛛血管痣

Question 11

Muscle atrophy

Answer 11

肌肉萎縮

Question 12

skin excoriation

Answer 12

scratching

Question 13

Asterixis

Answer 13

flap tremor

Question 14

USG

Answer 14

Ultrasonography

Question 15

What if patient allergic to contrast

Answer 15

Provide steriod cover

Question 16

ERCP

Answer 16

Endoscopic retrograde cholangiopancreatography

Question 17

Type of liver cirrhosis

Answer 17

Alcoholic
Post-necrotic
Biliary

Question 18

Liver enlargement belongs to compensated or decompensated

Answer 18

Compensated

Question 19

Purpura

Answer 19

Decrease in platelet
紫斑症

Question 20

Normal liver size

Answer 20

6-12 in midclavicular line

Question 21

Main clinical manifestation of liver cirrhosis

Answer 21

Liver enlargement
Portal hypertension
Ascites
Varices
Jaundice
Coagulopathy
Spontaneous bacterial peritonitis
Edema
Vitamin deficiency and anemia
Pruritus
Hepatic encephalopathy

Question 22

Sign and symptoms of Ascites

Answer 22

Increase body weight
Increase abdominal girth
Increase SOB
Shifting if dullness during percussion

Question 23

Pharmacological management for Ascites

Answer 23

Loop diuretics (lasix)
IV albumin

Question 24

Management for Ascites

Answer 24

Paracentesis (abdominal tapping)

Question 25

Advise for Ascites and reason

Answer 25

Stay bed rest To avoid activation of xxx system and sympathetic nervous systems

Question 26

Surgical intervention of ascite: Shunt location and purpose

Answer 26

From portal vein to hepatic vein To decrease the vascular resistance of liver

Question 27

S/s of jaundice

Answer 27

Yellowish discoloration of skin and sclera Clay color stool Tea color urine Pruritus, fatigue, anorexia

Question 28

Types of jaundice Causes

Answer 28

-Hepatocellular jaundice Caused by liver failure -Obstructive jaundice Caused by obstruction flow of bile ducts

Question 29

Prolonged PT, INR

Answer 29

Coagulopathy PT prothrombin time INR clotting time

Question 30

Why spontaneous bacterial peritonitis

Answer 30

Infected by intestinal flora

Question 31

Formation of edema

Answer 31

Decrease albumin (plasma albumin concentration) Failure to metabolize aldosterone -> increase sodium and water retention Fluid shift from vascular system to peritoneal space

Question 32

Pathophysiology of hepatic encepthalopathy

Answer 32

Increase serum ammonia levels

Question 33

Why provide neomycin and lactulose Route

Answer 33

Neomycin: to destroy bacteria in GI tract, reduce level of ammonia-forming bacteria in colon, reduce protein breakdown and production of ammonia Lactulose: to expel the ammonia in feces, promote excretion of ammonia in stool PO/PR

Question 34

Antidose for acetaminophen(paracetamol) mushroom poisoning

Answer 34

N-acetylcysteine Penicillin G and N-acetylcysteine

Question 35

Drug for nausea vomiting

Answer 35

Antiemetics

Question 36

Patient with liver disorder should avoid what drug

Answer 36

Aspirin Sedative

Question 37

Nursing management: Diet

Answer 37

High calories, carbohydrates, Low sodium(reduce edema), fat Provide oral hygiene to increase appetite and reduce unpleasant smell

Question 38

Nursing management against Ascites

Answer 38

-Small and frequent meal to prevent fullness and bloating -Elevate head of bed to reduce discomfort from abdominal distension

Question 39

Nursing management for pruritus

Answer 39

-Assess skin integrity -Frequent turning to prevent pressure ulcer and skin breakdown -soft clothes and bed lining to prevent skin scratching and infection from scratching -provide tepid water bath, avoid alkaline soap or alcohol-based location