Flashcards in Adult Health- Management of patients with problems of the liver, pancreas, and gallbladder Deck (22)
What are some things the liver does?
Glucose, protein and fat metabolism
Ammonia(found in urea and is the breakdown of protein) conversion
Vitamin (fat soluble vitamins A, D, E, K,) and iron storage
Metabolism of steroid hormones..
sex hormones, glucocorticoids,
Metabolism of drugs
Synthesis of clotting factors:
fibrinogen, prothrombin, factors
V, VII, IX, X
Bile formation and bilirubin excretion
Filtration of blood and removal of bacteria and particulate matter via Kupffer cells
Metabolic Activities of the Liver
Amino acid metabolism
Waste product removal
What are the metabolic activities of the liver?
Amino acid metabolism
Waste product removal
What is cirrhosis?
Cirrhosis is extensive scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis.
Complications depend on the amount of damage sustained by the liver
what is compensated cirrhosis?
, the liver has significant scarring but performs essential functions without causing significant symptoms
Describe the etiology of cirrhosis.
Known causes of liver disease include: see table 58-1
Alcohol (long term alcohol use)
Viral hepatitis (Hep A, B, C, D, E)- inflammation of the liver from some toxin
Steatohepatitis (fatty liver)
Drugs and toxins (NSAIDs as well- primarily Tylenol)
Cardiovascular disease (chronic right-heart failure)
Describe clinical manifestations of early liver disease
In early stages, signs of liver disease include:
Significant change in weight
Abdominal pain and liver tenderness
Describe clinical manifestations of late stages of liver disease
In late stages, the signs vary:
Jaundice and icterus
Petechiae, or ecchymoses (lesions)
Warm, bright red palms of the hands
Peripheral dependent edema of the extremities, sacrum and abdomen (ascites)
If portal vein becomes so scarred that it cannot work well, it will begin to block the fluid that will then cause severe edema and ascites
What happens if the portal vein becomes so scarred that it cannot work well?
it will begin to block the fluid that will then cause severe edema and ascites
What is fetor hepaticus?
breath odor that is kinda musty
What is asterixis?
what is melena?
old blood in the stool- dark purplish or dark tarry stool
what are some physical assessments with liver disease?
Assess for presence of bleeding
Fetor hepaticus (breath odor)- musty odor
Gynecomastia, testicular atrophy, impotence
Bruising, petechiae, enlarged spleen
Neurologic changes (due to increase of ammonia which will cross the blood brain barrier)
Asterixis (flappy hands)
Melena- old blood in the stool – dark purplish- dark tarry stool
What are some complications of cirrhosis?
Bleeding esophageal varices
Portal-systemic encephalopathy with hepatic coma
Spontaneous bacterial peritonitis (distention, hard abdomen, a bunch of rebound painful tenderness, and signs of infection.) possible paracentesis to get a sample
Describe an abdominal assessment of liver disease/cirrhosis
Caput medusae (dilated abdominal veins)
Hepatomegaly (liver enlargement)
Describe a laboratory assessment for liver disease and cirrhosis.
Aminotransferase serum levels and lactate dehydrogenase may be elevated
Alkaline phosphatase levels may increase
Total serum bilirubin and urine urobilinogen levels may increase (fecal urobilinogen may fall)
Total serum protein and albumin levels decrease
Will total serum protein and albumin levels increase or decrease?
Will total serum bilirubin and urine urobilinogen levels increase or decrease? and what about fecal urobilinogen?
Increase in total serum bilirubin and urine urobilinogen
Decrease in fecal urobilinogen
What are some more laboratory assessments for liver disease and cirrhosis?
Prothrombin time is prolonged; platelet count is low.
Hemoglobin and hematocrit values are decreased.
Ammonia levels are elevated.
Serum creatinine level is possibly elevated
When would you do a liver biopsy?
Liver biopsy may be used to confirm the diagnosis of hepatitis and to establish the stage and grade of liver damage. Characteristic changes help the pathologist distinguish among a virus, drug, toxin, fatty liver, iron, and other disease. It is usually performed in an ambulatory care setting as a percutaneous procedure (through the skin) after a local anesthetic is given. If coagulation is abnormal, however, it may be done using either a CT-guided or transjugular route to reduce the risk for pneumothorax or hemothorax. Ultrasound also may be used.
Ignatavicius, Donna, M. Workman. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th Edition. Saunders, 2016. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.
What are some interventions for excess fluid volume?
Nutrition therapy consists of low sodium diet, vitamin supplements
Drug therapy includes a diuretic (Aldactone first line) electrolyte replacement
Paracentesis is the insertion of a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity (chart 58-1) KNOW THIS
Observe for possibility of impending shock
What is a paracentesis?
is the insertion of a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity (chart 58-1)