Adult Health- Management of patients with problems of the liver, pancreas, and gallbladder Flashcards Preview

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Flashcards in Adult Health- Management of patients with problems of the liver, pancreas, and gallbladder Deck (22)
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1

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,
aldosterone

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
Carbohydrate metabolism
Lipid metabolism
Amino acid metabolism
Waste product removal
Vitamin storage
Mineral storage
Drug inactivation

2

What are the metabolic activities of the liver?

Carbohydrate metabolism
Lipid metabolism
Amino acid metabolism
Waste product removal
Vitamin storage
Mineral storage
Drug inactivation

3

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

4

what is compensated cirrhosis?

, the liver has significant scarring but performs essential functions without causing significant symptoms

5

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
Autoimmune hepatitis
Steatohepatitis (fatty liver)
Drugs and toxins (NSAIDs as well- primarily Tylenol)
Biliary disease
Metabolic/genetic causes
Cardiovascular disease (chronic right-heart failure)

6

Describe clinical manifestations of early liver disease

In early stages, signs of liver disease include:
Fatigue
Significant change in weight
GI symptoms
Abdominal pain and liver tenderness
Pruritus- itching

7

Describe clinical manifestations of late stages of liver disease

In late stages, the signs vary:
Jaundice and icterus
Dry skin
Petechiae, or ecchymoses (lesions)
Warm, bright red palms of the hands
Spider angiomas
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

8

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

9

What is fetor hepaticus?

breath odor that is kinda musty

10

What is asterixis?

flappy hands

11

what is melena?

old blood in the stool- dark purplish or dark tarry stool

12

what are some physical assessments with liver disease?

Assess for presence of bleeding
Fetor hepaticus (breath odor)- musty odor
Amenorrhea
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
spider angiomas!

13

What are some complications of cirrhosis?

Portal hypertension

Ascites

Bleeding esophageal varices

Coagulation defects

Jaundice

Portal-systemic encephalopathy with hepatic coma

Hepatorenal syndrome

Spontaneous bacterial peritonitis (distention, hard abdomen, a bunch of rebound painful tenderness, and signs of infection.) possible paracentesis to get a sample

14

Describe an abdominal assessment of liver disease/cirrhosis

Massive ascites

Umbilicus protrusion

Caput medusae (dilated abdominal veins)

Hepatomegaly (liver enlargement)

15

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

16

Will total serum protein and albumin levels increase or decrease?

DECREASE

17

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

18

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

19

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 1206)
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.

20

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

21

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)

22

What are some comfort measures for hepatopulmonary syndrome?

For dyspnea, elevate the head of the bed at least 30 degrees, or as high as the patient wishes to help minimize shortness of breath (decreases abdominal pressure on lungs)

Patient is encouraged to sit in a chair

Weigh patient in standing position, because supine position can aggravate dyspnea