Assessment and mgmt of pt with liver disorders Flashcards

Question

Diagnostics for liver dysfunction

Answer 1

* Ultrasound * CT scan * MRI * ERCP (Endoscopic retrograde cholangiopancreatography) * Transient liver elastography (Stiffness of the liver) * Liver biopsy (Invasive)

Answer 2

* Exposure to hepatotoxic substances (Environmental exposures) * Infections (Hepatitis) * Travel, substance use disorder * Lifestyle (High risk behaviors) * Meds, OTC supplements (Patient won't tell you all the supplements that they take) * Familial liver disorders

Answer 3

* May be pale from anemia * Jaundice * Jaundice can lead to pruritus and excoriations * Peticuli * Spider angiomas

Answer 4

* Skin * Cognitive status * Motor function * Abdomen: Palpation and percussion

Answer 5

* Cognitive changes * Altered sleep wake * Gastroesophageal bleeding- hematemesis, melena * Splenomegaly * Ascites * Jaundice * Petechiae, ecchymosis, nosebleeds * Palmar erythema * Spider angiomas * Dependent peripheral edema of extremities and sacrum * Asterixis * Fetor hepaticus * Gyneo, testicular shrinkage

Answer 6

Coarse tremor that causes a flapping motion of the wrist to occur

Answer 7

Breath smells fruity, or stool

Answer 8

Liver cant break down estrogen leading to increased levels

Answer 9

Inflammation of the liver, when liver disease progresses and cirrhosis occurs, the liver will shrink down and pain will subside

Answer 10

1. Ascites: Absent 2. Bilirubin: < 2 3. Albumin: >3.5 4. Prothrombin time: 1-3 5. Encephalopathy: None ## Footnote Probably dont need to know

Answer 11

1. Ascites: Slight 2. Bilirubin: 2-3 3. Albumin: 2.8-3.5 4. Prothrombin time: 4-6 5. Encephalopathy: Grade 1-2 ## Footnote Probably dont need to know

Answer 12

1. Ascites: Moderate 2. Bilirubin: > 3 3. Albumin: < 2.8 4. Prothrombin time: >6 5. Encephalopathy: Grade 3-4 ## Footnote Probably dont need to know

Answer 13

* Fatty liver disease (Non-alcoholic fatty liver disease, Nonalcoholic steatohepatitis) * Infection (Hepatitis) * Cirrhosis of the liver (Compensated vs decomp) * Liver failure (Acute, Endstage)

Answer 14

* Jaundice (Billirubin build up) * Portal hypertension * Varicies (esophgeal) * Acities * Hepatic encephalopathy and coma * Nutritional deficiencies (Often with alc)

Answer 15

* Yellow or greenish-yellow sclera and skin (Not too much discoloration) * Bilirubin levels greater than 2 * Most commonly associated with liver disease * **Dmg liver cells from infection, excessive alc use, and prolonged obstructive jaundice** * Mild to severely ill * Lack of appetite, N+V, weight loss * Malaise, fatigue, weakness * HA, chills , fever, infection

Answer 16

* Yellow or greenish-yellow sclera and skin * Bilirubin levels greater than 2 * Most commonly associated with liver disease * Extrahepatic (Gallstones, inflammatory processes, tumor) * Intrahepatic (Stasis, thickening of bile in canaliculi) * Dark orange/brown colored urine, **Clay colored stool** * Indigestion and intolerance of fats, impaired digestion * Pruritus * Skin excoriation from scratching (Jaundice makes you itchy) ## Footnote More jaundiced than other forms of jaundice

Answer 17

* Yellow or greenish-yellow sclera and skin * Bilirubin levels greater than 2 * From the breakdown of RBC

Answer 18

* Obstructed blood flow through the liver results in increased pressure throughout the portal venous system * Causes Ascites * Causes Esophageal and gastric varices * Splenomegaly sometimes too ## Footnote (Essentially due to this pressure, it forces fluid to follow the path of least resistance and go where it normally woudnt )

Answer 19

Caused by portal hypertension * Decreased serum osmotic pressure with movement of albumin from intravascular space to extravascular space including peritoneal cavity: Peripheral edema and ascites * Genital swelling * Can also occur from cancer, Kidney disease and HF ## Footnote Essentially albumin gets moved into peritoneal space and water follows it

Answer 20

* Record the abdominal girth and weight daily (Can have rapid weight gain and fluid buildup)

Answer 21

* Striae * Distended veins (Caput medusae) * Abdominal hernia

Answer 22

* percussion for a shifting dullness (Dullness=fluid) * Fluid wave

Answer 23

Dyspnea can occur with ascites for 3 main reasons 1. Anemia 2. Fluid is pressing on the diaphragm, limiting expansion 3. Fluid has moved into the pleural cavity, causing a pleural effusion

Answer 24

Monitor for potential fluid and electrolyte imbalances * Sodium: Reabsorbed by the kidney * Potassium is often imbalanced * Renal function

Answer 25

Test for ascites * Pt puts hand midline and then the nurse presses on one side, if fluid is in the abdomen you are able to feel it on the opposite side, if not its not fluid

Answer 26

Fluid, and it should shift with gravity with ascites

Answer 27

* Low sodium, fluid restrictions ( People hate this) * Diuretics (Spironolactone is the choice, also furosemide) * Bedrest (During exasperations, standing up causes fluid retention, as ADH levels increase, bed rest helps ya pee) * Paracentesis (Draining the abdomen, can cause hypotension) * Administration of salt poor albumin * Transjugular intrahepatic portosystemic shunt (TIPS) (Shunt to help with portal hypertension) * Peritoneal drains

Answer 28

Spironolactone: First line therapy due to its K+ sparing effects

Answer 29

K+ sparing diuretic Blocks the activity of aldosterone, increasing urination and sodium excretion Decreased overall fluid volume Can be given with furosemide to decrease K+ levels

Answer 30

* Mild Hyponatremia, Hypomagnesemia, hypocalcemia, abdominal pain, N+V, leg cramping, dizziness, lightheadedness, male gyno * Serious **Hyperkalemia, hypotension** , decreased kidney function, anaphylaxis, steven johnson syndrome, toxic epidermal necrolysis

Answer 31

* Occurs as liver disease progresses * Dilated, knotty veins of esophagus and stomach that develop due to **portal vein hypertension** and obstruction of portal venous circulation * Manifestations: **GI bleeding** hematemesis, melena and hemorrhagic shock * Prevention: Pt with cirrhosis should undergo screening endoscopy every 2-3 years to monitor for varices ## Footnote GI bleeding is main thing, they are vomiting alot of blood

Answer 32

* Balloon tamponade (Needs sedation), saline lavage (Cold water on the bleeding wound) * ICU most likely * **Treat hemorrhagic shock** (ABC) * Oxygen, maintain **Airway** may need intubation * IV fluids, electrolytes, volume expanders and blood products * Vasopressin, Somatostatin, **Octreotide** * Nitro in combo with vasopressin to reduce coronary vasoconstriction * Propranolol and nadolol (Beta blockers), decreasing portal pressure

Answer 33

* Endoscopic sclerotherapy * Endoscopic variceal ligation (Esophageal banding, placing a band to stop blood flow to that area) * Transjugular intrahepatic portosystemic shunt (TIPS) * Surg mgmt

Answer 34

* Life threatening issue * Two main issues: HE and coma 1. Hepatic insufficiency 2. Portosystemic shunting * Accumulation of ammonia levels in the blood (Ammonia enters the brain and causes neuro changes) * Early signs: Mental status changes and motor disturbances

Answer 35

Cause of Hepatic Encephalopathy and coma inability for the liver to detox toxic by products of the metabolism (ammonia)

Answer 36

Cause of Hepatic Encephalopathy and coma Collateral vessels develop allowing elements of the portal blood (Filled with toxins extracted by the liver) to enter they systemic circulation

Answer 37

Assessment * EEG * Changes in LOC and motor function **(First sign)** * Potential seizures * Fetor hepaticus (Poop breath) asterixis (Flappy wrist) * Monitor fluid, electrolyte and ammonia levels Stages * 1-4

Answer 38

* Normal LOC with periods of lethargy and euphoria * Reversal of day night sleep patterns * Impaired writing and ability to draw line figures * Normal EEG

Answer 39

* Increased drowsiness * Disorientation * Inappropriate behavior * Mood swings * Agitation * Asterixis * Fetor hepaticus * Abnormal EEG with generalized slowing

Answer 40

* Stupor: Difficult to rouse * Marked confusion * Incoherent speech * Asterixis * Absent deep tendon reflexes * Rigidity of extremities * EEG markedly abnormal

Answer 41

* Comatose, may not respond to painful stimuli * Absence of asterixis * Absence of deep tendon reflexes * Flaccidity of extremities * EEG markedly abnormal

Answer 42

* Reduce protein intake * Reduction of ammonia from systemic circulation by gastric suction, lactulose, enemas, oral antibiotics (Kill ammonia producing bacteria in gut) * Discontinue sedatives, analgesics and tranquilizers and any other med which can affect liver function

Answer 43

* Lipids accumulate in hepatocytes * NAFLD * NASH * Combination of obesity and heavy drinking -> severe liver dmg (Can take 20-30 yrs to develop into ESRD) * Those at risk should be monitored closely for S+S liver dysfunction ## Footnote Obesity and drinking

Answer 44

* Lipids accumulate in hepatocytes * NAFLD * NASH * Combination of obesity and heavy drinking -> severe liver dmg (Can take 20-30 yrs to develop into ESRD) * Those at risk should be monitored closely for S+S liver dysfunction ## Footnote Obesity and drinking

Answer 45

Less serious than NASH Associated with obesity

Answer 46

More serious than NAFLD Results in dmg, fibrotic changes in the liver (Cirrhosis) ## Footnote Assosiated with obesity

Answer 47

* ABCDEG * Causes necrosis and inflammation of liver cells, resulting in liver enlargement and obstruction of blood flow to the liver

Answer 48

* Toxic and drug induced * Alc, hepatotoxic chemicals, Botanical agents * S+S: Anorexia, N+V, jaundice, hepatomegaly, bleeding, chills, fever, rash, pruritus * Recovery unlikely of prolonged period, with exposure and symptoms ## Footnote Acetaminophen, mushrooms, carbon tetracholoride

Answer 49

* Flu like symptoms (Fatigue, Decreased appetite, N, Ab pain, joint pain) * Physical (Fever, vomiting, dark colored urine, clay colored stool, jaundice)

Answer 50

* Source: Feces * Route of transmission: Fecal oral * Chronic infection: No * Prevention: Pre and post immunizations

Answer 51

* Source: Blood, blood derived bodily fluids * Route of transmission: Percutaneous membranes * Chronic infection: Yes * Prevention: Immunization

Answer 52

* Source: Blood, Blood derived body fluids * Route of transmission: Percutaneous permucosal * Chronic infection: Yes * Prevention: Blood donor screening , risk behavior modification

Answer 53

* Source: Blood/ blood derived body fluids * Route of transmission: Percutaneous permucosal * Chronic infection: Yes * Prevention: Immunizations, risk behavior modification ## Footnote Cant have D without B

Answer 54

* Source: Feces * Route of transmission: Fecal oral * Chronic infection: No * Prevention: Ensure safe drinking water

Answer 55

* Spread by poor hand hygiene or sanitation **Fecal oral ** * Ingestion of contaminated food or water, especially shellfish * Contact with infected stool (Incontinence, anal sex) * Hep A antibodies reveal presence of Hep A * S+S: Mild flu like symptoms, low grade fever, anorexia, later jaundice , and dark urine , indigestion and epigastric distress enlargement of liver and spleen * Mgmt: Bedrest during acute stage, and supportive care | Not chronic

Answer 56

* Spread by poor hand hygiene or sanitation **Fecal oral ** * Ingestion of contaminated food or water, especially shellfish * Occurs often with food service industry * Contact with infected stool (Incontinence, anal sex) * Hep A antibodies reveal presence of Hep A * S+S: Mild flu like symptoms, low grade fever, anorexia, later jaundice , and dark urine , indigestion and epigastric distress enlargement of liver and spleen * Mgmt: Bedrest during acute stage, and supportive care | Not chronic

Answer 57

* Hep A immunization * Immune globulin for passive immunity to close contacts, non-immune and institutionalized * Good handwashing, safe water and proper sewage disposal * No treatment except supportive

Answer 58

* Transmitted via: Blood, saliva, semen , and vaginal secretions, STI, transmitted to infant at birth * Major cause of cirrhosis and liver cancer (Chronic infections) * Manifestations: Insidious and variable, similar to hep , loss of appetite, dyspepsia, ab pain , aching, malise and weakness, +/- jaundice (Clay colored stool, dark urine * Hep B antigen indicates a person is infectious, chronic carriers are infectious * Can be chronic

Answer 59

* Acute infection: no meds, supportive care * Chronic infection: They are unable to clear the virus and given **antivirals are needed** * Bedrest and nutritional support * Passive immunization with hep B immune globulin * Vaccine is available

Answer 60

* Transmission is via blood * 1/3 cases of liver cancer are caused by this and is the #1 reason for liver transplant * Risk factors are the same for Hep B, Blood and all that * **Symptoms are usually mild if at all** * Can have the disease and not know they have it, leading to transmission to others * Chronic cases are common

Answer 61

* No found benifit to rest, vitamins and diet * Give Direct acting antivirals, can be undetectable and cured 8-12 weeks of completed treatment * Alc progresses diseases, pt cannot drink when they have hep C * Meds that affect the liver should be avoided

Answer 62

* Newer med that is given for hep C * Destroys the virus directly, preventing further replication * More effective than prior antivirals, less side effects * Can be undetectable and cured in 8-12 weeks ## Footnote Simeprevir, sofosbtavit, paritaprevir, glecaprevir, grazoprevir

Answer 63

* Main thing is you cant have Hep D without B (Needs the hep B antigen) * Blood and sexual contact transmission, injectable drugs, hemodialysis and recipients of multiple blood transmission * S+S similar to hep B, but more likely to develop **acute, fulminant liver failure or chronic active hepatitis and cirrhosis** * High dose interferon For **ONE year**

Answer 64

Fecal oral transmission, contaminated water mainly * Resembles hep A, self limiting, abrupt onset, not chronic * No treatment except supportive care

Answer 65

False, only pt with hep B can get hep D

Answer 66

Scar tissue surrounds the portal areas, most common

Answer 67

Broad bands of scar tissue across the liver

Answer 68

Scarring occurs in the liver around the bile ducts Occurs from chronic biliary obstruction

Answer 69

Replacement of normal liver tissue with **diffuse fibrosis** Liver becomes fibrotic and nodular

Answer 70

* Liver enlargement (Shrinking later into the disease, when fibrosis progresses) * Portal obstruction * Ascites * Infection/peritonitis * Varices * Edema * Vitamin deficiency * Anemia * Mental deterioration

Answer 71

* Acetaminophen * Alc * Coke * Nsaids * Kava Kava * Mushrooms

Answer 72

Depends on successful Immune suppression

Answer 73

MELD score

Answer 74

* Rejection of transplanted liver * S+S of acute liver injury like inflammation of liver

Answer 75

* Stringent criteria if they have primary liver cancer, small early lesions (1 x < 5 cm or 3 x < 3 cm) * End stage liver disease: whole liver from deceased donor or partial liver from live donor

Answer 76

* Cyclosporine * Tacrolimus * Sirolimus * Everolimus * Mycophenolate ## Footnote Corticosteroids are only given when neeeded, (Induction or rejection)

Answer 77

* Cyclosporine * Tacrolimus * Sirolimus * Everolimus * Mycophenolate ## Footnote Corticosteroids are only given when neeeded, (Induction or rejection)

Answer 78

Sclera of the eye

Answer 79

* Contact precautions * Educate pt and fam about preventing transmission * Avoid sex until hep antigen testing is neg * Use proper hand hygiene and contact precautions * Refer for substance abuse program * Avoid alc and injection drugs * Needle syringe exchange programs

Answer 80

* Comfort measures by positioning pt to ease resp effort (Can be difficult due to presence of ascites * Sit in a chair or elevate HOB 30 degrees with feet elevated (Lay them flat during the acute period) * Oxygen, deep breathing and coughing * Call for changes in resp status (Can indicate pleural effusion)

Answer 81

* Measures to prevent pressure injuries (T/P 2 hrs) * Reduce pressure points * Monitor for skin breakdown (Especially with peripheral edema) * Measures to alleviate pruritus (Gentle skin care, avoid soap, washing with cool water, applying lotion to decrease the itching, keep lotion in the fridge * Assess for excoriations bruising, petechiae, jaundice

Answer 82

* High carb, high cal, moderate fat/protein and low sodium * Vitamin supplements (Thiamine, folate, multivitamins) * Small frequent meals * Proper positioning during meals * Label reading for salt content, don't add salt to food

Answer 83

Monitor and measure increasing abdominal distension, peripheral edema Keep I+O daily weights Restrict fluids if prescribed

Answer 84

* Bedrest during acute illness * Planned exercise and rest periods

Answer 85

* Monitor and call for deteriorating mental status and dementia consistent with hep encephalopathy * Monitor for asterixis and fetor hepaticus * Lactulose if elevated ammonia level/ hepatic encephalopathy to reduce ammonia

Answer 86

* If ascites measure abdominal girth daily * Observe for potential bleeding, from varices (S+S: Anxiety, restlessness, Tachycardia, **N+V, Hematemesis,** melena) * Pain mgmt: Based on provider, analgesics, antacids acid blockers, antiemetics

Assessment and mgmt of pt with liver disorders Flashcards

(112 cards)