Chapter 48 Liver, Biliary Tract, and Pancreas Problems Part 1 Flashcards
(494 cards)
1
Q
A
2
Q
What organs are closely positioned together and associated with digestive functions?
A
Liver, pancreas, and gallbladder
These organs work together in the digestive system.
3
Q
What are some potential consequences of liver and pancreas problems?
A
Altered nutrient absorption and use, malnutrition, impaired elimination
These consequences can significantly affect overall health.
4
Q
What symptoms may be present in patients with liver or pancreatic issues?
A
Pain, nausea, vomiting
These symptoms can indicate inflammation or other complications.
5
Q
What is the focus of nursing care for patients with liver and pancreatic problems?
A
Helping the patient and caregiver manage symptoms and cope with diagnosis and prognosis
Supportive care is essential for quality of life.
6
Q
What does health promotion for liver problems focus on?
A
Reducing risk through immunizations and avoiding substance use
Preventative measures can help maintain liver health.
7
Q
What is hepatitis?
A
Inflammation of the liver
It can be caused by various factors including viral infections.
8
Q
What is the most common cause of hepatitis?
A
Viral infections
Hepatitis viruses include A, B, C, D, and E.
9
Q
What are some other causes of hepatitis besides viral infections?
A
- Alcohol
- Medications
- Chemicals
- Autoimmune diseases
- Metabolic problems
Hepatitis can arise from various non-viral factors.
10
Q
A
11
Q
A
12
Q
What is the incubation period for Hepatitis A Virus (HAV)?
A
15-50 days (average 28 days)
HAV is primarily transmitted through the fecal-oral route.
13
Q
How is Hepatitis A Virus (HAV) primarily transmitted?
A
Fecal-oral route
Transmission can occur through contaminated food, water, and shellfish.
14
Q
What are common sources of infection for Hepatitis A?
A
- Contaminated food
- Milk
- Water
- Shellfish
- Crowded conditions (e.g., daycare, nursing homes)
- Infected food handlers
- Poor personal hygiene
- Poor sanitation
15
Q
When is Hepatitis A most infectious?
A
Most infectious during 2 weeks before onset of symptoms
Infectious for 1-2 weeks after symptoms start.
16
Q
What is the incubation period for Hepatitis B Virus (HBV)?
A
115-180 days (average 56-96 days)
HBV is transmitted through percutaneous or mucosal exposure.
17
Q
What are the modes of transmission for Hepatitis B Virus (HBV)?
A
- Percutaneous (parenteral) exposure to blood
- Mucosal exposure to blood
- Sexual contact
- Perinatal transmission
18
Q
What is the incubation period for Hepatitis C Virus (HCV)?
A
14-180 days (average 56 days)
HCV is transmitted through percutaneous or mucosal exposure.
19
Q
What are the modes of transmission for Hepatitis C Virus (HCV)?
A
- Percutaneous exposure to blood
- Mucosal exposure to blood
- High-risk sexual contact
- Perinatal contact
20
Q
What is the incubation period for Hepatitis D Virus (HDV)?
A
2-26 weeks
HBV must precede HDV infection.
21
Q
What is the relationship between Hepatitis B Virus (HBV) and Hepatitis D Virus (HDV)?
A
HBV must precede HDV infection
Chronic carriers of HBV are always at risk for HDV.
22
Q
What is the incubation period for Hepatitis E Virus (HEV)?
A
15-64 days (average 26-42 days)
HEV is transmitted through the fecal-oral route.
23
Q
What are common sources of infection for Hepatitis E Virus (HEV)?
A
- Contaminated water
- Poor sanitation
- Blood and blood products
- Needles and syringes
24
Q
Which viruses can also cause liver disease besides the main hepatitis viruses?
A
- Cytomegalovirus (CMV)
- Epstein-Barr virus (EBV)
- Herpesvirus
- Coxsackievirus
- Rubella virus
25
What type of virus is Hepatitis A Virus (HAV)?
Ribonucleic acid (RNA) virus
## Footnote
HAV is a self-limiting infection.
26
What are the risk factors for Hepatitis A transmission?
* Poor hygiene
* Improper food handling
* Homelessness
* Crowded situations
* Poor sanitary conditions
27
What is the primary symptom of Hepatitis A?
Mild flu-like illness and jaundice
## Footnote
In severe cases, it can cause acute liver failure.
28
Who is at increased risk for Hepatitis A infection?
* Drug users (IV and non-injection)
* Men who have sex with men (MSM)
* Persons traveling to developing countries
29
When is Hepatitis A virus present in feces relative to symptom onset?
1-2 weeks before onset of symptoms and at least 1 week after onset of illness
## Footnote
This means it can be carried by persons with undetectable infection.
30
How long can fecal excretion of Hepatitis A virus occur in infants?
For months
## Footnote
This can lead to transmission even after the initial infection.
31
32
What is the incubation period for hepatitis A virus (HAV)?
Typically 2 to 6 weeks
## Footnote
The period between exposure to the virus and the onset of symptoms.
33
What does jaundice indicate in hepatitis?
A symptom often associated with liver dysfunction.
34
What is the significance of T ALT in hepatitis diagnosis?
Alanine aminotransferase (ALT) levels indicate liver inflammation.
35
What does the presence of Anti-HAV IgM indicate?
Acute hepatitis A infection.
36
What does the presence of Anti-HAV IgG indicate?
Past infection or immunity to hepatitis A.
37
Which population has a higher incidence of hepatitis B?
Asian Americans and Pacific Islanders.
38
Which population has a higher incidence of hepatitis C?
Blacks.
39
What is the primary cancer associated with hepatitis B?
Liver cancer.
40
Which group has the highest incidence of gallbladder disease?
Whites and Native Americans.
41
What does the presence of HAV IgM indicate during the acute phase?
Active hepatitis A infection.
42
What is the best way to prevent hepatitis A outbreaks?
HAV vaccination and thorough hand washing.
43
What does HBsAg indicate in hepatitis B infection?
Active hepatitis B infection.
44
What is the global prevalence of hepatitis B virus (HBV)?
3.5% to 3.9%.
45
What are common modes of transmission for HBV?
* Perinatal transmission
* Percutaneous transmission
* Sexual transmission.
46
Who is at increased risk for HBV infection among men?
MSM (men who have sex with men) practicing unprotected anal intercourse.
47
What are common risk factors for hepatitis C virus (HCV) infection?
* IV drug use
* High-risk sexual behavior among MSM.
48
What type of virus is hepatitis C virus (HCV)?
A blood-borne RNA virus.
49
How is HCV primarily transmitted?
Percutaneously, often through sharing contaminated needles.
50
What is a key complication of chronic HBV infection?
Liver cancer and severe liver inflammation.
51
What does the presence of anti-HBs in the blood indicate?
Immunity from the HBV vaccine or past infection.
52
What is a common source of HBV infection in healthcare settings?
Accidental needle-stick injuries.
53
Fill in the blank: The presence of HBsAg in the serum for _______ indicates chronic HBV.
6 months or longer.
54
True or False: Hepatitis B virus can be transmitted through casual contact like hugging.
False.
55
56
What is the main mode of transmission for hepatitis E virus (HEV)?
Fecal-oral route
57
What are the acute symptoms of hepatitis?
Anorexia, lethargy, nausea, vomiting, skin rashes, diarrhea or constipation, malaise, fatigue, muscle pain, joint pain, RUQ tenderness
58
What is the incubation period for hepatitis E virus infection?
It varies, but HEV infection epidemics occur primarily in the tropics
59
What is the role of the immune response in viral hepatitis pathophysiology?
Hepatocytes become targets of the virus through direct action or cell-mediated immune response
60
What is a significant risk factor for chronic hepatitis C virus (HCV) infection?
Immunosuppressed individuals, such as liver transplant recipients and HIV positive persons
61
What percentage of people in the United States infected with HCV are estimated to be undiagnosed?
Greater than 50%
62
What complications can arise from chronic viral hepatitis?
Fibrosis, cirrhosis, liver failure, primary liver cancer
63
What is the significance of a positive anti-HCV test?
It indicates a past infection, followed by a viral load test to confirm active infection
64
True or False: There is a vaccine available for hepatitis C virus (HCV).
False
65
What is the relationship between hepatitis B virus (HBV) and hepatitis D virus (HDV)?
HDV requires HBV to infect hepatocytes and cannot survive on its own
66
What is the primary method of transmission for hepatitis D virus?
Similar to HBV transmission
67
What can happen to the liver after acute hepatitis resolves without complications?
Liver cells can regenerate and resume normal appearance and function
68
Fill in the blank: Chronic viral hepatitis can be _______ and silent, causing persistent destruction of infected hepatocytes.
insidious
69
What systemic effects may occur during the early phases of hepatitis infection?
Rash, angioedema, arthritis, fever, malaise, cryoglobulinemia, glomerulonephritis, vasculitis
70
What is the typical duration of the acute phase of viral hepatitis?
1 to 6 months
71
What is the common reason for liver transplantation in the United States?
HCV hepatitis
72
What is the impact of co-infection with HIV and HCV?
Increased risk for progression to cirrhosis if HCV is untreated
73
What are the antibodies tested in the context of hepatitis B infection?
Anti-HBs IgG, Anti-HBc IgM, Anti-HBc IgG, HBeAg, Anti-HBe
74
What is a potential outcome of severe acute hepatitis?
Liver failure or death
75
What is the primary focus of current efforts regarding chronic HCV?
Prevent transmission, screening, and provide necessary healthcare
76
77
What is hepatomegaly?
Hepatomegaly is the enlargement of the liver.
78
What are common physical assessment findings in hepatitis?
Common findings include hepatomegaly, lymphadenopathy, abdominal tenderness, and sometimes splenomegaly.
79
What is the acute phase of hepatitis?
The acute phase is the period of maximal infectivity.
80
What does jaundice indicate?
Jaundice indicates a change in normal bilirubin metabolism or disruption of the flow of bile.
81
What can cause darker urine in hepatitis?
Darker urine can occur due to the kidneys excreting excess bilirubin.
82
What color are stools if conjugated bilirubin cannot pass into the intestines?
Stools will be clay-colored.
83
List some manifestations of acute hepatitis.
* Anorexia
* Clay-colored stools
* Dark urine
* Diarrhea, constipation
* Fatigue, lethargy, malaise
* Flu-like symptoms
* Jaundice
* Hepatomegaly
* Nausea, vomiting
* RUQ tenderness
84
What is asterixis?
Asterixis, also known as 'liver flap', is a tremor of the hand when the wrist is extended.
85
What is pruritus?
Pruritus is intense generalized itching that can accompany jaundice.
86
What characterizes the convalescent phase of hepatitis?
The convalescent phase can last weeks to months, with malaise and fatigue.
87
What is the mortality rate for acute hepatitis?
The overall mortality rate for acute hepatitis is less than 1%.
88
What complications can arise from acute hepatitis?
* Chronic hepatitis
* Cirrhosis
* Portal hypertension
* Liver cancer
* Acute liver failure
89
What is chronic hepatitis?
Chronic hepatitis is a long-lasting inflammation of the liver.
90
What percentage of people with chronic HBV may develop cirrhosis or liver cancer?
15% to 40% of people with chronic HBV may develop cirrhosis or liver cancer.
91
Which type of hepatitis is more likely to become chronic, HBV or HCV?
HCV infection is more likely than HBV to become chronic.
92
Define hemolytic jaundice.
Hemolytic jaundice is caused by increased breakdown of RBCs, producing increased unconjugated bilirubin in blood.
93
What causes hepatocellular jaundice?
Hepatocellular jaundice results from the liver's altered ability to take up or excrete bilirubin.
94
What is obstructive jaundice?
Obstructive jaundice results from decreased or obstructed flow of bile through the liver or biliary duct system.
95
What are the common causes of obstructive jaundice?
* Common bile duct obstruction from stones
* Biliary strictures
* Pancreatic cancer
* Sclerosing cholangitis
96
What does elevated serum bilirubin indicate?
Elevated serum bilirubin indicates severe disease.
97
True or False: Most patients with acute viral hepatitis recover completely.
True
98
99
What is the test for Hepatitis A (HAV) acute infection?
HAV immunoglobulin M (IgM)
## Footnote
Indicates recent infection with HAV
100
What does HAV immunoglobulin G (IgG) indicate?
Previous infection or immunization
## Footnote
Indicates immunity to HAV
101
What is the significance of HBsAg in Hepatitis B (HBV)?
Marker of infectivity
## Footnote
Present in acute or chronic infection
102
What does Anti-HBs signify in HBV infection?
Indicates previous infection with HBV or immunization
## Footnote
Indicates immunity to HBV
103
What does HBeAg indicate in chronic HBV?
Indicates high infectivity
## Footnote
Used to determine clinical management
104
What is the purpose of HBV genotyping?
Indicates the genotype of HBV
## Footnote
Helps in determining treatment approach
105
What does Anti-HCV test for?
Marker for acute or chronic infection with HCV
## Footnote
Indicates exposure to HCV
106
What does HCV RNA quantitation indicate?
Active ongoing viral replication
## Footnote
Best indicator of treatment effectiveness
107
True or False: Anti-HEV IgM indicates active infection with Hepatitis E.
True
## Footnote
Indicates recent or acute infection
108
What is ascites?
Accumulation of excess fluid in the peritoneal cavity
## Footnote
Common manifestation of cirrhosis
109
What causes ascites in hepatitis patients?
Reduced protein levels in the blood
## Footnote
Leads to decreased plasma oncotic pressure
110
What is the screening test for HCV infection?
HCV antibody testing
## Footnote
Antibodies can be detected within 4 weeks of infection
111
What does a prolonged prothrombin time indicate in acute hepatitis?
Liver cell injury
## Footnote
Indicates impaired liver function
112
What abnormal finding is associated with alkaline phosphatase in acute hepatitis?
Moderately elevated
## Footnote
Indicates impaired excretory function of liver
113
What is the significance of total bilirubin levels in acute hepatitis?
Increased to about 8-15 mg/dL
## Footnote
Indicates liver cell injury and conjugated hyperbilirubinemia
114
Fill in the blank: HCV RNA testing assesses for chronic _______.
HCV infection
## Footnote
Follows positive antibody test
115
What skin manifestations may occur in advanced liver disease?
Spider angiomas, palmar erythema, gynecomastia
## Footnote
Common in patients with liver dysfunction
116
What are potential complications of hepatic encephalopathy?
Neurologic, psychiatric, and motor disturbances
## Footnote
Results from the liver's inability to remove toxins
117
118
What is the purpose of HCV RNA testing?
To confirm chronic infection and assess recent HCV infection.
## Footnote
HCV RNA testing is particularly important for immunocompromised patients who may not develop detectable antibody levels.
119
How many genotypes does HBV have?
At least 8 different genotypes (A to H).
## Footnote
HBV genotype may predict disease course and treatment outcomes.
120
What is the most common HCV genotype in the United States?
HCV genotype 1 causes 70% of HCV infections.
121
What is the role of a liver biopsy in hepatitis diagnosis?
Allows for histologic examination of liver cells and determination of inflammation, fibrosis, or cirrhosis.
## Footnote
A liver biopsy may not be performed on patients with bleeding disorders due to the risk of bleeding.
122
What is one noninvasive method to assess liver fibrosis?
Ultrasound elastography (e.g., FibroScan).
## Footnote
Magnetic resonance elastography (MRE) is another technique for measuring liver fibrosis.
123
What is emphasized in the management of acute viral hepatitis?
Adequate nutrition and rest to help the liver regenerate and repair.
124
What type of specialists may be involved in the care of patients with chronic viral hepatitis?
Liver specialists, infectious disease specialists, pharmacists, dietitians, and mental health or substance use specialists.
125
What are the key components of the diagnostic assessment for viral hepatitis?
* History and physical assessment
* Liver function tests
* PT time and INR
* Hepatitis testing (HAV, HBV, HCV, HDV, HEV)
* FibroScan
* FibroSure (FibroTest)
126
What is the main goal of drug therapy for chronic HBV?
To decrease viral load and liver enzymes, slowing disease progression.
127
What do nucleoside and nucleotide analogs do?
Inhibit viral DNA replication by mimicking normal DNA building blocks.
128
Name two nucleoside analogs used to treat chronic HBV.
* Lamivudine (Epivir)
* Adefovir (Hepsera)
129
True or False: There is a specific treatment for acute viral hepatitis.
False.
## Footnote
Most patients with acute viral hepatitis are managed at home.
130
Fill in the blank: One supportive drug therapy for chronic hepatitis may include _______.
Antihistamines for generalized itching.
131
What is the purpose of HBV core Ab (HBVcAb) IgG testing?
To determine if the patient has a history of recovered HBV infection.
132
What does HCV genotyping determine?
The choice and duration of therapy for HCV treatment.
133
What is FibroSure (FibroTest)?
A biomarker that assesses the extent of hepatic fibrosis using serum test results.
134
135
What are the drug classes used for treating Viral HBV?
* Immune modulator
* Nucleoside and nucleotide analogs
136
Name two examples of nucleoside and nucleotide analogs used for HBV.
* adefovir
* entecavir (Baraclude)
137
What is the mechanism of action of pegylated interferon?
Has antiviral, antiproliferative, immune-regulating actions
138
What chronic condition is treated with adefovir?
Chronic HBV
139
What is the role of NS3/4A protease inhibitors in HCV treatment?
Blocks viral protease enzyme. Prevents viral replication in genotype 1 HCV
140
List two examples of NS5A inhibitors.
* elbasvir
* ledipasvir
141
What are combination therapies in HCV treatment?
* elbasvir + grazoprevir (Zepatier)
* ledipasvir + sofosbuvir (Harvoni)
* pibrentasvir + glecaprevir (Mavyret)
* velpatasvir + sofosbuvir (Epclusa)
* velpatasvir + sofosbuvir + voxilaprevir (Vosevi)
142
True or False: Interferon therapy can have flu-like side effects.
True
143
What is the treatment duration for most patients receiving DAA therapy for HCV?
12 weeks
144
What is the goal of drug therapy for chronic HCV?
Eradicating the virus and preventing HCV-related complications
145
Fill in the blank: Patients with advanced fibrosis or cirrhosis can receive drug therapy if liver _______ is not present.
[decompensation]
146
What nutritional considerations are important during acute viral hepatitis?
Adequate calories are important because the patient usually loses weight
147
What vitamin supplements may be given to patients with viral hepatitis?
* B-complex
* Vitamin K
148
How often should patients receiving interferon have blood counts and liver function tests?
Every 4 to 6 weeks
149
What is a common side effect of interferon therapy that needs monitoring?
Depression
150
What is the significance of monitoring liver enzymes after stopping HBV treatment?
Severe exacerbations can develop after ending treatment
151
What is the preferred treatment for patients with stable HIV and intact immune systems who also have HCV?
HCV treatment with the goal of eradicating HCV and reducing the risk for progression to cirrhosis
152
True or False: There is a special diet for the treatment of viral hepatitis.
False
153
154
What are important health history factors to consider in hepatitis assessment?
Hermophilia, cancer, exposure to infected persons, ingestion of contaminated food or water, exposure to hepatotoxic agents, crowded living conditions, exposure to contaminated needles, recent travel, organ transplant, new drug regimens, hemodialysis, blood transfusions before 1992, HIV status.
## Footnote
Include specific exposures and health conditions that increase risk for hepatitis.
155
What medications should be assessed in patients with hepatitis?
Use and misuse of acetaminophen, new medications or supplements.
## Footnote
Important due to potential liver toxicity.
156
What subjective data should be gathered regarding health perception and management in hepatitis patients?
IV drug use, chronic alcohol use, malaise, distaste for cigarettes, high-risk sexual behaviors.
## Footnote
Behavioral factors that may contribute to hepatitis.
157
What are some nutritional-metabolic symptoms associated with hepatitis?
Weight loss, anorexia, nausea, vomiting, feeling of RUQ fullness.
## Footnote
Symptoms indicating liver dysfunction.
158
What elimination symptoms might indicate hepatitis?
Dark urine, light-colored stools, constipation or diarrhea, skin rashes, hives.
## Footnote
These symptoms reflect biliary obstruction or liver dysfunction.
159
What cognitive-perceptual symptoms are common in hepatitis?
RUQ pain, liver tenderness, headache, itching.
## Footnote
Indicative of inflammation or liver dysfunction.
160
What general objective findings may be present in a hepatitis patient?
Low-grade fever, lethargy, lymphadenopathy.
## Footnote
Non-specific signs of infection or systemic illness.
161
What are some possible diagnostic findings in hepatitis?
Liver enzyme levels, serum total bilirubin, hypoalbuminemia, anemia, bilirubin in urine, prolonged PT time, positive hepatitis tests, abnormal liver scan, abnormal liver biopsy results.
## Footnote
Diagnostic tests to confirm hepatitis and assess liver function.
162
What clinical problems may arise for patients with viral hepatitis?
Nutritionally compromised, activity intolerance, risk for bleeding.
## Footnote
Potential complications that require nursing interventions.
163
What are the overall goals for a patient with viral hepatitis?
Relief of discomfort, resuming normal activities, return to normal liver function without complications.
## Footnote
Goals to guide nursing care and intervention.
164
What are some preventive measures for hepatitis A?
Personal and environmental hygiene, health education, hand washing, use of PPE when contamination is likely.
## Footnote
Essential practices to prevent transmission.
165
Who should receive the hepatitis A vaccine?
Children at 1 year, adults at risk including travelers, MSM, IV drug users, persons with clotting factor disorders, chronic liver disease.
## Footnote
Target populations for vaccination to prevent hepatitis A.
166
What is the composition of the HAV vaccine?
Inactivated HAV protein, available as Havrix and Vaqta.
## Footnote
Types of vaccines used for hepatitis A prevention.
167
What is the recommended schedule for HAV vaccination?
Primary immunization consists of 1 dose IM, with a booster recommended 6 to 12 months later.
## Footnote
Schedule to ensure long-term immunity.
168
What are the side effects of the HAV vaccine?
Mild soreness and redness at the injection site.
## Footnote
Common reactions to vaccination.
169
What is Twinrix?
A combined HAV and HBV vaccine for people over 18, consisting of 3 doses on a 0-, 1-, and 6-month schedule.
## Footnote
Vaccine option for high-risk populations.
170
What is the purpose of immune globulin (IG) in hepatitis A prevention?
Provides temporary passive immunity after exposure, effective for 1 to 2 months.
## Footnote
Used in postexposure prophylaxis.
171
172
What are general measures for the prevention of Hepatitis A?
* Hand washing
* Proper personal hygiene
* Environmental sanitation
* Control and screening of food handlers
* Serologic screening for carriers
* Active immunization: HAV vaccine
## Footnote
These measures help reduce the risk of Hepatitis A transmission.
173
What is the recommended timing for administering immune globulin after exposure to Hepatitis A?
1-2 weeks after exposure
## Footnote
Early administration is crucial for effective prophylaxis.
174
What special considerations should health care personnel take regarding Hepatitis A?
Health care personnel should follow standard precautions and be aware of infection risks related to Hepatitis A.
175
What are the two main transmission routes for Hepatitis B and C?
* Percutaneous transmission
* Sexual transmission
## Footnote
Understanding these routes is vital for implementing prevention strategies.
176
What screening tests are used for Hepatitis B and C?
* HBV: HBsAg
* HCV: Anti-HCV
## Footnote
These tests help identify infected individuals.
177
What are general preventive measures for Hepatitis B?
* Hand washing
* Avoid sharing toothbrushes and razors
* HBIG administration for exposure
* Active immunization: HBV vaccine
## Footnote
These measures are essential to prevent the spread of Hepatitis B.
178
What is the HBV vaccine schedule?
0-, 1-, and 6-month schedule
## Footnote
The vaccine is highly effective in preventing Hepatitis B infection.
179
What is the effectiveness of the HBV vaccine?
95% effective
## Footnote
This high efficacy underscores the importance of vaccination.
180
What is the newer formulation of the HBV vaccine called?
Heplisav-B
## Footnote
It is approved for individuals 18 years or older and is given in 2 doses.
181
What is recommended for infants born to mothers positive for HBsAg?
HBIG administration and HBV vaccination
## Footnote
This approach helps protect newborns from potential infection.
182
What precautions should be taken for postexposure prophylaxis for Hepatitis B?
HBV vaccine series and HBIG
## Footnote
This combination provides both active and passive immunity.
183
What is the primary prevention strategy for Hepatitis C?
Identify high-risk individuals and teach risk reduction
## Footnote
No vaccine is currently available for Hepatitis C.
184
What are key measures to prevent Hepatitis C transmission?
* Screening of blood, organ, and tissue donors
* Using infection control precautions
* Modifying high-risk behavior
## Footnote
These measures aim to reduce the incidence of Hepatitis C.
185
What are general measures for the prevention of Hepatitis A?
* Hand washing
* Proper personal hygiene
* Environmental sanitation
* Control and screening of food handlers
* Serologic screening for carriers
* Active immunization: HAV vaccine
## Footnote
These measures help reduce the risk of Hepatitis A transmission.
186
What is the recommended timing for administering immune globulin after exposure to Hepatitis A?
1-2 weeks after exposure
## Footnote
Early administration is crucial for effective prophylaxis.
187
What special considerations should health care personnel take regarding Hepatitis A?
Health care personnel should follow standard precautions and be aware of infection risks related to Hepatitis A.
188
What are the two main transmission routes for Hepatitis B and C?
* Percutaneous transmission
* Sexual transmission
## Footnote
Understanding these routes is vital for implementing prevention strategies.
189
What screening tests are used for Hepatitis B and C?
* HBV: HBsAg
* HCV: Anti-HCV
## Footnote
These tests help identify infected individuals.
190
What are general preventive measures for Hepatitis B?
* Hand washing
* Avoid sharing toothbrushes and razors
* HBIG administration for exposure
* Active immunization: HBV vaccine
## Footnote
These measures are essential to prevent the spread of Hepatitis B.
191
What is the HBV vaccine schedule?
0-, 1-, and 6-month schedule
## Footnote
The vaccine is highly effective in preventing Hepatitis B infection.
192
What is the effectiveness of the HBV vaccine?
95% effective
## Footnote
This high efficacy underscores the importance of vaccination.
193
What is the newer formulation of the HBV vaccine called?
Heplisav-B
## Footnote
It is approved for individuals 18 years or older and is given in 2 doses.
194
What is recommended for infants born to mothers positive for HBsAg?
HBIG administration and HBV vaccination
## Footnote
This approach helps protect newborns from potential infection.
195
What precautions should be taken for postexposure prophylaxis for Hepatitis B?
HBV vaccine series and HBIG
## Footnote
This combination provides both active and passive immunity.
196
What is the primary prevention strategy for Hepatitis C?
Identify high-risk individuals and teach risk reduction
## Footnote
No vaccine is currently available for Hepatitis C.
197
What are key measures to prevent Hepatitis C transmission?
* Screening of blood, organ, and tissue donors
* Using infection control precautions
* Modifying high-risk behavior
## Footnote
These measures aim to reduce the incidence of Hepatitis C.
198
199
What is the best way to reduce HBV infection?
Identify those at risk, screen them for HBV, and vaccinate those who are not infected.
200
List general measures for the prevention of Hepatitis A.
* Hand washing
* Proper personal hygiene
* Environmental sanitation
* Control and screening of food handlers
* Serologic screening for virus carriers
* Active immunization: HAV vaccine
201
What should patients at high risk for contracting HBV be taught?
To follow good hygienic practices, including hand washing and using gloves when expecting contact with blood.
202
What personal items should patients not share to prevent HBV transmission?
* Razors
* Toothbrushes
* Other personal items
203
What is the recommended vaccination schedule for the HBV vaccine?
A series of 3 IM injections in the deltoid muscle on a 0-, 1-, and 6-month schedule.
204
What is the effectiveness rate of the HBV vaccine?
95% effective.
205
True or False: The HBV vaccine can be given during pregnancy.
True.
206
What is the newer formulation of the HBV vaccine called?
Heplisav-B.
207
What is the dosage schedule for Heplisav-B?
2 doses, spaced 4 weeks apart.
208
What is recommended for household members of a patient with HBV?
They should be tested and vaccinated if they are HBsAg and antibody negative.
209
What is the role of HBIG in postexposure prophylaxis?
HBIG has antibodies to HBV and confers temporary passive immunity.
210
When should HBIG ideally be administered after exposure?
Within 24 hours of exposure.
211
What are some measures to prevent HCV transmission?
* Screening of blood, organ, and tissue donors
* Using infection control precautions
* Modifying high-risk behavior
212
What is the recommended action for acute exposure to a sexual partner of an HBsAg-positive person?
Administer HBIG to the sexual partner.
213
Fill in the blank: The traditional HBV vaccine of 3 doses is normally given in _______.
[childhood]
214
What should be done for infants born to mothers positive for HBsAg?
They should receive HBIG and vaccination.
215
What is the purpose of using disposable needles and syringes in healthcare settings?
To reduce the risk of HBV transmission.
216
What is the main goal of the CDC recommendations for patients with HBV?
Follow standard precautions to prevent HBV transmission.
217
True or False: There is currently a vaccine available for Hepatitis C.
False.
218
219
What is the primary recommendation for HCV testing in patients with known risk factors?
Testing for patients with known risk factors for HCV is recommended.
220
What does RDT stand for in the context of HCV testing?
Rapid Diagnostic Tests
221
What is a major risk factor for hepatitis C virus (HCV)?
IV drug use
222
Why is early diagnosis of HCV important?
For best patient outcomes and preventing transmission to others.
223
What are the US current screening guidelines for HCV testing for individuals 18 years and older?
One-time opt-out HCV testing is recommended.
224
What is recommended for IV drug users regarding HCV screening?
Annual HCV screening.
225
Where is jaundice typically first observed in light-skinned individuals?
In the sclera of the eyes.
226
In dark-skinned individuals, where is jaundice usually seen first?
In the hard palate of the mouth and inner canthus of the eyes.
227
What may cause the urine to have a dark-brown or brownish-red color in hepatitis patients?
Bilirubin excretion from the kidneys.
228
What comfort measures can help relieve symptoms in hepatitis patients?
Relieve itching, headache, and joint pain.
229
What dietary approach may help a patient with hepatitis who has anorexia?
Small, frequent meals may be preferable.
230
What is the recommended fluid intake for patients with hepatitis?
2500 to 3000 mL/day.
231
What is critical for promoting hepatocyte regeneration in hepatitis patients?
Rest.
232
What should be assessed to ensure a patient is coping with their care plan?
The patient's response to the rest and activity plan.
233
What are some complications to assess for in hepatitis patients?
* Bleeding tendencies
* Encephalopathy
* Bloody or tarry stools
* Vomiting of blood
* High liver enzymes
234
After a diagnosis of hepatitis, how long should patients have regular follow-ups?
At least 1 year.
235
What should all patients with chronic HBV or HCV avoid?
Alcohol.
236
What is a potential consequence of excessive alcohol use on the liver?
Injury and necrosis of liver tissue.
237
What can occur after decades of excessive alcohol use?
Advanced fibrosis and cirrhosis.
238
Fill in the blank: The presence of jaundice is usually seen first in the ______ for light-skinned persons.
sclera of the eyes
239
True or False: Anorexia in hepatitis patients is often more manageable in the evening.
False
240
What is the primary recommendation for HCV testing in patients with known risk factors?
Testing for patients with known risk factors for HCV is recommended.
241
What does RDT stand for in the context of HCV testing?
Rapid Diagnostic Tests
242
What is a major risk factor for hepatitis C virus (HCV)?
IV drug use
243
Why is early diagnosis of HCV important?
For best patient outcomes and preventing transmission to others.
244
What are the US current screening guidelines for HCV testing for individuals 18 years and older?
One-time opt-out HCV testing is recommended.
245
What is recommended for IV drug users regarding HCV screening?
Annual HCV screening.
246
Where is jaundice typically first observed in light-skinned individuals?
In the sclera of the eyes.
247
In dark-skinned individuals, where is jaundice usually seen first?
In the hard palate of the mouth and inner canthus of the eyes.
248
What may cause the urine to have a dark-brown or brownish-red color in hepatitis patients?
Bilirubin excretion from the kidneys.
249
What comfort measures can help relieve symptoms in hepatitis patients?
Relieve itching, headache, and joint pain.
250
What dietary approach may help a patient with hepatitis who has anorexia?
Small, frequent meals may be preferable.
251
What is the recommended fluid intake for patients with hepatitis?
2500 to 3000 mL/day.
252
What is critical for promoting hepatocyte regeneration in hepatitis patients?
Rest.
253
What should be assessed to ensure a patient is coping with their care plan?
The patient's response to the rest and activity plan.
254
What are some complications to assess for in hepatitis patients?
* Bleeding tendencies
* Encephalopathy
* Bloody or tarry stools
* Vomiting of blood
* High liver enzymes
255
After a diagnosis of hepatitis, how long should patients have regular follow-ups?
At least 1 year.
256
What should all patients with chronic HBV or HCV avoid?
Alcohol.
257
What is a potential consequence of excessive alcohol use on the liver?
Injury and necrosis of liver tissue.
258
What can occur after decades of excessive alcohol use?
Advanced fibrosis and cirrhosis.
259
Fill in the blank: The presence of jaundice is usually seen first in the ______ for light-skinned persons.
sclera of the eyes
260
True or False: Anorexia in hepatitis patients is often more manageable in the evening.
False
261
262
263
What is acute alcoholic hepatitis characterized by?
Hepatomegaly, jaundice, increased liver enzymes (AST, ALT, alkaline phosphate), low-grade fever
## Footnote
Ascites and prolonged PT time are possible. These manifestations may improve if alcohol intake ceases.
264
What can result from abstaining from alcohol in patients with end-stage cirrhosis?
Significant reversal in some patients
## Footnote
If liver function does not recover after abstaining from alcohol for 6 months or longer, liver transplantation may be an option.
265
What is chemical hepatotoxicity?
Liver injury caused by exposure to certain compounds (e.g., carbon tetrachloride, gold compounds)
## Footnote
Some agents can cause hepatotoxicity, cholestasis, necrosis, or liver cancer.
266
What is the main cause of drug-induced liver injury (DILI)?
Antimicrobial agents, especially amoxicillin-clavulanate
## Footnote
The most common cause of acute liver failure is acetaminophen.
267
What is Wilson disease?
An autosomal recessive disorder involving cellular copper transport
## Footnote
A defect in biliary excretion leads to copper accumulation in the liver.
268
What are the hallmark signs of Wilson disease?
Corneal Kayser-Fleischer rings, low serum ceruloplasmin levels, and elevated copper concentrations from liver biopsy
## Footnote
First-degree relatives of patients with Wilson disease need to be screened.
269
What are the first-line treatments for symptomatic patients with Wilson disease?
Chelating agents such as D-penicillamine or trientine
## Footnote
Zinc acetate (Galzin) is another therapy that interferes with copper absorption.
270
What is hemochromatosis?
A condition in which excess iron accumulates in the body
## Footnote
Mainly caused by a genetic defect (hereditary hemochromatosis).
271
What is autoimmune hepatitis?
A chronic inflammatory liver disorder where the immune system attacks the liver
## Footnote
Characterized by autoantibodies and high levels of serum immunoglobulins.
272
What laboratory tests are useful in diagnosing autoimmune hepatitis?
Antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), and antimitochondrial antibody (AMA) testing
## Footnote
A liver biopsy can confirm the diagnosis.
273
What is primary biliary cholangitis (PBC)?
A chronic disease of the small bile ducts of the liver characterized by T cell-mediated attack
## Footnote
This leads to loss of bile ducts and cholestasis.
274
What are common laboratory findings in primary biliary cholangitis?
High serum alkaline phosphatase, AMA, ANA, and serum lipid levels
## Footnote
Most patients diagnosed with PBC are middle-aged women.
275
What are the goals of treatment for primary biliary cholangitis?
Suppressing ongoing liver damage, preventing complications, and symptom management
276
True or False: Acetaminophen is safe when taken at recommended levels.
True
277
Fill in the blank: The most common cause of acute liver failure is _______.
acetaminophen
278
What should be done if drugs are identified as the cause of liver injury?
All drugs identified as the cause of liver injury should be stopped
279
280
What drugs are used for Primary Biliary Cholangitis (PBC)?
Ursodiol and obeticholic acid (Ocaliva)
## Footnote
These drugs decrease bile in the liver.
281
What are the main care focuses for patients with PBC?
* Preventing malabsorption
* Managing hyperlipidemia
* Addressing vitamin deficiencies
* Treating anemia
* Managing fatigue
* Treating skin disorders like itching and xanthomas
* Monitoring for progression to cirrhosis
## Footnote
Cholestyramine is used to treat itching.
282
What is Primary Sclerosing Cholangitis (PSC)?
A condition characterized by chronic inflammation, fibrosis, and narrowing of the medium and large bile ducts inside and outside the liver
## Footnote
The cause of PSC is unknown.
283
What are common complications associated with PSC?
* Cholangitis
* Cholestasis with jaundice
* Bile duct cancer
* Cirrhosis
## Footnote
Most patients with PSC also have ulcerative colitis or, less often, Crohn's disease.
284
What is the fundamental characteristic of Nonalcoholic Fatty Liver Disease (NAFLD)?
Accumulation of fatty infiltration in the hepatocytes
## Footnote
NAFLD occurs in individuals who do not consume excess alcohol.
285
What is the progression of Nonalcoholic Steatohepatitis (NASH)?
NASH can progress from fatty liver (steatosis) to cirrhosis, liver cancer, and liver failure
## Footnote
NASH occurs in 3% to 6% of the US population.
286
What are risk factors for NASH?
* Obesity
* Diabetes
* Hyperlipidemia
* Hypertension (or metabolic syndrome)
## Footnote
About 20% of patients with NASH progress to cirrhosis.
287
What tests are used to diagnose NAFLD?
* Elevated liver function tests (ALT, AST)
* Ultrasound
* CT scans
* Liver biopsy for definitive diagnosis
## Footnote
Liver function tests are often the first sign of NAFLD.
288
What is the primary goal of therapy for NAFLD?
Weight loss of at least 10% of body weight, if overweight or obese, and exercise
## Footnote
Bariatric surgery for morbidly obese persons can reduce the risk of NAFLD.
289
What is cirrhosis?
The end stage of liver disease characterized by extensive degeneration and destruction of liver cells
## Footnote
This results in fibrosis and regenerative nodules.
290
What are common causes of cirrhosis in the United States?
* Chronic HCV infection
* Nonalcoholic steatohepatitis (NASH)
* Alcohol-induced liver disease
## Footnote
Malnutrition can exacerbate alcohol-induced liver damage.
291
What is the role of chronic inflammation in cirrhosis development?
Chronic inflammation and cell necrosis from viral hepatitis can lead to progressive fibrosis and cirrhosis
## Footnote
Chronic hepatitis combined with alcohol use accelerates liver damage.
292
What is cardiac cirrhosis?
A spectrum of liver problems resulting from long-standing, severe right-sided heart failure
## Footnote
It causes hepatic venous congestion and fibrosis over time.
293
What are early manifestations of cirrhosis?
* Fatigue
* Enlarged liver
* Normal liver function tests (compensated cirrhosis)
## Footnote
Patients may be unaware of their liver condition in early stages.
294
What happens during the regenerative process of the liver in cirrhosis?
The regenerative process is disorganized, leading to abnormal blood vessel and bile duct architecture
## Footnote
This results in lobules of irregular size and shape and impeded blood flow.
295
296
What is liver fibrosis?
Liver fibrosis is the formation of excess fibrous connective tissue in the liver.
297
What are common symptoms associated with liver dysfunction?
* Pain
* Fever
* Nausea
* Vomiting
* Anorexia
* Fatigue
298
What hormonal changes can occur due to liver dysfunction?
* Increased androgens and estrogens
* Decreased hormone metabolism
299
What is gynecomastia?
Gynecomastia is the enlargement of breast tissue in males, often due to increased estrogen levels.
300
What is portal hypertension?
Portal hypertension is increased blood pressure in the portal venous system.
301
What is hyperbilirubinemia?
Hyperbilirubinemia is an excess of bilirubin in the blood, leading to jaundice.
302
What are the skin lesions associated with liver dysfunction?
* Spider angiomas
* Palmar erythema
303
What is ascites?
Ascites is the accumulation of fluid in the abdominal cavity, often due to liver failure.
304
What are some hematologic problems associated with liver dysfunction?
* Thrombocytopenia
* Leukopenia
* Anemia
305
True or False: Jaundice results from an increased ability to conjugate and excrete bilirubin.
False
306
What causes the increase in bilirubin in the vascular system?
Decreased ability to conjugate and excrete bilirubin due to liver damage.
307
Fill in the blank: The liver's inability to metabolize steroid hormones can lead to _______.
[skin lesions]
308
What is the relationship between splenomegaly and hematologic problems?
Splenomegaly causes increased removal of blood cells from circulation, leading to hematologic issues.
309
What are the late manifestations of liver failure?
* Jaundice
* Peripheral edema
* Ascites
* Skin lesions
* Hematologic problems
* Endocrine problems
* Peripheral neuropathies
310
What are esophageal and gastric varices?
Varices are swollen veins in the esophagus and stomach that can result from portal hypertension.
311
What is hepatic encephalopathy?
Hepatic encephalopathy is a decline in brain function due to severe liver disease.
312
What is the outcome of advanced liver dysfunction?
The liver becomes small and nodular, with dramatically impaired function.
313
What causes dark urine in liver dysfunction?
Increased urobilinogen due to decreased bilirubin metabolism.
314
What is the effect of decreased vitamin K absorption?
Bleeding tendency due to impaired coagulation.
315
What is the significance of albumin levels in liver dysfunction?
Decreased albumin levels indicate impaired liver function and can lead to edema and ascites.
316
317
What is hepatic encephalopathy?
A neurologic condition resulting from liver dysfunction
318
What is asterixis?
A flapping tremor seen in hepatic encephalopathy
319
Name three integumentary manifestations of liver problems.
* Jaundice
* Spider angioma
* Palmar erythema
320
What is fetor hepaticus?
A musty or sweet odor of the breath in liver disease
321
List two gastrointestinal symptoms associated with liver issues.
* Anorexia
* Nausea
322
What are esophageal and gastric varices?
Enlarged veins in the esophagus and stomach due to portal hypertension
323
What hematologic condition is common in liver disease?
Anemia
324
What metabolic imbalances can occur in liver dysfunction?
* Hypokalemia
* Hyponatremia
* Hypoalbuminemia
325
What reproductive issue can arise due to liver problems in men?
Gynecomastia
326
True or False: Peripheral edema occurs only after ascites develops.
False
327
What is portal hypertension?
Increased pressure in the portal venous system due to liver obstruction
328
What are collateral circulation pathways?
Alternate blood flow routes developed to reduce pressure in portal hypertension
329
What is caput medusae?
A ring of varices around the umbilicus due to portal hypertension
330
What can happen if esophageal varices rupture?
Variceal hemorrhages, considered a medical emergency
331
What are the signs of peripheral edema?
Swelling in lower extremities and presacral area
332
What causes peripheral edema in liver disease?
Decreased colloidal oncotic pressure and increased portacaval pressure
333
What is the significance of splenomegaly in liver disease?
It is a sign of portal hypertension
334
What is the relationship between liver dysfunction and coagulation?
The liver's inability to make prothrombin leads to coagulation disorders
335
What are the two types of cirrhosis?
* Compensated cirrhosis
* Decompensated cirrhosis
336
What is the risk associated with large esophageal varices?
Higher likelihood of bleeding
337
Fill in the blank: Peripheral neuropathy in alcoholic cirrhosis is likely due to a deficiency of _______.
thiamine, folic acid, and cobalamin
338
What is hematemesis?
Vomiting blood
339
What can happen to younger women with cirrhosis?
They may develop amenorrhea
340
What is the potential consequence of improper aldosterone metabolism in cirrhosis?
Hyperaldosteronism with sodium and water retention
341
342
What is ascites?
Accumulation of serous fluid in the peritoneal or abdominal cavity.
## Footnote
Ascites is a common manifestation of cirrhosis.
343
What is the first mechanism that leads to ascites formation?
Portal hypertension causing proteins to shift from blood vessels into lymph space.
## Footnote
This leads to leakage into the peritoneal cavity.
344
What happens when the lymphatic system cannot carry off excess proteins and water?
They leak into the peritoneal cavity.
## Footnote
The osmotic pressure of proteins pulls more fluid into the peritoneal cavity.
345
What is the second mechanism of ascites formation?
Hypoalbuminemia resulting from the liver's decreased ability to synthesize albumin.
## Footnote
This results in decreased colloidal oncotic pressure.
346
What is the third mechanism of ascites formation?
Hyperaldosteronism due to the damaged hepatocytes metabolizing aldosterone.
## Footnote
Increased aldosterone leads to sodium reabsorption and water retention.
347
How does hyperaldosteronism contribute to edema?
Increased sodium reabsorption by renal tubules leads to water retention.
## Footnote
This, combined with increased antidiuretic hormone, further contributes to edema.
348
What are the clinical manifestations of ascites?
Abdominal distention, weight gain, eversion of the umbilicus, abdominal striae, distended abdominal wall veins.
## Footnote
Patients may also show signs of dehydration and decreased urine output.
349
What is a common electrolyte imbalance associated with ascites?
Hypokalemia.
## Footnote
This is due to excessive loss of potassium caused by hyperaldosteronism.
350
Fill in the blank: Ascites is a common manifestation of _______.
[cirrhosis]
351
What factors contribute to ascites formation?
* Hepatic lymph flow
* Hyperaldosteronism
* Impaired water excretion
* Portal hypertension
* Serum colloidal oncotic pressure
## Footnote
These factors interact to cause ascites.
352
True or False: The increase in abdominal pressure from fluid accumulation can lead to umbilical eversion.
True
353
354
What can low potassium levels result from in patients with ascites?
Diuretic therapy
## Footnote
Diuretics are often used to manage fluid retention in ascites.
355
What risk do patients with severe ascites face related to pleural effusion?
Increased risk for hepatic encephalopathy
## Footnote
Hepatic encephalopathy can be precipitated by factors that increase ammonia.
356
What is spontaneous bacterial peritonitis (SBP)?
A bacterial infection of the ascitic fluid
## Footnote
SBP is common in patients with cirrhosis and ascites.
357
Which bacteria are most often responsible for SBP?
Gram-negative enteric pathogens, such as Escherichia coli
## Footnote
These pathogens migrate from the intestines into the peritoneal space.
358
What are some neurologic manifestations of hepatic encephalopathy?
Impaired consciousness, inappropriate behavior, sleep problems, trouble concentrating, deep coma
## Footnote
Changes in mental status can occur suddenly or gradually.
359
What grading system is used for hepatic encephalopathy?
A classification system based on levels of consciousness and neurologic findings
## Footnote
This system helps assess the severity of hepatic encephalopathy.
360
What is asterixis?
Flapping tremors commonly seen in hepatic encephalopathy
## Footnote
Asterixis may be observed when a patient is asked to hold their arms and hands outstretched.
361
What is the pathogenesis of hepatic encephalopathy?
Multifactorial including neurotoxic effects of ammonia, abnormal neurotransmission, astrocyte swelling, inflammatory cytokines
## Footnote
A major source of ammonia is from the deamination of amino acids in the intestines.
362
What happens to ammonia levels when blood is shunted past the liver?
Ammonia levels in systemic circulation increase
## Footnote
This occurs because the liver cannot convert ammonia to urea.
363
What are some risk factors for hepatic encephalopathy?
* Cerebral depressants
* Constipation
* Dehydration
* GI bleeding
* Hypokalemia
* Hypovolemia
* Infection
* Metabolic alkalosis
* Paracentesis
* Uremia
## Footnote
Each factor influences ammonia production or metabolism.
364
What is the grading scale for hepatic encephalopathy based on?
Level of consciousness and intellectual function
## Footnote
The scale ranges from normal to comatose states.
365
What are signs of Grade 1 hepatic encephalopathy?
Normal to minimal change in consciousness and intellectual function
## Footnote
Patients may experience subtle personality changes.
366
What characterizes Grade 2 hepatic encephalopathy?
Lethargy, short attention span, impaired memory, mild confusion
## Footnote
Patients may show personality changes and mild depression.
367
What are the signs of Grade 3 hepatic encephalopathy?
Somnolent, disoriented, marked confusion, incomprehensible speech
## Footnote
Patients may exhibit asterixis and abnormal reflexes.
368
What is the state of consciousness in Grade 4 hepatic encephalopathy?
Not arousable, comatose
## Footnote
Patients are unresponsive and may show decerebrate posturing.
369
370
What are writing impairments?
Difficulty moving the pen or pencil from left to right and apraxia
## Footnote
Apraxia refers to the inability to construct simple figures.
371
What are some signs associated with writing impairments?
Hyperventilation, hypothermia, twitching of the tongue, grimacing, and grasping reflexes
## Footnote
Fetor hepaticus may also occur, characterized by a musty, sweet odor of the patient's breath.
372
What is fetor hepaticus?
A musty, sweet odor of the patient's breath due to the accumulation of digestive by-products that the liver cannot degrade
373
Define hepatorenal syndrome.
A type of renal failure with azotemia, oliguria, and intractable ascites, without structural kidney problems
374
What is the primary cause of hepatorenal syndrome?
Portal hypertension and liver decompensation leading to renal vasoconstriction
375
What can reverse renal failure in hepatorenal syndrome?
Liver transplantation
376
What can trigger hepatorenal syndrome in patients with cirrhosis?
Diuretic therapy, GI bleeding, or paracentesis
377
What liver function tests are typically abnormal in patients with cirrhosis?
High enzyme levels, low serum total protein and albumin, increased serum bilirubin and globulin levels, prolonged PT time
378
What might indicate end-stage liver disease regarding enzyme levels?
AST and ALT levels may be normal due to death and loss of hepatocytes
379
What is the gold standard for a definitive diagnosis of cirrhosis?
Liver biopsy
380
Is a liver ultrasound reliable for diagnosing cirrhosis?
No, it is not a reliable diagnostic test for cirrhosis
381
What is ultrasound elastography (Fibroscan)?
A noninvasive test used to quantify the degree of liver fibrosis
382
List some components of the diagnostic assessment for cirrhosis.
* History and physical assessment
* Liver function tests
* Serum albumin
* Serum electrolytes
* PT time
* Complete blood count
* Liver biopsy (percutaneous needle)
* Liver ultrasound (e.g., Fibroscan)
* Upper endoscopy (esophagogastroduodenoscopy)
* CT scan, MRI
383
What are components of conservative therapy for cirrhosis management?
* Rest
* B-complex vitamins
* Avoiding alcohol
* Minimizing or avoiding aspirin, acetaminophen, and NSAIDs
384
What dietary modification is recommended for managing ascites?
Low-sodium diet
385
What is the purpose of diuretics in ascites management?
To remove excess fluid from the body
386
What is a paracentesis?
A sterile procedure to withdraw fluid from the abdominal cavity
387
When is paracentesis indicated for patients with cirrhosis?
For impaired respiration or abdominal discomfort caused by severe ascites not responding to diuretics
388
What is TIPS?
A procedure used to treat ascites that does not respond to diuretics
389
What is the role of spironolactone in cirrhosis management?
An effective diuretic that is an aldosterone antagonist and potassium-sparing
390
True or False: Hyponatremia is a common problem in patients with cirrhosis on diuretics.
True
391
What is the typical sodium intake limit for patients with ascites?
2 g/day
392
What can very low-sodium intake result in for patients?
Reduced nutrient intake and malnutrition
393
394
What is the main therapeutic goal for esophageal and gastric varices?
To prevent bleeding and variceal rupture by reducing portal pressure.
## Footnote
This goal is critical in managing patients with cirrhosis.
395
Which medications should patients with esophageal and/or gastric varices avoid?
Alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).
## Footnote
These substances can increase the risk of bleeding.
396
What procedure should all patients with cirrhosis undergo to screen for varices?
Upper endoscopy (esophagogastroduodenoscopy [EGD]).
## Footnote
This procedure helps in early detection of varices.
397
What role do nonselective beta-blockers play in the management of varices?
They decrease high portal pressure, reducing the risk of variceal bleeding.
## Footnote
Common examples include nadolol and propranolol.
398
What is the first step when variceal bleeding occurs?
Stabilize the patient and manage the airway.
## Footnote
This is critical for patient safety before further treatment.
399
What type of therapy is often combined for more successful management of bleeding varices?
Drug therapy and endoscopic therapy.
## Footnote
This combination is more effective than either approach alone.
400
What are the two main drug therapies used for bleeding varices?
* Octreotide (Sandostatin)
* Vasopressin.
## Footnote
Both drugs cause vasoconstriction and decrease portal blood flow.
401
Why is octreotide preferred over vasopressin for treating bleeding varices?
Octreotide has fewer side effects than vasopressin.
## Footnote
This makes it a safer option for patients.
402
What is endoscopic variceal band ligation (EVL)?
A procedure that places a small rubber band around the base of the varix to prevent rebleeding.
## Footnote
This technique is commonly used during endoscopy.
403
What is sclerotherapy?
Injecting a sclerosing solution into swollen veins through a needle placed through the endoscope.
## Footnote
This method helps to manage varices by promoting scarring.
404
What is balloon tamponade used for?
To control acute esophageal or gastric variceal hemorrhage through mechanical compression of the varices.
## Footnote
It is an alternative when endoscopic methods are ineffective.
405
What are the key supportive measures during an acute variceal bleed?
* Fresh frozen plasma
* Packed RBCs
* Vitamin K
* Proton pump inhibitors (PPIs).
## Footnote
These measures help stabilize the patient and prevent complications.
406
What is the risk associated with recurrent bleeding episodes in varices?
High incidence of recurrent bleeding after each episode.
## Footnote
This necessitates ongoing management and monitoring.
407
What are the long-term management strategies for patients who have had a bleeding episode?
* Nonselective beta-blockers
* Repeated band ligation
* Portosystemic shunts.
## Footnote
These strategies help manage portal hypertension and prevent further bleeding.
408
What is the TIPS procedure?
A nonsurgical procedure that creates a shunt between the systemic and portal venous systems to redirect portal blood flow.
## Footnote
TIPS is performed to reduce portal venous pressure.
409
What are the limitations of the TIPS procedure?
* Increased risk for hepatic encephalopathy
* Stenosis of the stent.
## Footnote
It is contraindicated in certain conditions like severe hepatic encephalopathy.
410
What is a portacaval shunt?
A surgical shunt that anastomoses the portal vein to the inferior vena cava to reduce portal hypertension.
## Footnote
This method preserves liver perfusion while diverting blood flow.
411
What is the distal splenorenal shunt?
A surgical procedure that anastomoses the splenic vein to the renal vein.
## Footnote
It selectively decompresses esophageal varices while maintaining portal venous flow.
412
413
What is the mechanism of action of furosemide (Lasix)?
Acts on distal tubule and loop of Henle to reabsorb sodium and water
414
What is the mechanism of action of spironolactone (Aldactone)?
Blocks actions of aldosterone, potassium sparing
415
What does lactulose do in the treatment of cirrhosis?
Acidifies feces in bowel and traps ammonia, causing its elimination in feces
416
What is the purpose of magnesium sulfate in cirrhosis management?
Corrects hypomagnesemia that may occur with liver dysfunction
417
What are the effects of nadolol and propranolol in cirrhosis?
Reduce portal venous pressure and esophageal variceal bleeding
418
How does neomycin sulfate help in cirrhosis treatment?
Reduces bacterial flora, thus reducing ammonia formation
419
What is the role of rifaximin (Xifaxan) in cirrhosis?
Reduces bacterial flora, thus reducing ammonia formation
420
What is the function of octreotide (Sandostatin) in cirrhosis?
Hemostasis and control of bleeding in esophageal and gastric varices, constricts splanchnic arterial bed
421
What does vitamin K correct in patients with cirrhosis?
Corrects clotting problems from decreased vitamin K levels
422
What are some subjective health history data important for cirrhosis assessment?
* Viral, toxic, or idiopathic hepatitis
* Alcohol use
* Metabolic syndrome
* Chronic biliary obstruction and infection
* Severe right-sided heart failure
423
What are some functional health patterns to assess in cirrhosis?
* Chronic alcohol use
* Weakness
* Anorexia
* Weight loss
* Dyspepsia
* Nausea and vomiting
* Gingival bleeding
* Dry, yellow skin
* Bruising
424
What are some objective data findings in cirrhosis?
* Fever
* Cachexia
* Wasting of extremities
* Abdominal distention
* Ascites
* Distended abdominal wall veins
* Palpable liver and spleen
* Foul breath
* Hematemesis
* Black, tarry stools
* Hemorrhoids
425
What is the goal of managing hepatic encephalopathy?
To reduce ammonia formation
426
How can lactulose be administered?
* Orally
* As an enema
* Through a nasogastric (NG) tube
427
What is the importance of regular bowel movements in hepatic encephalopathy management?
Minimize ammonia buildup
428
What is a common nutritional therapy for a patient with cirrhosis?
High in calories (3000 cal/day), high in carbohydrate content with moderate to low levels of fat
429
What dietary considerations should be made for a patient with alcoholic cirrhosis?
Oral supplements containing protein from branched-chain amino acids
430
What is a dietary recommendation for a patient with ascites and edema?
Low-sodium diet
431
What are some signs of hepatic encephalopathy?
* Altered mentation
* Asterixis
432
What are potential diagnostic findings in cirrhosis?
* Anemia
* Thrombocytopenia
* Leukopenia
* Abnormal liver function studies
* Increased INR
* Increased ammonia
* Increased bilirubin levels
433
Fill in the blank: The diet for a patient with cirrhosis should be high in _______.
calories
434
435
What are common clinical problems for patients with cirrhosis?
Ineffective tissue perfusion, activity intolerance, fluid imbalance
## Footnote
Additional details on clinical problems and interventions can be found in eNursing Care plan 48.2.
436
What are the overall goals for a patient with cirrhosis?
1. Relief of discomfort
2. Minimal to no complications
3. Return to as normal a lifestyle as possible
437
What are common risk factors for cirrhosis?
Alcohol use, malnutrition, viral hepatitis, biliary obstruction, obesity, right-sided heart failure
438
What is essential for promoting normal liver regeneration in patients at risk for cirrhosis?
Adequate nutrition
439
What should be encouraged for patients with chronic alcohol use to prevent cirrhosis?
Enrollment in support programs that help maintain sobriety
440
What is the focus of care for patients with cirrhosis?
Conserving strength while maintaining muscle strength and tone
441
What measures should be taken to prevent complications in patients requiring complete bed rest?
Prevent pneumonia, thromboembolic problems, pressure injuries
442
What dietary strategies can help improve nutrient intake in cirrhosis patients?
Oral hygiene before meals, offering between-meal snacks, offering preferred foods
443
What medications may help relieve itching associated with jaundice?
Cholestyramine or hydroxyzine (Atarax)
444
What is cholestyramine used for in cirrhosis patients?
It binds bile salts in the intestine, increasing their excretion in the feces
445
What are potential side effects of cholestyramine?
Nausea, vomiting, diarrhea or constipation, skin reactions
446
What is the preprocedure assessment for a patient undergoing paracentesis?
Baseline vital signs, pulse oximetry, weight, abdominal assessment, bladder distention
447
What is important to monitor postprocedure for a paracentesis?
Vital signs, abdominal girth, abdominal pain, signs of hypovolemia
448
What position should the patient be in during a paracentesis?
High-Fowler's position with feet on the floor
449
What should be assessed regarding urine and stool color in jaundice?
Urine is often dark brown, and stool is gray or tan
450
How should edema and ascites be monitored in cirrhosis patients?
Accurate calculation of intake and output, daily weights, measurements of extremities and abdominal girth
451
What position helps maximize respiratory efficiency in patients with severe ascites?
Semi-Fowler's or Fowler's position
452
What is a critical aspect of skin care for patients with cirrhosis?
Meticulous skin care to prevent breakdown of edematous tissues
453
Fill in the blank: The procedure that involves the removal of fluid from the abdominal cavity is called _______.
paracentesis
454
455
What is the focus of nursing care for a patient with hepatic encephalopathy?
Maintaining a safe environment, sustaining life, and assisting with measures to reduce ammonia formation.
## Footnote
This includes interventions like range-of-motion exercises, deep breathing, and monitoring vital signs.
456
What should be monitored in patients taking diuretics for hepatic encephalopathy?
Serum sodium, potassium, chloride, and bicarbonate levels.
## Footnote
Additionally, renal function (BUN, serum creatinine) should be monitored routinely.
457
How often should neurologic status be assessed in a patient with hepatic encephalopathy?
At least every 2 hours.
## Footnote
This includes noting reflexes, pupillary reactions, and orientation.
458
What are common signs of hypokalemia?
Dysrhythmias, hypotension, tachycardia, and generalized muscle weakness.
## Footnote
Muscle cramping, weakness, lethargy, and confusion may also occur.
459
True or False: Patients with hepatic encephalopathy should be placed in a safe environment to prevent falls.
True.
## Footnote
This is crucial due to the risk of confusion and altered levels of consciousness.
460
What nursing care should be provided for fluid and electrolyte imbalances?
Assess for signs of imbalances, especially hypokalemia, and monitor for muscle cramping and weakness.
## Footnote
Evaluate the patient's response to treatment measures.
461
Fill in the blank: Measures to minimize _______ are important to reduce ammonia production in hepatic encephalopathy.
constipation
462
What should caregivers understand about cirrhosis and the importance of continual health care?
The importance of proper diet, rest, avoiding hepatotoxic drugs, and abstaining from alcohol.
## Footnote
Abstinence from alcohol leads to improvement in most patients.
463
What is balloon tamponade used for in patients with cirrhosis?
To control bleeding that is unresponsive to band ligation or sclerotherapy.
## Footnote
The gastric balloon is inflated to maintain pressure and control bleeding.
464
What complications should be monitored for during balloon tamponade?
Rupture or erosion of the esophagus, regurgitation and aspiration of gastric contents, and airway obstruction.
## Footnote
If the gastric balloon breaks, it can lead to asphyxiation.
465
What are expected outcomes for a patient with cirrhosis?
Maintain food and fluid intake adequate to meet nutrient needs.
## Footnote
This is vital for managing the symptoms and complications of cirrhosis.
466
What should be included in the education for patients and caregivers regarding cirrhosis?
Complications, when to seek medical attention, and the importance of adequate rest periods.
## Footnote
Instructions about skin care, drug therapy side effects, and observation for bleeding should also be included.
467
What lifestyle changes may be necessary for patients with cirrhosis due to chronic alcohol use?
Major lifestyle changes to maintain health and manage symptoms.
## Footnote
This may include participation in community support programs.
468
469
What is rationing in the context of healthcare?
Rationing is the controlled distribution of scarce resources in healthcare.
470
What ethical problem does rationing present?
It weighs the needs of individual patients against the needs of many patients with a greater chance of recovery.
471
What can supersede individual rights in healthcare?
Health interests can supersede the interests or rights of a person.
472
What are the two individual rights that must be considered in healthcare decisions?
* Constitutional right to privacy
* Right to consent to or refuse medical procedures and therapy
473
Who may consent to or refuse treatment for healthcare problems?
The competent adult is the only person who may consent to or refuse treatment.
474
Under what circumstances can an intervening party refuse treatment consented to by a patient?
Only given substantial intervening circumstances and not as a threat to compel future behavior.
475
What may be necessary if involved parties cannot reach an agreement on treatment?
Legal intervention by way of a court order may become necessary.
476
What is cirrhosis?
Cirrhosis is a chronic illness that requires continual health care.
477
What should patients with cirrhosis be taught regarding symptoms?
They should be taught the symptoms of complications and when to seek medical attention.
478
What should patients with cirrhosis avoid to protect their liver?
They should avoid potentially hepatotoxic over-the-counter drugs.
479
What lifestyle change is encouraged for patients with cirrhosis?
Abstinence from alcohol is encouraged.
480
What medications should patients with esophageal or gastric varices avoid?
They should avoid aspirin and NSAIDs to prevent bleeding.
481
What activities may increase the risk of variceal hemorrhage in patients with portal hypertension?
* Straining at stool
* Coughing
* Sneezing
* Retching and vomiting
482
What is acute liver failure also known as?
Fulminant hepatic failure.
483
What characterizes acute liver failure?
Rapid onset of severe liver dysfunction in someone with no history of liver disease.
484
What is the most common cause of acute liver failure?
Drugs, usually acetaminophen.
485
What are some other drugs that can cause acute liver failure?
* Isoniazid
* Sulfa-containing drugs
* Anticonvulsants
486
What are some complications of acute liver failure?
* Cerebral edema
* Renal failure
* Hypoglycemia
* Metabolic acidosis
* Sepsis
* Multiorgan failure
487
What are common clinical manifestations of acute liver failure?
* Jaundice
* Coagulation problems
* Encephalopathy
488
What laboratory tests are important in diagnosing acute liver failure?
* Serum bilirubin
* PT time
* Liver enzyme levels (AST, ALT)
* Blood chemistries
* Complete blood count (CBC)
* Acetaminophen level
* Viral hepatitis serology
489
What imaging studies can provide information about acute liver failure?
CT or MRI can provide information about liver size and contour, presence of ascites or tumors, and blood vessel patency.
490
What is a critical step in managing patients with acute liver failure?
Planning for transfer to a transplant center should begin early.
491
What is a frequent complication associated with acute liver failure?
Renal failure.
492
What can protect renal function in patients with acute liver failure?
* Maintaining adequate fluid balance
* Avoiding nephrotoxic agents
* Promptly identifying and treating infection
493
What critical aspects must be monitored in patients with acute liver failure?
* Hemodynamic function
* Renal function
* Glucose
* Electrolytes
* Acid-base status
494
What should be conducted frequently in patients with acute liver failure?
Frequent neurologic evaluations for signs of changes in consciousness.
