Chapter 58 Flashcards
Liver problem history
Exposure such as needle stick, sexual history, family history, alcohol intake, illicit drug use, tattoos, prison
Physical assessment
Fatigue
Significant change in weight
GI symptoms
Abdominal pain and liver tenderness
Laboratory tests: abnormal liver fxn, thrombocytopenia
GI bleed, jaundice, ascites, spontaneous bruising, jaundice, dry skin, rashes, petechiae, ecchymoses, red palms, spider angiomas, peripheral edema, vit deficiency
Abdominal assessment cirrhosis
Ascites Erect body posture Balance problems Inguinal or umbilical hernias Hepatomegaly Splenomegaly Abdominal girth Daily weight
Other physical assessment
Observe vomitus and stool Fetor hepaticus- breath odor- liver disease and hepatic encephalopathy- fruity or musty Amenorrhea Testicular atrophy Gynecomastia Bruising and petechiae Asterixis
Psychosocial assessment
Personality changes
Cognitive changes
Euphoria
Depression
Laboratory assessment
Elevated AST and ALT because they are released during hepatic inflammation
As liver deteriorates, hepatocytes may not recognize inflammation, so normal values
ALT specific to liver
AST found in muscle, kidney, brain, heart
AST/ALT ratio > 2 is usually found in alcoholic liver disease
Alkaline phosphatase and GGT increased with cirrhosis
PT/INR prolonged because liver decreases production of prothrombin
Low platelets
Anemia- decreased RBC, Hgb, Hct,
Decreased WBC
Ammonia levels elevated with advanced liver disease
Dilutional hyponatremia in ascites
Imaging assessment
Xray- hepatomegaly, splenomegaly, massive ascites
MRI- mass lesions
Other diagnostic assessment
US- first assessment, detect ascites, splenomegaly, hepatomegaly, presence biliary stones, bile duct obstruction
Biopsy- exact pathology, problematic with bleeding
Arteriography
EGD- visualize upper GI, varices, stomach irritation, duodenall ulceration, bleeding
ERCP- inject contrast in sphincter of Oddi to view biliary tract and allow stone removal, stent placement, biopsy
Managing fluid volume
Prevent accumulation Low sodium diet < 2000 mg/day Exclude table salt Vitamin supplement- thiamine Diuretic to reduce fluid and prevent cardiac and resp problems Daily weight Daily I and O Abdominal girth Peripheral edema Assess electrolytes Oral or IV K+ supplement Monitor infection- give quinolones
Paracenthesis
Performed at bedside Drain abdomen fluid Short term drain may be placed May get sample of fluid Monitor for bleeding Obtain v.s. And weight Void prior to procedure Elevate HOB Document drainage Apply dressing Bed rest
Respiratory support
Caused by excess fluid called hepatopulmonary syndrome Auscultate lungs every 4-8H Monitor O2 sat Even ate HOB atleast 30 degrees Elevate feet
Fluid and electrolyte balance
BUN, serum protein, Hct, electrolytes
Elevated BUN, decreased serum protein, increased HCt indicates hypovolemia
Transjugular intrahepatic portal system shunt (TIPS)
Nonsurgical procedure for ascites
Control long term ascites and reduce variceal bleeding
Managing hemorrhage
Screen to detect earlier- varices
Nonselective beta blocker to prevent bleeding- decreases HR and hepatic venous pressure
Antibiotics
If bleed- give vasopressin, sandostatin
Banding to decrease blood supply
Sclerotherapy- stop bleeding, cam cause mucosal ulceration
Also do balloon tamponade, stent, shunt, TIPS
Monitor vs every hr, check coag studies
Managing hepatic encephalopathy
Management is slowing or stopping the accumulation of ammonia- formed in GI by action of bacteria on protein
Dietary limitations and drug therapy to reduce bacterial breakdown
Diet- high carbs, mod fat, high protein
Drugs- use sparingly, lactulose, nonabsorbable antibiotics(neomycin, rifaximin)
Assess change in LOC, check for liver flap, liver breath
