Cirrhosis

Question 1

What is Laennec’s (Alcoholic) portal cirrhosis?

Answer 1

Scar tissue out #’s normal cells and the liver is unfunctional; results of alcohol or nutritional probs

Question 2

Postnecrotic cirrhosis is what?

Answer 2

Complication of hepatitis/hepatoxins

Question 3

What is biliary cirrhosis?

Answer 3

Chronic biliary obstruction/infection and scarring from diseases of the bile duct

Question 4

What is cardiac cirrhosis?

Answer 4

From long standing right CHF

Question 5

What is the primary risk factor for cirrhosis?

Answer 5

Alcohol consumption

Question 6

What are other risk factors?

Answer 6

Malnutrition: low protein intake, high phosphate intake; occupation exposure; men between ages 40-60

Question 7

What are the early clinical manifestations of?

Answer 7

Liver enlargement/fatty liver, vascular changes, abnormal labs: Tiny increases in ALT/AST/LDH/PT and decreased albumin

Question 8

How do you get rid of a enlarged/fatty liver?

Answer 8

Quit drinking, exercise and maintain a healthy diet

Question 9

What are the advanced stages severe complications?

Answer 9

Ascities, GI varices, encephalopathy and portal HTN

Question 10

Where are the 3 main places ascities can accumulate?

Answer 10

Esophagus, rectum and stomach

Question 11

What is encephalopathy caused by? And some s/s?

Answer 11

Ammonia; Confusion, mental deterioration, somnalence

Question 12

What is portal HTN?

Answer 12

Increase pressure of blood flow around the liver

Question 13

What of the liver cannot be reversed?

Answer 13

Fibrosis (thickening/scarring of CT)

Question 14

What anti-inflammatory is often used for the pharmacological management of cirrhosis?

Answer 14

Colchicine

Question 15

What potassium sparing diuretic is used for the pharmacological management of cirrhosis?

Answer 15

Aldactone

Question 16

What meds can cause liver damage?

Answer 16

Barbiturates, tylenol and sedatives

Question 17

What other meds can be used for the pharmacological management of cirrhosis?

Answer 17

Vit. K, antacids and H2 receptor blockers

Question 18

What is the nutritional therapy for cirrhosis?

Answer 18

Protein, high calories, moderate fat, decrease sodium, limit fluids and vit/mineral supplements

Question 19

How much salt can a person w/ cirrhosis intake?

Answer 19

2g/day

Question 20

What vitamin/mineral supplements can be used for nutritional therapy?

Answer 20

B complex, fat soluble vitamins and Mg

Question 21

What other supportive therapy is used in the treatment for cirrhosis?

Answer 21

Rest: semi-fowlers position, O2 therapy and actions to prevent immobility

Question 22

What’s the major risk factor of portal HTN?

Answer 22

Hemorrhage

Question 23

What is the non-surgical managements of portal HTN?

Answer 23

Endoscopic screening, non-selective beta blockers

Question 24

If a pt is a high risk for bleeding what non-selective beta blocker is used?

Answer 24

Propanolol Hydrochloride (Inderal)

Question 25

What other common non-selective beta blocker is used to treat portal HTN?

Answer 25

Nadolol (Cogard)

Question 26

What is ascities?

Answer 26

Accumulation of fluid in the peritoneal cavity

Question 27

What surgical procedure can be used for portal HTN?

Answer 27

Transjugular intrahepatic portosystemic shunt (TIPS)

Question 28

What is TIPS?

Answer 28

Stent placed b/t hepatic and portal vein to decrease pressure and prolong life

Question 29

Frequent complication of portal HTN, fluid leaks from GI organs, fluid leaks from vascular system and sodium and water retention are all causes of what?

Answer 29

Ascities

Question 30

What are the dietary modifications to manage ascities?

Answer 30

Low sodium diet and the use of salt substitutes w/o ammonia

Question 31

What diuretics are used to manage ascities?

Answer 31

Spirnalactone (Aldactone)

Question 32

What nursing care is done to measure salt-poor albumin?

Answer 32

Daily weights, monitor F/E, I/O, measuring abd girths

Question 33

What surgical procedure can be performed to manage ascities?

Answer 33

LaVeen shunt

Question 34

What is a LaVeen Shunt?

Answer 34

A tube inserted from the liver to the heart to help blood flow when you breathe

Question 35

What are complications of a LaVeen Shunt?

Answer 35

CHF, infection, repeated clotting

Question 36

What should be monitored in a pt w/ ascities?

Answer 36

H/H and coagulation studies

Question 37

What is the most advanced stage of hepatic encephalopathy?

Answer 37

Hepatic coma

Question 38

What is the management for heaptic encephalopathy?

Answer 38

Remove offending agent, reduce/restrict protein intake, reduce intestinal bacteria, and reduce serum ammonia levels

Question 39

What is admin. to reduce intestinal bacteria in hepatic encephalopathy?

Answer 39

Flagyl, enemas, neomycin, sulfasuxidine, sulfathaladine

Question 40

What is admin. to reduce ammonia levels?

Answer 40

Lactulose: flushes out ammonia through diarrhea

Question 41

What are the side effects of Lactulose?

Answer 41

Intestinal bloating and cramping

Question 42

What should you dilute lactulose w/ if given PO?

Answer 42

Fruit juice

Question 43

What are varices?

Answer 43

Enlarged, thin-walled veins that form and may rupture or cause massive hemorrhage