Cirrhosis of the liver (Study Guide)

Question 1

normal liver function

Answer 1

carb, fat, protein metabolism, immune system function, detoxifies, steroid metabolism, bile synthesis, storage of glucose, vit., amino acids

Question 2

patho of cirrhosis

Answer 2

• liver attempt’s to regenerate
• abnormal blood vessels/bile duct architecture
• overgrowth of fibrous connective tissue distorts lobular of structure of the liver
• irregular/disorganized/poor nutrition/hypoxia = decreased liver function.

Question 3

what actually happens to the liver’s structure and during cirrhosis?

Answer 3

scarring and fibrosis due to the chronic progressive disease of the liver due to extensive degeneration and destruction of liver cells

Question 4

how does cirrhosis affect neuro

Answer 4

HE, peripheral neuropathy

Question 5

how does cirrhosis affect GI

Answer 5

anorexia, dyspepsia, and slash V, change in bowel habits, abdominal pain, esophageal varices, gastritis, hemorrhoids

Question 6

how does cirrhosis affect repro

Answer 6

amenorrhea, testicular atrophy, gynecomastia

Question 7

how does cirrhosis affect Integ

Answer 7

jaundice, spider angioma, purpura, petechiae

Question 8

how does cirrhosis affect hem

Answer 8

anemia, thrombocytopenia, leukopenia, coagulation disorders, splenomegaly

Question 9

how does cirrhosis affect metabolic

Answer 9

hypokalemia, hyponatremia, hypoalbuminemia

Question 10

how does cirrhosis affect CV

Answer 10

fluid retention, peripheral edema, ascites

Question 11

what are the early signs of cirrhosis

Answer 11

your liver cannot metabolize carbs, fats, proteins so you have GI disturbances, enlarged liver or spleen, fatigue

Question 12

what are late signs of cirrhosis

Answer 12

Hepatocellular failure with portal hypertension, jaundice from the decreased ability to excrete bilirubin, edema, ascites

Question 13

what causes jaundice in cirrhosis

Answer 13

the decreased ability to excrete bilirubin

Question 14

comp of cirrhosis

Answer 14

portal hypotension
esophageal varices
peripheral edema and ascites
hepatic encephalopathy

Question 15

portal hypotension and varices

Answer 15

• come from increased venous pressure in the portal vein –> collateral circulation to develop in the lower esophagus and anterior abd. (varices) –> they are enlarged and swollen and they dont handle pressure well so they can rupture and bleed easily
• if ruptures = most life threatening complication

Question 16

care for portal hypotension and varices

Answer 16

• meds to decrease BP (beta blocker, sandostatin or vasopressin
• sclerotherapy or band litigation ( band around varices so when they rupture it doesnt cause a huge problem)
• balloon tamponade
• transjugular intrahepatic portosystemic shunt (TIPS) which re routes the blood flow but could have HE as post op comp
• Teach them to: avoid ETOH, aspirin, NSAIDS

Question 17

Balloon tamponade

Answer 17

• needs to be NPO when inflated

- temporary stabilization if bleed has happened

Question 18

peripheral edema

Answer 18

-Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen. Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites).

Question 19

ascites

Answer 19

• accumulation of serous fluid in the peritoneal cavity (abdomen)
  
  • increased proteins to lymph due to portal hypertension which pulls fluid into cavity
  • hypoalbuminemia
  • hypoaldosteronism - increases water retention
• at risk for bacterial peritonitis

Question 20

care for edema and Ascites

Answer 20

• sodium restriction (2g/day)
• diuretics (watch INO)
  - sprinolactone: K+ sparing and antagonist to aldosterone
  - lasix
  - tolvaptan for hyponatremia that will increase H20 excretion and increase Na+
• paracentesis: for pain and difficulty breathing
• TIPS
• Monitor for signs of infection and peritonitis (fever, pain, altered mental status)
• IV albumin to maintain intravascular volume and increase plasma colloid osmotic pressure

Question 21

Hepatic encephalopathy

Answer 21

• increase in ammonia due to bacterial and enzymatic deamination
• ammonia is not converted to urea
• signs: changes in mental status

Question 22

GI hemorrhage leading to HE

Answer 22

Increase in ammonia in GI tract

Question 23

things that can lead to HE

Answer 23

1. GI hemorrhage
2. constipation
3. hypokalemia
4. Hypovolemia
5. infection
6. cerebral depressants
7. metabolic alkalosis
8. paracentesis
9. dehydration
10. increased metabolism
11. uremia (renal failure)

Question 24

constipation

Answer 24

Increase in ammonia from bacterial action on feces

Question 25

HYPOKALEMIA

Answer 25

-Potassium is needed by brain to metabolize ammonia

Question 26

hypovolemia

Answer 26

Increase in blood ammonia because of hepatic hypoxia. Impairment of cerebral hepatic, and renal function because of decreased blood flow

Question 27

infection

Answer 27

Increase in catabolism and increase in cerebral sensitivity to toxins

Question 28

cerebral depressants (opioids)

Answer 28

Decrease in metabolism by liver, causing higher drug levels and cerebral depression

Question 29

metabolic alkalosis

Answer 29

Facilitation of transport of ammonia across blood brain barrier. Increase in renal production of ammonia

Question 30

paracentesis

Answer 30

Loss of sodium and potassium ions. Decrease in blood volume

Question 31

dehydration

Answer 31

Potentiates of ammonia toxicity

Question 32

increased metabolism

Answer 32

Increase in workload of the liver

Question 33

uremia

Answer 33

Retention of nitrogenous metabolites

Question 34

Care for HE

Answer 34

- reduce ammonia using lactulose or rifaximin (usually both given together) - avoid constipation so the ammonia levels dont build up

Question 35

how does lactulose reduce ammonia

Answer 35

-it traps the ammonia in the gut then helps expel it in the stool

Question 36

how does rifaximin reduce ammonia

Answer 36

antibiotic

Question 37

DX of cirrhosis

Answer 37

- increased AST and ALT - increased GGT - increased ammonia - prolonged PT, PTT (have clotting issues) - liver ultrasound: not reliable may be good for initial evaluation - endoscopy to look for varices - liver biopsy definitive

Question 38

overall goals of care for cirrhosis

Answer 38

- no cure | - slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis

Question 39

What are the potential treatments for bleeding esophageal varices

Answer 39

balloon tamponode, band litigation, sclerotherapy, TIPS

Question 40

nursing priorities for cirrhosis

Answer 40

- nutrition - atarax to relieve jaundice and pruritus - daily weight and measure girth of abd - monitor labs for hypokalemia and hyponatrmia

Question 41

conservative therapy for cirrhosis

Answer 41

- rest - admin of vit b - avoid alcohol - minimize or avoid aspirin, acetaminophen, and NSAIDS

Question 42

diet for cirrhosis

Answer 42

low sodium and fat, restrict protein maybe (rare), high calories, decrease alcohol