Hepatic Disorders

Question 1

causes of cirrosis

Answer 1

Hep. B and C, ETOH, autoimmune, bile duct problems, fat collection (hyperlipidemia)

Question 2

role of liver

Answer 2

metabolizes, detoxifies, stores, produces

Question 3

chronic scarring of the liver. nodular, bumpy, irreversible

Answer 3

hepatic cirrosis

Question 4

causes of hepatic cirrosis

Answer 4

inflammation, fibrosis, bile duct occlusion

Question 5

risk factors for cirrosis

Answer 5

ETOH, chronic viral hep., fatty liver disease/hepatic steatosis, toxic chemical or drug exposure, male, age 40-60

Question 6

hand flapping

Answer 6

asterixis (due to ammonia)

Question 7

study manifestations of cirrhosis on page 5

Answer 7

examples: fatigue, bruising, fetor hepaticus (smell),

Question 8

the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.

Answer 8

caput medusae, due to portal HTN

Question 9

rash looking on palms

Answer 9

palmer erethymea

Question 10

given to decrease gastric distress and minimize possiblity of GI bleed

Answer 10

Pepcid, protonics (antacids, HIstamine 2 )

Question 11

given to promote healing of damaged livers cells and improve general nutrition

Answer 11

adequate diet, vitamines, and nutritional supplements

Question 12

given to minimize F and E imbalance

Answer 12

potassium sparing diuretics (spironolactone or triamterene) to decrease ascites and monitor hypotension

Question 13

promotes excretion of ammonia via stool

Answer 13

lactulose

Question 14

medication that reduces levels of ammonia

Answer 14

neomycin, metronidazole (Flygyl), rifaximin (Xifaxan)

Question 15

cautious use due to decreased liver function

Answer 15

opioids, sedatives, barbiturates

Question 16

lower albumin leads to

Answer 16

fluid excess

Question 17

impaired skin integrity due to

Answer 17

bile salts

Question 18

Diet

Answer 18

high calorie, lower sodium, LOW PROTEIN

Question 19

provide what kind of vitamins if patient has steatorrhea

Answer 19

water soluable

Question 20

when it comes to vitamins for cirrosis, which is most important

Answer 20

B complex

Question 21

monitor carefully in cirrosis

Answer 21

coagulation studies

Question 22

restrict these due to edema

Answer 22

sodium, fluids, proteins, document I/O

Question 23

elevate legs to prevent peripheral edema and increase venous return

Answer 23

assess for dyspnea, increased RR, hypoxia, pleural effusion (fluids pushed into pleural space) everything pushing up

Question 24

avoid which medication

Answer 24

acetaminophen, aspirin contraindicated with GI bleed

Question 25

blood pools back due to blockage of bumpy liver. often caused by portal HTN

Answer 25

esphageal varices

Question 26

what often causes esophageal varices

Answer 26

portal HTN

Question 27

risk factors for bleeding of esophageal varices

Answer 27

heavy lifting, straining, sneezing, coughing, vomiting, swallowing poorly chewed foods, erosion of vessel walls due to gastric acid, ETOH, or meds

Question 28

Clinical manifestions of? bleeding may be the only symptom. Melena. Hematemesis, mental or physical deterioration, hemorrhagic shock

Answer 28

esophageal varices

Question 29

clinical manifestions: splenomegaly, ascites, black stool, spontaneous bruising, hypotension

Answer 29

hepatic cirrhosis

Question 30

if patient is diagnosed with cirrosis, how often do they need an endoscopy?

Answer 30

q 2 years

Question 31

umbrella term for identifying cause and source of bleeding for esophageal varices

Answer 31

endoscopy

Question 32

pharm for bleeding that is preferred for immediate control

Answer 32

octreotide (Sandostatin)

Question 33

pharm for bleeding that is contraindicated in CAD

Answer 33

vasopressin (Pitressin) w/ nitro

Question 34

most common for PREVENTING 1st bleed and PREVENTING re bleed

Answer 34

BB - propranolol, nadolol

Question 35

may be used in combination with BB to stop bleed

Answer 35

nitrates - isosorbide (isordil)

Question 36

short term use in stopping esophageal bleed. MUST BE INTUBATED IN ORDER TO USE

Answer 36

balloon tamponade

Question 37

balloon tamponade is for which use only

Answer 37

emergency. used to stablize. risk for rupture, airway obstruction, asphyxiation, aspiration, etc. check q 4-6 hours

Question 38

stops bleeding but does not prevent subsequent bleeding. Need GI protection (Antacids, H2, PPI)

Answer 38

endoscopic sclerotherapy

Question 39

preferred method and treatment of choice over sclerotherapy. Reduces re bleeding of Esoph. Varices, mortality, and procedure related complications

Answer 39

esophageal Banding - Esophageal Variceal Ligation (EVL)

Question 40

used when EVL or sclerotherapy and meds are ineffective in controlling esophageal variceal bleeding. Rapidly reduces portal pressure

Answer 40

transjugular intrahepatic portosystemic shunt (TIPS)

Question 41

effective in decreasing portal HTN and variceal bleeding. Last resort.

Answer 41

portal systemic shunts

Question 42

complications of portal shunts

Answer 42

thrombosis, encephalopathy, accelerated liver failure

Question 43

major factor in hepatic encephalopathy

Answer 43

ammonia

Question 44

neuropsychiatric manifestation of hepatic failure associated with portal HTN and shunting of blood into system circulation

Answer 44

Hepatic Encephalopathy

Question 45

which stage of Hep. Enceph? sleep problems, periods of lethargy, euphoria, trouble concentrating, normal EEG

Answer 45

Stage 1 - Mild

Question 46

which stage of Hep. Enceph? increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation, asterixis, fetor hepaticus, abnormal EEG with marked slowing

Answer 46

Stage 2 - Moderate

Question 47

stage of Hep. Enceph. stuporous, difficult to arouse, incoherent speech, asterixis, rigid extremities, hyperreflexia, markedly abnormal EEG

Answer 47

3 - Severe

Question 48

which stage of Hep. Enceph. Comatose, no esterixis, absent deep tendon reflexes, flaccid extremities, markedly abnormal EEG

Answer 48

4 - Final

Question 49

what should you do for hepatic encephalopathy to reduce serum ammonia

Answer 49

administer lactulose. Goal of 2-3 soft stools/day,

Question 50

cautions for lactulose

Answer 50

hypokalemia, watery diarrhea, dehydration

Question 51

administer this for hepatic Eceph. to minimize protein breakdown

Answer 51

IV glucose. Also correct vitamin deficiencies: A, B, C, K, folic acid, and electrolyte imbalance

Question 52

administer which antibiotics as needed

Answer 52

neomycin (nephrotoxic), metronidazole (Flagyl), rifaximin

Question 53

discontinue which meds that precipitate encephalopathy

Answer 53

sedatives, tranquilizers, barbiturates, opiates

Question 54

administer this benzo antagonist for Hep. Enceph

Answer 54

flumazenil

Question 55

atixis (flapping) caused by

Answer 55

ammonia in brain

Question 56

syndrome of sudden and severely impaired liver function or severe hepatocyte necrosis in teh absence of preexisting liver disease

Answer 56

fulminant hepatic failure

Question 57

where is ammonia produced

Answer 57

gut

Question 58

Bacteria in your gut and in your cells create ammonia when your body breaks down

Answer 58

protein

Question 59

common cause of fulminant hepatic failure

Answer 59

viral hep