Hepatic System: Cirrhosis Flashcards
(56 cards)
1
Q
What is Cirrhosis?
A
• Extensive degeneration, destruction and fibrosis (scarring) of the liver
2
Q
What is the patho for cirrhosis?
A
- Inflammation of the liver results in destruction and replacement of hepatocytes with scar tissue
- This impairs blood flow in the liver and ↓ in liver function
3
Q
What are the 3 main types/causes:
A
- Postnecrotic
- Viral hepatitis
- Toxins/drugs
- Biliary
- Chronic biliary obstruction
- Laennec’s
- Chronic alcoholism
4
Q
What are the early s/s of Cirrhosis?
A
- Pain
- Fever
- N/V
- Fatigue
- Hepatomegaly
5
Q
What labs indicate cirrhosis?
A
- ↑ ALT,AST, Bilirubin, Ammonia
- ↓ Serum protein, Albumin, RBC, Hgb/Hct, Platelets
6
Q
What are the dx tests for cirrhosis?
A
- Liver biopsy
- Ultrasound
- CT/MRI
7
Q
What are the tx options for cirrhosis?
A
- Medications
- Vitamin/mineral supplements
- Diuretics
- Lactulose
- Procedures
- Liver transplant
8
Q
What is the nursing care for cirrhosis?
A
- Monitor I/Os
- Restrict fluids and sodium as ordered
- Monitor for complications
- Encephalopathy
- Portal hypertension
- Esophageal varices
- Hemorrhage
9
Q
What is our pt teaching for cirrhosis?
A
- Low sodium diet
- Small freq meals
- No alcohol (encourage recovery program)
10
Q
True or False
The liver is the strongest organ in the body and by the time the patient dies of liver failure from cirrhosis, the liver is already 90% dead.
A
• True
11
Q
What is the difference between where hepatitis pts and cirrhosis pts get their tx?
A
- Hep pts get their care as an outpatient at a doctor’s office
- Cirrhosis pts get their tx in the hospital
12
Q
What is Korsakoff’s syndrome?
A
- A disorder that primarily affects the memory system in the brain.
- It usually results from a deficiency of thiamine (vitamin B1), which may be caused by chronic alcohol abuse and malnutrition
13
Q
What does vitamin B1 (thiamine) do?
A
• Helps the body convert carbohydrates into glucose, which is critical for brain function
14
Q
What are the s/s of Korsakoff’s syndrome?
A
- Anterograde amnesia
- Retrograde amnesia
- Confabulation
- Meager content in conversation
- Lack of insight
- Apathy
- Ataxia
- Tremor
15
Q
What is anterograde amnesia?
A
• Decreased ability to retain new information
16
Q
What is retrograde amnesia?
A
• Inability to remember what happened in the years, or decades , prior to injury
17
Q
What is confabulation?
A
• Made-up stories fill in any gaps in memory
18
Q
What is ataxia?
A
• A condition that presents with difficulties with: balance and walking. speaking. swallowing.
19
Q
What are the neurologic s/s of cirrhosis?
A
- Hepatic encephalopathy
- Peripheral neuropathy
- Asterixis
20
Q
What is hepatic encephalopathy?
A
- Uncleared toxins due to liver malfunction can travel to the brain and affect brain function.
- People with hepatic encephalopathy may seem confused.
- Treatments can rid the body of toxins and reverse this temporary condition
21
Q
What is peripheral neuropathy?
A
- Damaged nerves located outside of the brain and spinal cord (peripheral nerves) that causes weakness, numbness and pain in the hands and feed.
- Can also affect digestion, urination and circulation
22
Q
What are the GI s/s of cirrhosis?
A
- Anorexia
- Dyspepsia
- N/V
- Change in bowel habits
- Dull pain
- Fetor hepaticus
- Esophageal, gastritis and hemorrhoidal varices
- Hematemesis
23
Q
What are the reproductive s/s of cirrhosis?
A
- Amenorrhea
- Testicular atrophy
- Gynecomastia (enlargement of the breast tissue in men or boys)
- Impotence
24
Q
What are the integumentary s/s of cirrhosis?
A
- Jaundice
- Spider angioma
- Palmar erythema (red palms)
- Purpura
- Petechiae
- Caput medusae
25
What is caput medusae?
• Cluster of swollen veins in your abdomen
26
What are the hepatologic s/s of cirrhosis?
* Anemia
* Thrombocytopenia (low platelet count)
* Leukopenia
* Coagulation disorders
* Splenomegaly
27
What are the cardiovascular s/s of cirrhosis?
* Fluid retention
* Peripheral edema
* Ascites
28
What metabolic conditions occur with cirrhosis?
* Hypokalemia
* Hyponatremia
* Hypoalbuminemia
29
What are the normal potassium levels?
• 3.5-5.0
30
What are the s/s of hypokalemia?
* Dysrhythmias
* Weakness/cramps
* Constipation
* Hypotension
* Weak pulse
31
What are the normal sodium levels?
• 135-145
32
What are the s/s of hyponatremia?
* Tachycardia
* Hypotension
* Confusion
* Fatigue
* N/V, HA
33
Explain the patho of portal hypertension and how it leads to ascites/splenomegaly.
* Liver inflammation/scarring results in hepatic resistance to blood flow and causes it to back up into the portal vein
* Pressure builds causing portal hypertension
* As portal vein pressure (around 25mmHg) exceeds interstitial pressure (5-10mmHg) the vesicles start to leak into the abdomen resulting in ascites
* The portal vein pressure also backs up into the spleen resulting in splenomegaly
34
How does ascites cause hyponatremia and how does this affect the kidneys?
* The water of ascites draws the sodium out of circulation into the abdomen
* The resulting hyponatremia causes the kidneys to retain sodium and more water
* This fluid retention results in a feedback loop that feeds ascites and causes the peripheral edema
35
What are some ways to treat ascites?
* Medication
* Paracentesis
* TIPS (transjugular intrahepatic portosystemic shunt)
36
What is the safest way to resolve ascites?
* Sodium restriction (to slow feedback loop)
* Diuretics (for fluid removal)
* Albumin (keeps and draws sodium back into circulation)
37
What diuretic should be used in resolving ascites and why?
* Tolvaptan (samsca)
* It is an electrolyte sparing diuretic
38
Why is paracentesis a risky procedure for ascites?
• Due to the internal pressure, it could result in constant leakage and cause the pt to become hemodynamically unstable
39
What is the relationship between portal hypertension and varices?
* When the portal pressure gets too high, it can back up and make the veins around the stomach and esophagus to swell.
* These swollen veins are called varices.
* If they swell too much, they break open and bleed.
* This is called variceal bleeding
40
What is the TIPS procedure?
* Pt put under general anesthesia
* A catheter will be inserted into the jugular vein
* An X-ray with contrast dye, is used to guide the catheter until it gets to the liver.
* Then the doctor will create a channel from the hepatic vein, which is the vein that takes blood out of the liver, to the portal vein.
* This channel allows blood to bypass your liver.
* The TIPS stent, which is a wire mesh tube, will be placed to keep the channel open.
* The doctor can measure the blood flow in the veins to make sure the pressure drops.
* If it's still too high, they might use a balloon on the catheter to open the stent wider.
* The procedure usually takes 2 to 4 hours.
* Hospitalization is required, but most pts can go home after a day or 2.
* It can take weeks or months for the TIPS to work.
41
What devices could be employed to stop bleeding from esophageal or gastric varices as a result of portal hypertension?
* Minnesota Tube
* Sengstaken-Blakemore Tube
42
When using tubes to stop variceal bleeding, what is important to monitor?
• Pulse and O2
43
How do the Minnesota and sengstaken-blakemore tubes work?
* Both tubes contain esophageal and gastric balloons that are inflated once in place.
* This pressure gives time for clotting to occur and stops the bleeding
44
Why are vitamin K and fresh frozen plasma (FFP) important w/ cirrhosis?
• They both promote clotting
45
Why would packed RBCs be given to a cirrhosis pt?
• To treat for anemia
46
What do Propranolol and Nadolol lower?
• Portal hypertension
47
Spironolactone or Triamterene are administered for what purpose relating to liver cirrhosis?
• Treat ascites or edema
48
In a pt w/ liver cirrhosis, lactulose or Rifaximin are used to treat what, and can lead to…
* Encephalitis
* Diarrhea
49
Cholestyramine is used to lower…
• Cholesterol
50
Ursodiol and antihistamines are used to treat what s/s of cirrhosis
• Pruritus
51
Why would PPIs be used for someone w/ cirrhosis?
• To relieve hypertensive gastropathy (gastric pressure) caused by ascites
52
What is the recommended diet for a cirrhosis pt?
* High calorie (3000/day)
* High carb for energy
* Low/moderate fat for bile production/nutrition
* Low/restricted protein as more protein produces more ammonia and increases risk of encephylopathy
53
Describe stage 1 of the development of cirrhosis.
• mild fibrosis without walls of scarring
54
Describe stage 2 of the development of cirrhosis.
• mild to moderate fibrosis with walls of scarring
55
Describe stage 3 of the development of cirrhosis.
• bridging fibrosis or scarring that has spread to different parts of the liver but no cirrhosis.
56
Describe stage 4 of the development of cirrhosis.
• severe scarring, or cirrhosis.
