L8

Question 1

Hepatitis A

Answer 1

• RNA
• destroyed by chlorine and high temperature
• faecal-oral route
• presence of IgM shows acute hepatitis A
• presence of IgG without IgM shows past infections

Question 2

Hepatitis B

Answer 2

• double-shelled participle containing DNA
• transmit from mother to infants; through percutaneous, body fluid, or sexual transmission

Question 3

Hepatitis C

Answer 3

• RNA virus
• blood-borne
• cause of liver failure and cancer

Question 4

Treatment for hepatitis

Answer 4

• Immune modulator (for chronic hepatitis B and C): anti-viral, anti-proliferate
• Nucleoside and nucleotide analogs (for chronic hepatitis B): inhibit HBV DNA polymerase to prevent viral replication

Question 5

Non-alcoholic fatty liver disease (NAFLD)

Answer 5

Can progress to non-alcoholic steatohepatitis, which involves liver inflammation, lead to cirrhosis and liver cancer
Diagnosed by ultrasound, CT scan, MRI, liver biopsy

Question 6

Pre-hepatic jaundice

Answer 6

Excessive hemolysis (breakdown of RBC)
Increase serum unconjugated bilirubin

Question 7

Intra-hepatic jaundice

Answer 7

Impaired liver function disrupt the conversion and excretion of bilirubin
Increased both serum conjugated and unconjugated bilirubin
Dark urine

Question 8

Obstructive jaundice

Answer 8

Impaired excretion of bilirubin
Increased serum conjugated bilirubin
Light stool and dark urine

Question 9

Complications of portal hypertension

Answer 9

1. Esophageal/gastric varices
2. Splenomegaly
   (Increase destruction rate of RBC, WBC, and platelets —> anemia, leukopenia, thrombocytopenia)
3. Ascites
4. Hepatorenal syndrome
   (Oliguria: urinary flow <500mL/24hrs;
   Elevated BUN and creatinine level; decreased urine sodium excretion—> increased urine osmolarity)

Question 10

Hepatic encephalopathy

Answer 10

Accumulation of ammonia
Symptoms: confusion, agitation, asterixis: involuntary jerking movement

Question 11

Laboratory tests for liver disease

Answer 11

CBC, coagulation profile, total protein and albumin, serum ammonia, viral antigens

Question 12

Liver function test

Answer 12

1. Bilirubin: assess for hepatic clearance; diagnosis for jaundice
2. AST: check for hepatocellular disease
3. ALT: check for hepatocellular disease; ALT lower than AST in alcoholic-induced disease
4. ALP: elevated show cholestasis, hepatic infiltration, alcoholic hepatitis
5. Albumin: assess severity of hepatic synthetic functions

Question 13

Diet for cirrhosis

Answer 13

• High carbohydrate, moderate fat, high protein diet
• If high serum ammonia with encephalopathy then diet change
• Sodium restriction, vitamin supplements

Question 14

Medication for cirrhosis

Answer 14

1. Diuretics
2. Laxatives
3. Anti-infective agents
4. Beta-blocker: for portal hypertension
5. Ferrous sulphate, folic acid, vitamin B12: for anemia
6. Vitamin K: decrease risk of bleeding
7. Antacids and H2 antagonist: manage associated gastritis and upper GI bleeding
8. Proton pump inhibitors: for esophageal varices require banding
9. Anti-histamine: for pruritus

Question 15

Nursing care for Diuretics
E.g. Flurosemide (Lasix), Spironolactone (Aldactone)

Answer 15

1. Monitor BP/P, ECG, BUN and creatinine level, serum K, and hydration status
2. Daily body weight, monitor I&O
3. Monitor for increased K if take spironolactone alone
   (Symptoms: bradycardia, widening QRS, spiking T, ST segment depression, diarrhoea and muscle twitching)
4. Assess for decreased K
   (Symptoms: confusion, fatigue, apprehension憂心）

Question 16

Laxatives (lactulose)

Answer 16

Reduce ammonia-producing bacteria in stool
1. Assess bowel sounds and abdominal girth
2. Maintain accurate stool chart
3. Adjust dose to achieve 2-4 soft stool per day
4. Monitor for electrolyte and hydration

Question 17

Anti-infective agents

Answer 17

Decrease intestinal bacteria and ammonia production
1. Assess hearing, renal and neurological functions
2. Monitor BUN and creatinine level
3. Monitor I&O
4. Check for previous hypersensitivity reaction before administration

Question 18

Therapeutic paracentesis

Answer 18

Withdraw ascitic fluid for analysis

Question 19

Pre-op for therapeutic paracentesis

Answer 19

1. Signed consent
2. Record baseline vital signs, weight the patient, record the abdominal girth
3. Monitor I&O
4. Check blood tests for CBC, LRFT, clotting profiles
5. Empty bladder
6. Position the patient supine with head elevated
7. Prepare equipment

Question 20

Nursing care during therapeutic paracentesis

Answer 20

1. Check vital signs and LOC
2. Apply dressing to secure catheter
3. Connect catheter to the drainage bag
4. Administer colloid/albumin infusion as prescribed in large volume paracentesis (5-8 g/L)

Question 21

Post-op for therapeutic paracentesis

Answer 21

1. Monitor and document MEWS Q15 mins in the first hour, Q30mins for 1 hour, then Q4H
2. Monitor pain level and drainage output (free-flowing up to 5L)
3. Clamp the drainage and inform medical team if adverse reaction
4. Encourage the patient to change position

Question 22

Management for bleeding esophageal/gastric varices

Answer 22

• endoscopic variceal band ligation
• ballon tamponade: deflate every 4 hours to prevent necrosis