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Test 3 🏁🏁🏁 > Liver > Flashcards

Liver Flashcards

1
Q

Liver, gallbladder, pancreas, and bile passage

A
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2
Q

Liver functions:

A
  • Removes potentially toxic by products of certain medications
  • Metabolizes, or breaks down, nutrients from food to produce energy, when needed
  • Helps your body fight infection by removing bacteria from the blood
  • Produces most of the substances that regulate blood clotting
  • *Prevent shortages of nutrients by storing vitamins, minerals, and sugar
  • Produces most proteins needed by the body
  • produces erythropoietin
  • Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
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3
Q

AGE RELATED CHANGES OF THE HEPATOBILIARY SYSTEM

A
  • Atypical clinical presentation of biliary disease
  • More severe complications of biliary tract disease
  • More rapid progression of hepatitis C infection & lower response rate to therapy
  • Increased prevalence of gallstones due to the increase in cholesterol secretion in bile
  • Decrease in the following:
    — Clearance of hepatitis B surface antigen
    — Drug metabolism and clearance capabilities
    — Intestinal and portal vein blood flow
    — Gallbladder contraction after a meal
    — Rate of replacement and or repair of liver cells after injury
    — Size and weight of liver (especially in women)
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4
Q

Liver Cirrhosis

A
  • Chronic progressive liver disease
  • Irreversible scarring of the liver tissue
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5
Q

Liver Cirrhosis (Scar)

A
  • Widespread/extensive fibrotic (scarred) tissue develops
  • Liver tissue becomes nodular. These nodules can block bile ducts and normal blood flow throughout liver
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6
Q

Types of cirrhosis

A
  • Alcoholic cirrhosis
    — most common type of cirrhosis
    — Scar tissue surrounds portal areas
    — Caused by chronic alcoholism (Laennec’s Cirrhosis)
  • Postnecrotic cirrhosis
    — Broad bands of scar tissue
    — Late result of previous acute viral hepatitis {Caused by *viral hepatitis (esp Hep C) and certain drugs/toxins}
  • Biliary cirrhosis
    — *Liver scarring around bile ducts
    — Usually results from chronic biliary obstruction, infection or *autoimmune disease
    — Much less common type
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7
Q

Cirrhosis s/s

A
  • Usually no symptoms for decades (until late stage)
  • In early disease, if symptoms occur- they are usually vague/nonspecific:
    — Loss of appetite, indigestion, dull ab pain esp.in right upper quad, nausea, vomiting
  • Late stage: Jaundice, GI bleeding, spontaneous bleeding
  • Jaundice of skin/yellowing of eyes
  • Dry itchy skin- don’t forget the lotion!
  • Ascites
  • Peripheral dependent edema
  • Palmar erythema (red hands)
  • Spider angiomas (spider veins)
  • Thrombocytopenia- early indication of liver dysfunction
  • Ecchymoses/petechiae
  • Compensated vs decompensated (Chart 43-9)
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8
Q

Cirrhosis s/s

A
  • Usually no symptoms for decades (until late stage)
  • In early disease, if symptoms occur- they are usually vague/nonspecific:
    — Loss of appetite, indigestion, dull ab pain esp.in right upper quad, nausea, vomiting
  • Late stage: Jaundice, GI bleeding, spontaneous bleeding
  • Jaundice of skin/yellowing of eyes
  • Dry itchy skin- don’t forget the lotion!
  • Ascites
  • Peripheral dependent edema
  • Palmar erythema
  • Spider angiomas
  • Thrombocytopenia- early indication of liver dysfunction
  • Ecchymoses/petechiae
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9
Q

Cirrhosis- complications

A
  • Portal Hypertension: persistent increase in pressure in liver; decrease of blood into liver; back flow of blood into spleen
    — Splenomegaly
    — Esophageal varies (distended veins)
    — Ascites: increased vascular permeability; can get peritonitis
  • Hepatic Encephalopathy; toxins ammonia build up in brain
  • Hepatorenal Syndrome: back up causes kidneys to fail
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10
Q

Portal Hypertension

A
  • elevated pressure in the portal vein because blood flow is obstructed through the liver
  • Major complication of cirrhosis
  • Blood flows back into the spleen= splenomegaly
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11
Q

splenomegaly

A
  • Bleeding, risk of infection
  • spleen stores plts and WBCs)
    — Thrombocytopenia, bleeding
    — Increased risk of infection
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12
Q

Esophageal varies (distended veins)

A
  • Veins becoming dilated in the stomach, intestines, abd, rectum & esophagus
  • The fragile thin- walled esophageal veins become dilated and tortuous from increased pressure
  • Potential to bleed severely
  • Severe blood loss potentially leading to hypovolemic shock
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13
Q

Ascites

A
  • excessive peritoneal fluid
  • Dehydration
  • Hypokalemia
  • Acute spontaneous peritonitis (SBP) as result of low proteins
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14
Q

Hepatic Encephalopathy (aka portal-systemic encephalopathy PSE)

A
  • accumulation of ammonia due to liver failure -can lead to neurologic issues (sleep & mood disturbance, mental status changes & speech problems)
  • ALOC
  • Life threatening complication
  • Reversible
  • Asterixis in hepatic encephalopathy
  • give lactulose: allows pt to poop out ammonia
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15
Q

Hepatorenal Syndrome

A
  • Life threatening complication of advanced liver disease
  • Kidneys lose ability to function due to compromised blood supply (Renal failure associated with hepatic failure)
    — indicates poor prognosis (liver transplant needed in most cases)
    — often cause of death for cirrhosis pts.
  • *Sudden decrease in urine flow “oliguria” (<400mL/24hrs)
  • Elevated BUN and Creatinine levels with abnormally decreased urine sodium excretion
  • Increased urine osmolarity (more concentrated)
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16
Q

Cirrhosis Assessment

A
  • Decreased mental function
  • Poor cognition & movement disorders
  • SOB
  • Peripheral dependent edema
  • Ascites
  • Jaundice, pruritus, dry skin
  • Red palms (palmer erythema)
  • Spider angiomas
  • Bleeding, Ecchymosis
  • Petechiae
  • Hematemesis or melena (esophageal varices)
17
Q

Cirrhosis Nursing Care

A
  • Promote rest
  • Nutrition
  • Skin care
  • Enhance pt positioning (semi- fowlers)
    — to optimize pulmonary function
  • Prevent injury
  • Monitor for changes in neuro status
  • Monitor & maintain F&E balance
  • Monitor for infection (ab pain and fever may signal onset of infection
  • Prepare for possible Paracentesis
  • Drug therapy
    — Vitamins
    — - Fat soluable
    — - Vit K
    — Diuretics
    — Lactulose
    — Antibiotics
    — H2 receptor blockers/PPIs
    — Meds to stop bleeding
18
Q

Care of the Patient with Paracentesis:

A
  • Explain the procedure, and answer patient questions.
  • Obtain vital signs, including weight.
  • **Ask the patient to void before the procedure to prevent injury to the bladder! ***
  • Position the patient in bed with the head of the bed elevated.
  • Monitor vital signs per protocol or physician’s request.
  • Describe the collected fluid.
  • Measure the drainage, and record accurately.
  • Label and send the fluid for laboratory analysis; document in the patient record that specimens were sent.
  • After the physician removes the catheter, apply a dressing to the site; assess for leakage.
  • Maintain bedrest per protocol.
  • Weigh the patient after the paracentesis; document in the patient record weight both before and after paracentesis.
19
Q

Cirrhosis Possible Procedures:

A
  • Endoscopic variceal ligation (EVL)
  • Endoscopic sclerotherapy (EST)
  • TIPS
  • Balloon tamponade
20
Q

Endoscopic variceal ligation (EVL)

A

“banding” ◦ Small bands placed around base of varices to decrease blood supply to varices

21
Q

Endoscopic sclerotherapy (EST)

A

Varices injected with sclerosing agent to thrombose and destroy distended veins

22
Q

TIPS

A
  • In pts with severe liver problems
  • This is a procedure to create new connections between two blood vessels in your liver.
    used to control long-term ascites and reduce variceal bleeding
  • Stent inserted via catheter to portal vein
    — will redirect blood from liver to systemic circulation
    — Stent will divert blood flow and reduce portal hypertension
  • Effective in decreasing sodium retention and improving kidney response to diuretics and preventing recurrence of fluid accumulation
  • High cost compared to paracentesis & albumin
  • Stent is inserted to connect the portal veins to adjacent blood vessels that have lower pressure.
    — This relieves the pressure of blood through the diseased liver and can help stop bleeding and fluid back up.
23
Q

Balloon tamponade

A
  • to treat bleeding varices if unable to have endoscopic procedures or TIPS procedure
  • Balloon is inflated to put pressure on the bleeding esophageal varices to decrease bleed
  • Potentially life-threatening complications
    — Ex. Sengstaken-Blakemore Tube
24
Q

Parecentisis

A
  • Removal of fluid from peritoneal cavity
  • incision through ABD. Wall
  • sterile: U.S. guided
  • diagnostic
  • 5-6 liters removed

Test 3 🏁🏁🏁 (9 decks)

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