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Unit #3 > Liver > Flashcards

Liver Flashcards

(46 cards)

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1
Q

EGD

A

Visual exam of esophagus, stomach, & duodenum.

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2
Q

TIPS procedure

A

Transjugular intrahepatic potto systemic shunt.
Interventional radiologic technique that reduces portal pressure.
Under conscious sedation, a stent is places percutaneously from right jugular vein into the hepatic vein.
Creates a connection between portal & systemic circulations.

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3
Q

Endoscopic variceal ligation (EVL)

A

“Banding”
Involves application of small “O” bands around the base of the varices to decrease blood supply to varices.
Cause no discomfort and pt is unaware of band presence.

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4
Q

Sclerotherapy

A

Sclerosant solution is injected into the bleeding varix or overlying submucosa.

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5
Q

Ballon tube tamponade

Aka Stegstaken-Blakmore tube

A

May be lifesaving in pts with active variceal bleeding.
3 lumens: gastric aspiration, esophageal balloon, inflated gastric balloon.
Tension is needed to be kept in place, do not leave longer than 48h

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6
Q

Nurses role in paracenthesis

A
  • Explain, answer pt questions
  • obtain VS, including weight
  • ask pt to void prior to prevent injury to bladder.
  • position pt in bed with HOB elevated
  • measure drainage, record accurately
  • describe collected fluid
  • label & send them lab for analysis
  • after physician removes cath, apply dressing to site & apply pressure; assess for leakage
  • maintain bed rest
  • weigh pt after paracentesis; record.
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7
Q

Complication of paracentesis

A

-Fluid & electrolyte imbalances

….increased BUN, decreased protein, & increased Hct may indicate hypovolemia

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8
Q

Priority problems for pts with cirrhosis.

A
  1. Excess fluid volume related to third spacing of abdominal & peripheral fluid
  2. Potential for hemorrhage due to portal hypertension
  3. Hepatic encephalopathy due to shunting of portal venous blood &/or increased ammonia levels.
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9
Q

Nutritional needs for pt with ascites

A

Low sodium diet (1-2g)
No table salt
Vitamin supplements
Low protein, high fat?

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10
Q

Complications of cirrhosis

A
  • portal hypertension
  • gastric & esophageal varices
  • biliary obstruction
  • hepatic encephalopathy
  • splenomegaly
  • peripheral edema & ascites
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11
Q

Endoscopic Retrograde Cholangiopancreatography

A

“ERCP”

Includes visual & radio graphic exam of liver, gallbladder, bile ducts, and pancreas to identify cause & location of obstruction

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12
Q

Liver transplant complications

A

-acute graft rejection
Occurs 4-10th day post-op (s/s: tachycardia, fever, RUQ/flank pain, diminished bile drainage, change in bile, jaundice)

-infection
Occurs at any time

-hepatic complications
Bile leakage, abscess formation, hepatic thrombosis

-acute renal failure
Caused by hypotension, antibiotics, acute liver failure, hypothermia.

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13
Q

Ciprofloxacin

A 
Antibiotic
Bactericidal 
Side effects:
-N/V
-diarrhea
-dyspepsia
-constipation
-flatulence
-confusion
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14
Q

Lactulose

A 
Decreases ammonia forming organisms & increase acidity of bowel.
side effects: 
-abdominal cramping
-flatulence
-increased thirst
-abdominal discomfort
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15
Q

Metronidazole

A 
Antibacterial
Used in tx of anaerobic infections
Side effects: 
-anorexia 
-nausea
-dry mouth
-metallic taste

Vaginal:

  • symptomatic vaginitis
  • abdominal cramps
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16
Q

Neomycin

A

Decrease ammonia forming organisms. Typically recommended when pt does not tolerate lactulose.

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17
Q

Norfloxacin

A 
Antibiotic 
Side effects:
-nausea
-headache
-dizziness
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18
Q

Salt poor albumin

A

Decreases complications of paracentesis such as:

  • electrolyte imbalance
  • increases in serum creatinine levels secondary to large shifts of intravascular volume.
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19
Q

Propranolol

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A 
Antihypertensive, antianginal, anti arrhythmic, anti migraine.
Side effects:
-diminished sexual function
-drowsiness
-difficulty sleeping
-unusual fatigue/weakness
20
Q

Rifaximin

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A 
Site specific antibiotic
Side effects:
-flatulence
-headache
-abdominal discomfort
-rectal tenesmus
-defecation urgency 
-nausea
21
Q

Somatostatin

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A

Constrict guy vessels

22
Q

Spironolactone

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A

Potassium sparing diuretic
Anti hypertensive,
Antihypokalemic

Side effects:

  • hyperkalemia
  • dehydration
  • hyponatremia
  • lethargy
23
Q

Thiamine

Vitamin B1

Study These Flashcards
A

Prevents, reverses thiamine deficiency.
Side effects:
Pain, induration, tenderness at IM injection site

24
Q

Common liver transplant medications.

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A
  • cyclosporine
  • fluconazole
  • mycophenolate
  • nystatin
  • prednisone
  • prenisolone
  • sirolimus
  • tacrolimus
  • valganciclovir
25
Liver trauma key features
- RUQ pain with abdominal tenderness - abdominal distention & rigidity - guarding of abdomen - increased abdominal pain exaggerated by deep breathing & referred to as right shoulder pain ( Kehr's sign) - hemorrhage/ hypovolemic shock
26
Functions of the liver
- regulates composition of blood, including amount of glucose, protein, fat that enter the blood stream. - removes bilirubin, ammonia, and other toxins from blood - processes most of the nutrients absorbed by the intestines during digestion and converts nutrients into forms that body can use. - stores nutrients such as Vitamin A, iron, and other minerals - produces cholesterol, & proteins such as albumin - produces clotting factors - metabolizes alcohol & many drugs
27
Bilirubin
By-product of the breakdown of hemoglobin from RBCs
28
Hep A
Oral-fecal, contaminated water/food. 15-50 days communicable, 1-2 was post symptoms. S/S: Fever, fatigue, nausea, diarrhea, anorexia, jaundice, RUQ pain
29
Hep B
Blood transfusion, IV drug abuse, sexual contact, hemodialysis. 48-180 days Chronic: fulminant hep is a complication of HBV that leads to liver failure. Hep B vaccine available
30
Hep C
Primarily blood contact, IV drug abusers, sexual contact (low) 14-180 days Chronic progressive. No vaccine available
31
Medications impacting the liver
Pain meds; aspirin, acetaminophen, ibuprofen, naproxen, diclofenac, phenylbutazone. Anti-seizure medications; phenytoin, valproic acid, carbamazepine, phenobarbital. Anti-depressants; TCAs Antibiotics; tetracyclines, sulfonamides, isoniazid, sulfamethoxazole, trimethoprim, nitrofurantoin. Cholesterol; "statins" Cardiovascular; Amiodarone, Hydralazine, quinidine.
32
4 types of cirrhosis
1. Alcoholic (Laennec's) 2. Post necrotic cirrhosis 3. Biliary 4. Cardiac- from R side heart failure
33
Manifestations of liver disease
- jaundice - portal hypertension - ascites - hepatic encephalopathy - splenomegaly - blood abnormalities - light stools/ dark urine - peripheral edema - pruritis - abdominal pain
34
Diagnostic tests: liver function studies
-ALT, AST, GGT: elevate -alkaline phosphatase: present in Liver & bones elevated in hepatitis - CBC: low RBC, H/H, WBCs, platelets - AFP: liver cancer marker
35
Diagnostic test liver function studies cont...
- prolongedPT (norm: 12-14s) - INR: 0.8-1.2 without coag therapy - hyponatremia - hypokalemia, hypophosphatemia, hypomagnesmia - bilirubin: total (2-14 umol/L) - albumin: low (3.3-5) - ammonia: high (0-150) - glucose & cholesterol: abnormal Tests: ab ultrasound, EGD, liver biopsy, CT, MRI
36
Stages of portal-systemic encephalopathy
Stage I- prodromal Stage II- impending Stage III- stuporous Stage IV- comatose
37
Nursing management: ASCITES
- assess for resp. distress - measure abdominal growth - high fowlers position - low protein, sodium diet - mouth care/dehydration - K+ sparing diuretics - paracentesis - salt poor albumin - daily wt - strict I&O - monitor fluid & electrolytes - perform "fluid wave" test
38
Portal hypertension
Normal 3 mmHg | 12mmHg= esophageal rupture
39
Hepatic encephalopathy
Alteration in neuro status due to accumulation of ammonia Build up of other substances such as hormones, GI toxins, other drugs
40
Phases of Hepatin encephalopathy
1. Onset: personality changes, disturbance of awareness, forgetfulness, irritability, & confusion. 2. Second: hyperreflexia, asterixis, altered hand writing, violent, abusve behavior 3. Coma: + babinski, hyperactive reflexes
41
Cirrhosis nutrition
- Low protein (sometimes), high carb, high cal-if signs of acute hepatic encephalopathy. - high carb, high protein, low salt - low sodium (500mg-2g) At first sign encephalopathy decrease protein intake (sometimes)
42
Why would we have a low protein diet?
Ammonia is a by-product of protein breakdown.
43
Contraindications to liver transplant
- Pulmonary HTN - morbid obesity - obstructed splanchnic blood flow, - MELD 50 mmHg or CPP
44
Model for end stage liver disease | MELD
Ranges from 6 (less ill) to 40 (gravely ill). Ages 12 & over Uses 3 routine lab results: - bilirubin - PT/INR - creatinine
45
AST lab
Aspartate aminotransferase 5-40 units/L
46
ALT lab
Alanine aminotransferase 8-20 units/L

Unit #3 (5 decks)

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