Liver Diseases Flashcards
(27 cards)
Why is NRTI not used in Hep C?
Does not require reverse transcriptase. It replicates directly in cytoplasm using its own RNA dependent RNA polymerase
Which Hepatitis is treated with Interferon Therapy?
Hep B
Why are there no vaccines for Hep C?
Due to high genetic variability
Cirrhosis caused by alcohol use is reversible with abstinence?
False
Which condition involves increased pressure in the portal vein due to blocked liver circulation
Portal HTN
Spontaneous bacterial peritonitis is a rare complication of Cirrhosis
False, it is common
Which diuretic is first line therapy for managing ascites in cirrhosis
Spironolactone
What is the definitive treatment for end-stage liver failure
Liver Transplant
Which of the following is an essential nursing responsibility for patients with liver disease
Monitor for signs of jaundice or ascites
Which antibiotic is commonly used in bacterial infections in cholecystitis
Metronidazole and Ceftriaxone
Fasting and Bowel rest are essential for managing acute cystitis
True
What is the GOLD standard for acute cholecystitis
Laparoscopic Cholecystectomy
Hepatitis A
- Spreaded by
- Symptoms
- Management
Spreaded by
- Faecal-Oral route
Symptoms
- Fatigue, Jaundice, Nausea, Abdominal Pain
Management
- Prevention: Vaccination
- No treatment (Self-limiting)
- Post-exposure prophylaxis: Immunoglobulins (HAIg)
Hepatitis B
- Spreaded by
- Symptoms
- Management
Spreaded by
- Blood, Sexual Contact, Vertical Transmission
Symptoms
- More concerns as it leads to chronicity (lifelong) leading to irreversible conditions like Liver Cirrhosis and risk of HCC
Management
- Prevention: Vaccination
- Post-exposure prophylaxis: HBIG
CHRONIC HBV Treatment with:
1. Nucleoside Reverse Transcriptase (NRTIs) like Entecavir and Tenofovir
- MOA: Inhibits HBV DNA polymerase which is responsible for converting RNA to DNA), reducing viral replication and liver damage
- Interferon Therapy to boost immune response to fight virus
Regular monitoring of LFT and HBV viral load
Hepatitis C
- Spreaded by
- Symptoms
- Management
Spreaded by
- Blood and sexual contact
Symptoms
- Over 70% of acute cases progress to chronic hepatitis
Management
- NO vaccine available due to high genetic variability
Early HCV Treatment:
- Direct Acting Antivirals (DAA) is FIRST LINE TREATMENT
- Target at specific HCV proteins
- Highly effective, well-tolerated and convenient, leading to significantly higher SVR rates
Chronic HCV Treatment:
1. Protease Inhibitors like Grazoprevir, Telaprevir, Boceprevir
- MOA: Block viral protease enzyme activity of the HCV NS3 protease region that is necessary for protein processing required for viral replication
Notes:
- Avoid: Sharing needles and having unprotected sex
- Leading cause of liver transplants worldwide
- Early detection and treatment can prevent progression into end-stage liver disease
Nursing Implications for Hepatitis
*Encourage vaccination for Hep A and B
*Educate on avoiding risk factors for diff types of Hepatitis
*Monitor patients with chronic hepatitis for liver dysfunction – LFT, viral load
*Support adherence to treatment and follow up care
*Encourage regular screening for Hep B and C in high-risk groups
What is Viral Hepatitis and What are the common ones
Definition: Inflammation of liver caused by specific viruses
Common: Hep A B C
What is liver cirrhosis and list causes
A chronic condition where healthy liver tissue is replaced with scar tissues (Fibrosis), impairing liver function
Causes:
o Chronic alcohol use
o Viral Hepatitis B and C
o Non-alcoholic fatty liver disease
o Autoimmune Diseases
o Genetic Disorders (Wilson’s diseases)
What is Liver Failure
What are the symptoms
- Occurs when liver loses most/all of its functional capacity, resulting in life-threatening complications
- Can be:
o Acute (sudden onset)
o Chronic (Progressive deterioration, due to cirrhosis
Symptoms:
- Encephalopathy
- Stigmata of Chronic liver disease: Spider Naevi, Gynaecomastia, Sparse body hair, muscle wasting, Caput Medusa, Jaundice, Palmar erythema etc
Complications of Liver Cirrhosis
- Portal HTN
- Not systemically
- Increased BP only in portal vein due to blocked liver circulation
- Leads to varices (enlarged veins) in the oesophagus and stomach, increasing the risk of bleeding - Ascites
- Accumulation of fluid in the abdominal cavity due to reduced albumin production and portal HTN - Hepatic Encephalopathy
- Accumulation of toxins (ammonia) affecting brain function, leading to confusion, tremors and coma
- Due to loss of liver function and unable to detoxify and ammonia gets shunted into the brain - Spontaneous Bacterial Peritonitis (SBP)
- Infection of ascitic fluid caused by bacteria, common in advanced cirrhosis - Coagulopathy
- Impaired production of clotting factors, increasing bleeding risk - Hepatorenal Syndrome
- Kidney failure resulting from reduced blood flow to the kidneys due to severe liver disease due to portal HTN
- Severe vasodilation in the splanchnic circulation, leading to reduced effective arterial blood volume and marked renal vasoconstriction, causing reduction in GFR
Pharmacological Management for Liver Cirrhosis and Liver Failure
- Portal HTN and Varices:
- Betablockers (Propranolol) to reduce the portal pressure and prevent variceal bleeding - Ascites:
- Diuretics: Spironolactone as 1st line, Furosemide in combination for refractory cases
- Paracentesis: Removal of ascites fluid if diuretics are insufficient - Hepatic Encephalopathy:
- Lactulose (Reduce ammonia absorption in the gut)
- Rifaximin (Abx that reduces ammonia-producing gut bacteria) - Spontaneous Bacterial Peritonitis:
- Rifaximin: Broad spectrum and minimal liver toxicity
- Ciprofloxacin: Minimal PK changes in cirrhotic patients
- Acetaminophen overdose: NAPQI accumulate and cause liver damage: N-acetylcysteine as an antidote by replenishing glutathione and detoxifying harmful metabolites
Acetaminophen Overdose and Liver Failure
*Avoided due to risk for hepatotoxicity
If alcohol induced cirrhosis + taking Acetaminophen = Increased risk of worsening liver disease due to increased production of toxic metabolite: N-acetyl-p-benzoquinone imine
*Max dose: <2000mg
*Anti-dote: N-acetylcysteine – Replenishes glutathione stores in liver in overdose patient
What is Cholecystitis?
Cholecystitis: Inflammation of the gallbladder, usually caused by gallstones blocking the cystic duct (Calculous Cholecystitis) – Most common 90%
Acalculous Cholecystitis (Without gallstones) in critically ill patients
Causes of Cholecystitis
Calculous Cholecystitis 90%
o Gallstones obstruct the bile flow, causing inflammation and bacterial infection
Acalculous Cholecystitis
o From trauma, burns, sepsis and prolonged fasting
