Liver Problems Flashcards
1
Q
Viral Hepatitis - Pathophysiology (&types)
A
- Viral infection of liver w/ necrosis & inflamm of liver cells
- Types:
> A & E: fecal-oral route
> B: body fluids
> C common cause for liver cx & transplant
> D with some B; IV drug use
2
Q
Viral Hepatitis - CMs
A
- Incubation (1-6mnths)
- Arthalgia and rashes
- Anorexia
- Malaise, weakness
- Jaundice & dark urine
- Vague epigastric distress, nausea, heartburn, & flatus
- Enlarged liver/abd tenderness
3
Q
Hepatitis B - Diagnostics
A
-
Incrd liver enzymes
> ALT (4-36 iu/L)
> AST (0-35 u/L) - Antibodies
- Liver biposy
4
Q
Hepatitis B - Medical/Surgical Interventions
A
-
Alpha-interferon
> injections 3x weekly for 16-24wks -
2 antiviral agent
> Entecavir
> Tenofovir - Bed rest until manis resolve
- Diet
- Liver transplant
5
Q
Hepatitis B - Nursing Diagnosis
A
- Activity intolerance
- Fatigue
- Imbalanced nutrition, less than
- Acute pain
- Social isolation
- Knowledge deficit
6
Q
Hepatitis B - Nursing Interventions
A
- Encourage physical activity
- Avoid sexual contact
> chronic: may pass infection; for life - Psychosocial issues & concerns
- Education self care
- Prevention
7
Q
Non-Viral Hepatitis - Common Meds
that cause condition
A
-
Acetaminophen
> leading cause - Psychotropic meds
- Antimetabolites
- Anesthetic agents
- Anticonvulsants
8
Q
Chemicals That Have Toxic Effects on Liver
A
- Acute liver cell necrosis
- Similar to acute viral hep, but parenchymal destruction tends to be more extensive
- Most common cause of acute liver failure greater than 50%
9
Q
Cirrhosis - Pathophysiology
A
-
Chronic disease characterized by replacement of normal liver tissue w/ diffuse fibrosis
> disrupts structure & func
> liver becomes nodular; blood & lymph flow are impaired - Men greater than women
- 40-60yr old
10
Q
Cirrhosis - Types
A
- 3 Types:
> Alcoholic cirrhosis: most common
> Post-Necrotic Cirrhosis: late result of acute viral hep
> Biliary Cirrhosis: scarring occurs around bile ducts
11
Q
Cirrhosis - Medical/Surgical Interventions
A
- Antacids: GI distress
- Potassium sparing diuretics
> Spironolactone: dcr ascites - Diet
- Colchicine/Statins: antifibrotic activity
- Herb milk thistle (Silybum marianum): regenerative properties
11
Q
Cirrhosis - Diagnosis
A
- Serum albumin lvl dcr
- Serum globulin lvl rises
-
Liver func tests
> serum alkaline phosphatase, AST, ALT, & GGT lvls incr
> bilirubin incr - CT, MRI, US
- Liver biopsy: confirms diagnosis
12
Q
Cirrhosis - Risk Assessment
A
- Exposure to alcohol & drugs, herbs, meds, & chemicals
- Needle stick injury, tattoo placement
- Employment as a hlthcare worker, firefighter, or police officer
- Assess sexual hx & orientation
- Inquire abt family hx
- Collect previous medical hx
13
Q
Cirrhosis - CMs
A
- Pallor/jaundice
- Muscle atrophy
- Edema
- Skin excoriation (scratching)
- Petechiae/spider angiomas
- Enlarge liver or small/hard
- Bilateral gynecomastia & testicular atrophy
- Cognitive status/weakness
14
Q
Cirrhosis - Progression
A
- Portal HTN
- Ascites & edema
- Esophageal varices
- Coagulation defects/anemia
- Jaundice/pruritus
- Hepatic Encephalopathy/coma
- Bacterial peritonitis
- Metabolic abnormalities
- Vit deficiencies
15
Q
Cirrhosis - Vitamin Deficiency
A
- Inadequate formation, use, and storage of certain vitamins
- A, C, D, K
16
Q
Cirrhosis - Anemia
A
Chronic gastritis & impaired GI func, together w/ inadequate dietary intake & impaired liver func
17
Q
Cirrhosis - Clotting Factor Deficiency
A
Incrd bleeding
18
Q
Cirrhosis - Metabolic Abnormalities
A
- Abnormalities of glucose metabolism
> BG high after a meal
> Hypoglycemia during fasting bc of dcrd hepatic glycogen reserves & dcrd gluconegensis - Abnormalities Endocrine
> liver cannot properly metabolize hormones: androgens & sex hormones
19
Q
Cirrhosis - Nursing Diagnosis
A
- Activity intolerance
- Disturbed body image
- Excess fluid vol
- Risk for bleeding
- Risk for injury: LOC
- Risk for acute confusion
- Imbalanced nutrition: less than
- Impaired skin integrity r/t pruritus from jaundice & edema
- Fatigue
20
Q
Cirrhosis - Nursing Interventions
A
- Promoting rest
- Improving nutritional status
- Providing skin care
- Reducing risk for injury
- Monitoring & managing potential complications
21
Q
Cirrhosis - Jaundice & Pruritus
A
- Flow of bile impeded
- Bilirubin concentration in blood incrd; collects in tissues causing jaundice
> serum bilirubin lvl exceeds 2.0 mg/dL - Bile salts cause severe pruritus
22
Q
Cirrhosis Progression & Hepatic Encephalopathy
A
- Monitor: to identify early deterioration in mental stat
-
Early: include mental stat changes & motor disturbances
> extensive baseline & ongoing neurologic evaluation is key - Monitor electrolytes & ammonia lvls
- Provide pt safety; prevent injury, bleeding infection
- Prevention & early identification of life-threatening comps
> resp failure & cerebral edema - Treatment: admin lactulose; traps & expels ammonia in feces
23
Q
Cirrhosis Progression - Ascites & Edema
Formation
A
- Blood from digestive organs collects portal veins; carried to liver
- Cirrhotic Liver: no free blood passage
- Blood backs up into spleen & GI tract; chronic passive congestion
> indigestion/alt bowel func result - Protein rich fluid accumulate in peritoneal cavity, producing Ascites
- Liver cannot metabolize aldosterone further incring fluid
- Reduces plasma albumin = Edema
24
Cirrhosis Progression - Ascites & Edema
## Footnote
Nursing Interventions
- Measure abd girth
- Daily weights (fluid); I&Os
- Na restricted diet
- No salt subs unless ok w/ HCP
> salt subs contain potassium & should be avoided if pt has impaired renal func
- Admin diuretics (Spironolactone)
- Monitor electrolytes, Cr, BUN, ammonia
- Admin Albumin; pulls fluid into vascular system to be excreted by kidneys
- Monitor for signs of infec/peritonitis
25
Cirrhosis - Esophageal Varices
- Varices are varicosities tht develop from portal HTN
- Prone to rupture; massive hemorrhages UGI tract & rectum (hematemesis, melena)
- **Major cause of death in pts w/ cirrhosis**
- Several type of procedures used to treat & stop bleeding
26
Cirrhosis - Esophageal Varices
## Footnote
Nursing Interventions
- Support through procedure
- Admin/monitor parenteral nutrition
- NG to suction
- Oral care
- Close monitoring VS
- Admin vit K/blood products
- Manage delirium secondary to alcohol withdrawal
27
Liver Transplant
- Used to treat End Stage Liver Disease (ESLD) which no other treatment is available
- Pt must undergo a thorough eval
> model for End Stage Liver Disease (MELD) classification
- Total removal diseased liver & replacement w/ a hlthy liver from a cadaver donor or right lobe from live donor in same anatomic location
- Success of liver transplantation depends on successful immunosuppression
28
Liver Transplant - Post Op Complications
- **Bleeding**
> result from coagulopathy portal HTN, & fibrinolysis caused by ischemic injury
- **Infection**
> leading cause of death after liver transplantation
- **Rejection**
> perceived by the immune system as a foreign antigen; immunosuppressive agents
29
Liver Transplant - Nursing Interventions
- **Preop**
> stop drinking
> must be available at all times in case liver becomes available
- **Admin of platelets, fresh-frozen plasma, or other blood products**
- **Immunosuppression**
- **Bacteria free envir't**
- **Follow up appts**
- **Recognize signs of organ rejection**
30
Liver Transplant - Home Care
- Provide written/verbal education abt meds
- Avoid running out of meds or skipping dose
- S/S tht indicate problems; consultation transplant team
- Pt w/ a T-tube in place must be educated abt how to manage tube, drainage, & skin care
- Follow-up lab tests & appts w/ transplant team
> trough blood lvls of immunosuppressive agents
> labs assess the func of liver & kidneys
- Routine ophthalmologic examinations
> cataracts & glaucoma associated w/ long-term corticosteroid therapy
- Dental Care: admin of prophylactic antibiotics before dental exams
- Birth control
31
Liver Cancer - Pathophysiology
- **Primary**
> Hep B & C
> Cirrhosis
- **Secondary**
> Metastases: other primary sites, particularly the digestive system, breast, & lung
32
Liver Cancer - CMs
- Pain
- Weight loss
- Loss strength
- Anorexia
- Anemia
- Jaundice
- Ascites
33
Liver Cancer - Nursing Diagnosis
- Bleeding, risk for
- Falls, risk for
- Imbalanced nutrition, less than
- Nausea
- Fatigue
- Infection, risk for
34
Liver Cancer - Nursing Interventions
- Education
- Bleeding precautions
- Antiemetics
- Maintain sterile technique
- Post op care
35
Liver Cancer - Home Care
## Footnote
biliary drainage at home
- Pt/family fear tht catheter will become dislodged
> reassurance * instruction can help reduce
- Instruction on:
> how to assess cath & insertion site
> how to keep cath site clean & dry
> irrigation of cath w/ sterile normal saline solution or water
> proper technique to avoid introducing bacteria into biliary system or cath
> instruct: not to aspirate or draw back on syringe during irrigation; prevent entry of irritating duodenal contents into biliary tree or cath
> signs of infec of other comps; when to call
