Flashcards in Test #3 Chapter 61 Care of Patients with Liver Problems Deck (60):
What quadrant is the liver in?
Forms and continually secretes Bile that is used to digest fats. Aids in the destruction of old RBC’s. It get gets rid of them through your stool. That is what gives it the color that it has.
What do hepatic ducts do?
Hepatic Ducts transport bile from liver.
Where does the liver receive blood from?
Receives blood supply from hepatic artery and portal vein. About 1500mL of blood flows through liver every minute. So it is very vascular. This is why liver trauma is such as big deal.
What are the 3 main functions of the liver?
Function: Storage, Protection, Metabolism
What does the liver store?
Stores: Minerals and Vitamins such as iron, magnesium and fat-soluble vitamins A, D, E, K. Since it stores Vitamin K, if it is not working properly, liver patient will have a lot of clotting issues.
What is the protective mechanism of the liver?
Protective: Phagocytic Kupffer cells, detoxifies and metabolizes a lot of medications.
What does the liver metabolize?
Metabolism: Amino acid breakdown, transports your lipids and hormones, Synthesizes plasma protein, fatty acids and triglycerides, produces bile.
What is Jaundice-
build up of billirubin. This is a classic liver issue.
What is Liver-Cirrhosis?
Extensive irreversible scarring of the liver usually caused by chronic reaction to hepatic inflammation and necrosis. Once a person has liver cirrhosis, their life expectancy decreases as well as their quality of life. Some can be put on the liver transplant list and some can not. It depends if they are going to stop using the drugs or alcohol.
Does Liver-Cirrhosis develop fast or slow?
Develops slowly, is irreversible. Widespread fibrotic (scarred) bands of connective tissue that changes the liver’s normal makeup, this causes it to not work properly.
Hepatocytes are destroyed
As cirrhosis develops the tissue becomes nodular
Nodules can block bile ducts and normal blood flow
True or False
Early on, the liver is enlarged (hepatomegaly), firm and hard and may be palpated within the RUQ.
Later, as it progresses, the liver shrinks and liver function decreases
What are the S&S of Liver Cirrhosis?
S&S may not develop until serious complications occur- GI symptoms. Will usually be found on a CT.
What is the etiology of liver cirrhosis?
Etiology - Hepatitis, Alcoholism and Biliary Obstruction. Hepatitis C leading cause of cirrhosis in America. Transmitted via blood. Alcohol has a direct toxic effect on the hepatocytes. Affects men more than women.
What are the more common types of liver cirrhosis?
Common types of liver cirrhosis: Laennec’s Cirrhosis (alcohol,
most common in the US),
Billiary, Cirrhosis and Post Necrotic Cirrhosis are the three main groups.
What are the risk factors for liver cirrhosis?
Risk Factors- Alcohol intake, IV illicit drug use, Tattoos, Profession (RN, drawing blood)
WHat are the clinical manifestations of liver cirrhosis?
Clinical Manifestations - Non-specific early, not a lot of signs and symptoms. The liver tries to fix it, and does a good job. But over time, it just cannot do it anymore.
****WHat are the labs that you do for liver cirrhosis?
Lab work: Transaminase Enzymes --- PT/INR usually changes first (increases will cause patient to bleed easily). PTT will change second, AST, ALT will be elevated (this indicates liver injury).
What are the complications of liver cirrhosis?
1. Portal HTN-
2. Ascites and Esophageal Varices-
3. Coagulation Defects-
5. Portal-Systemic Encephalopathy with Hepatic Coma
6. Hepatorenal Syndrome-
7. Spontaneous Bacterial Peritonitis-
8. Hepatopulmonary Syndrome-
What are the 3 most common liver complications for patients with Cirrosis?
2. Esophageal Varices
3. Hepatic Encephalopathy
What is Portal HTN-
elevated pressure in the portal vein system. The damage in the liver puts extra pressure on the portal Vein.
What are Coagulation Defects-
PT, PTT, INR will be elevated. Will be worried about bleeding issues with liver patients.
What is Hepatorenal Syndrome-
decrease in kidney function. Increase in portal vein system causes the renal arteries to constrict thus reducing blood flow to the kidney’s.
What is Hepatopulmonary Syndrome-
prone to SOB and Hypoxia. Get alot of vasodilation in the lungs related to the portal vein system. They have extra fluid in the lungs so you will hear crackles. They cannot tolerate lying flat very well.
What is Ascites
A collection of fluid within the peritoneal cavity. This is related to portal vein HTN. The liver makes Albumin, when it is not working, it does not produce enough albumin to keep the fluid in the vascular space. (sort of like a magnet) So the fluid just hangs out in the peritoneal cavity. This can cause hypovolemia and pitting edema all at the same time.
**What are the Nursing Interventions for Ascities,-
Nutrition: Low Na, Vitamins
**Drug Therapy: Diuretic, (Lasix), Albumin (in a glass bottle, just hang it like a drip) Normal albumin level is 3.5 - 5. It will become low when the liver is not working correctly.
Monitor for Spontaneous Bacterial Peritonitis (SBP) and for Fluid and Electrolyte Imbalances the patients are at risk for these.
**Paracentesis - drawing off the fluid in the peritoneal cavity. A sample is sent to the lab to make sure that there is not an infection (peritonitis). Usually done in radiology. When they come back from the procedure, what you need to monitor is Blood Pressure and Urine Output. May cause hypotension. They should be able to breathe easier. Cultures take about 3 days to come back.
**Respiratory Support- because all of that fluid in the abdomen can make it hard to breathe. Make sure they are sitting up, Do not lay them back even to cath them. Put them on Oxygen.
What are Esophageal Varices-
hese patients are prone to having a GI Bleed. What happens is portal HTN causes increased pressure so causes blood to back up from the liver into the esophageal gastric vein system. These veins are very fragile and can break easily.
What are the S&S of Esophageal Varices-
S/S of Esophageal Varices- Patients will present with vomiting blood.
Nursing Interventions for Esophageal Varices-
Medications: Prevention-Beta-Blocker (keeps the pressure low to prevent the patient from bleeding), Bleeding-Vasoactive (if actively bleeding, PT will be placed on a Vasoactive drug until they can go for a Ligation or Sclerotherapy.)
Esophageal Varices- Patients will be NPO, if they do not have a balloon they will have an NG tube to decompress the stomach, may give Blood, get Labs, Vital Signs, keep their nausea under control.
***Endoscopic Therapies: This is for THE FIRST TIME BLEEDERS ONLY. Ligations (They get an O Ring and place it at the base of the bleeding vessel and block it off. This works well for patients) and Sclerotherapy (Inject the vein with saline, the vein will collapse and the body will reabsorb it in theory.
****What are the nursing interventions for a person who has Esophageal Varices and underwent endoscopic therapy but is now RE-BLEEDING?
Rescue Therapies for Re-Bleeding: This is more aggressive therapy.
***Balloon- Blakemoore tube, has a lot of complications attached with it. It is kind of like an NG Tube. It inflates and places pressure against the esophageal wall until it stops. If your patient has it monitor their breathing. They can aspirate easily. If ballooned to tight it can rupture the esophagus. Airway and breathing is priority. High Fowlers position. Mostly done in ICU. Remember that you can deflate and remove it if in distress.
Stents- are similar to cardiac stents. Fairly new therapy. Teach that the patient needs to eat soft foods after these are placed.
TIPS. Trans-Juggular Intra-Hepatic Portal Systemic Shunt- opens the portal vein up so that all of the pressure is not so high.
What is Hepatic Encephalopathy-
This is very common in liver patients. What you liver normally detoxifies and gets rid of, it isn’t able to do any more, so it gets put back into the GI tract which causes an elevated ammonia bi-product. This ammonia level builds up in the circulation and the first place that gets affected is your brain. It can causes LOC changes that range from confusion to coma. The liver cannot get rid of the ammonia. This is why we have them on a low protein diet because the more protein that you eat, the more ammonia that you have.
******What are the Nursing Interventions for Hepatic Encephalopathy-
**Nutrition: Low-to-Moderate Protein ( VERY LITTLE)
**Drug Therapy: Lactulose (binds with the ammonia and they get rid of it that way. It takes it a hour or so to work and then the patients LOC will start to get Better) , Some medications are restricted
**Neuro, Safety- Patient is confused so will be more prone to falling and will not be able to turn themselves in bed ect.
Ammonia levels are drawn and put on ice when sent to lab (so is lactic acid) (NOT ON TEST)
What is Hepatitis
Widespread inflammation of liver cells.
Viral Hepatitis results from one of the following:
What happens after a person is exposed to hepatitis (patho)?
Liver injury with inflammation develops after exposure. The liver enlarges and is congested with inflammatory cells, lymphocytes and fluid resulting in RUQ pain.. If not treated, the patient will develop Jaundice. They will become fatigued, like they have the flu almost.
As the disease progresses the pressure within the portal lobules increases interfering with the blood flow into the hepatic lobules. Edema of the liver’s bile channels results in obstructive jaundice.
****What is the etiology and recovery of Hepatitis A?
**Etiology: Fecal-Oral Route, Contaminated Food or Water (restaurants)
Incubation: 15-50 days, with peak 25-30 days
S&S: Flu-Like and and GI Illness
***Recovery on its own, some do not even know that they have been exposed. You just get it and it goes away.
****What is the etiology and recovery of Hepatitis B as well as 2 distinct classic S&S?
***Etiology: Blood, Unprotected sex
Incubation: 25-180 days
S&S N/V, Fever, **FATIGUED, RUQ pain, Dark Urine, Light Stool, **JAUNDICED
***Recovery: Some will recover and develop immunity. Others are carriers and are at risk for cirrhosis and liver cancer. Now that we have the vaccine we do not see it as much. This is a serious Illness.
****What is the etiology and recovery of Hepatitis C?
***Etiology: Blood, IV Drug use
Incubation: 7 weeks
S&S: Some none, others RUQ pain, malaise, fever, jaundice or when they begin to have liver problems
****Recovery: Typically develop Liver Cirrhosis 9 times if not 10 time out of 10. Be careful when drawing blood.
****What is the etiology and recovery of Hepatitis D?
**Etiology: Parenteral Routes, Sexual Contact. Person infected with Hep D must also have Hep B in order for the Virus to Multiply
Incubation: 14-56 days
S&S: Fever, Malaise, N/V, RUQ pain, Jaundice
***Recovery: Chronic Liver problems
****What is the etiology and recovery of Hepatitis E?
**Etiology: Fecal-Oral routes, overseas. Traveling places you at risk for this one. This is what makes it different then HEP A.
Incubation: 15-64 days
S&S: Flu-Like and and GI Illness
**Recovery on its own. Teaching includes- Do not drink the water or eat fresh fruits and veggies while traveling out of the country. Wash your hands frequently.
When is hepatitis considered chronic?
Considered to be chronic when liver inflammation last longer than 6 months
Which 2 types of hepatitis can be chronic?
Chronic Hepatitis usually occurs as a result of Hepatitis B (HBV) and Hepatitis C (HCV)
Which type of hepatitis is the most common?
Hep C most common
Which types of hepatitis are there vaccines for?
Vaccines for Hep A & B are available
**** What are the Nursing Interventions for Hepatitis-
**Rest: Periods of rest alternating with periods of activity
**Nutrition: High carbohydrates and calories with moderate fat and protein. Small frequent meals, No Alcohol (chart that they have been educated)
Medications: Antiviral, Immunomodulating, antiemetic, others use sparingly
What is Fatty Liver (Steatosis)
Accumulation of fat in liver cells-leads to liver damage
What is the etiology of Fatty Liver (Steatosis)
Etiology: Obesity, Alcohol Abuse
What are the S&S of Fatty Liver (Steatosis)
S&S: Usually asymptomatic, Once they start having symptoms they become Fatigued, Jaundiced
How is a fatty liver diagnosed
Diagnosed: MRI, Elevated Liver Function Test (AST and ALT)
What are the Nursing Interventions for Fatty Liver-
Weight loss and Diet (low in fat, no fast foods) and stop drinking. If someone comes in with an “attack” and they know that they ate bad ect, you just treat their symptoms such as nausea and vomiting, pain ect. There is not a cure. It is up to them to make those changes. Once the damage is done, there is no going back. They can keep it from getting worse if they try.
What is the etiology of a Hepatic Abscess
Etiology: Liver invaded with Bacteria or Protozoa , common etiology is gallstones in the gall bladder, Causes portal vein to get backed up which can cause an abscess to form.
Usual Cause: Acute Cholangitis
What are the S&S of a Hepatic Abscess
S&S: RUQ pain, Anorexia, Weight Loss, N/V, Fever, Chills, Malaise
Diagnosed: CT in order to see it.
What are the Nursing Interventions for a Hepatic Abscess
Drain it and then place them on Antibiotics. They will then try to figure out why they have it. Was it Gallstones ect. and then fix that as well.
What is the etiology of Liver Trauma
Etiology: Upper abdominal and or lower chest trauma, lacerations, avulsions, crush injuries
What are the S&S of liver trauma
S&S: Kehrs Sign- shoulder pain usually associated with some abdominal issue such as peritonitis, trauma, an organ issue. What happens is that they have the issue in the abdomen which causes a referred pain to the shoulder.
What are the nursing interventions for liver trauma?
Nursing Interventions: Surgery via Laparoscope or Open Exploratory Laparotomy, Blood Products.
Cancer of the Liver can be Primary Tumors or Metastatic Cancer.
What is the typical etiology of liver cancer?
Etiology: HBV, Hepatitis C which can lead to cirrhosis, which can lead to developing cancer
What is a huge risk factor for liver cancer
Risk Factors: History of Cirrhosis
What are the S&S of liver cancer?
S&S: RUQ pain, jaundice, bleeding, ascites
Diagnosed: CT, Biopsy.
What are the Nursing Interventions for liver cancer?
Nursing Interventions: Depend on what they find. Some may be moved straight to end of life care. Surgical Resection and Liver Transplantation may be an option,
Typically for patients with end-stage liver disease. Usually Related to hep C and Cirrhosis.
*****What is the post-op care for liver transplantation?
Post-Op Liver Transplantation: All typical post ops apply. But also need to monitor for rejection. They are at risk for infection. Monitor fever and coughing. When the body starts to reject, the HR will in INCREASE and so will AST and ALT. Monitor Vitals. Especially temperature.