TOPIC 8 - cirrhosis, liver disease, and hepatitis Flashcards
(49 cards)
cirrhosis
extensive irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis.
typically has a progressive, slow, destructive course resulting in end-stage liver disease.
characterized by widespread fibrotic scarring that changes the liver. Inflammation results in the destruction of hepatocytes and leads to nodular tissue and the liver becomes hard and shrinks in size leading to a decrease in liver function.
risk factors for cirrhosis
ETOH, viral hep (or chronic hep B and C), autoimmune hepatitis, fatty liver disease, drugs and chemical toxins, gallbladder disease, metabolic causes, genetic causes, cardiovascular disease
assessment and manifestations related to cirrhosis
Fatigue
Jaundice
Peripheral edema
Ascites
Skin lesions
Hematologic disorders
Endocrine disturbances
Peripheral neuropathies
labs related to cirrhosis
elevated AST, ALT, LDH, PT, INR, bilirubin
decreased K, protein, albumin
diagnostics for cirrhosis
gold standard = biopsy (identify liver cell changes)
– high risk for bleeding
xrays may show hepato or splenomegaly or massive ascites
ultrasound detects ascites, hepato or splenomegaly and the presence of biliary stones or duct obstruction
EGD directly visualizes the upper GI tract to detect bleeding, esophageal varices, stomach ulcers, or duodenal ulcers
nursing interventions for cirrhosis
monitor fluids, electrolytes, admin albumin and diuretics, skin care, Na restriction of 2g/day
pre and post op responsibilities for paracentesis
pre op :
Ensure permit is signed
Base line vital signs
Patient teaching
Have to empty their bladder
Ensure their IV is patent
post op :
Monitor vital signs
Lie down on side without wound for 2 hours
Monitor for leakage from site
Don’t get up until the nurse tells you to
Check for new orders for fluids
chronic liver complications
portal hypertension, ascites, peripheral edema, esophageal varices, coagulopathy, hepatic, encephalopathy, hepatorenal syndrome, biliary obstruction jaundice
complications of cirrhosis
Portal Hypertension
Bleeding
Jaundice
Hepatic encephalopathy
Hepatorenal syndrome
Ascites
Esophageal varices
biliary obstruction leads to
decreased production of bile and prevents absorption of vitamin K = bleeding and bruising
what can cause esophageal varices
portal hypertension
can be life threatening from severe blood loss that leads to hypovolemia
what causes neurologic toxic manifestations in hepatic encephalopathy
ammonia crossing the blood brain barrier
other characteristics of hepatic encephalopathy
asterixis (tremors in arms and hands)
fetor hepaticus (musty sweet breath from accumulation of digestive by-products that the liver cannot degrade)
incubation period of hepatitis A
15-50 days
incubation period of hepatitis B
45-180 days
incubation period of hepatitis C
14-180 days
transmission route of hepatitis A
fecal oral
transmission route of hepatitis B
Blood & mucous membranes
Perinatal
High risk sexual contact
transmission route of hepatitis C
same as hep B
those at risk for hepatitis A
Crowded conditions, poor personal hygiene, poor sanitation, contaminated food/milk/water/shellfish, sexual contact with an infected person, IV drug users, receiving food from someone handling/preparing food
those at risk for hepatitis B
Contaminated needles, syringes, blood, sexual contact with an infected person, tattoos/ body piercings with contaminated needle, asymptomatic person, blood and blood products
those at risk for hepatitis C
same as hep B
most infectious when (hep A)
During the first 2 weeks prior to onset of symptoms and 1-2 weeks after the onset of symptoms
most infectious when (hep B)
Before & after symptoms appear. Infectious 4-6 months, carriers can be infectious for life
