Unit 2: Liver Disease

Question 1

Causes of Post-necrotic Cirrhosis (2)

Answer 1

1. Viral Hepatitis (especially HepC
2. Drug-induced (or toxin-induced)

Question 2

Laennec’s Cirrhosis =

Answer 2

Alcoholic Cirrhosis (Chronic Alcoholism)

Question 3

Causes of Biliary Cirrhosis (2)

Answer 3

aka cholestatic cirrhosis
1. Biliary obstruction
2. Autoimmune disease

Question 4

______ cirrhosis = scarring present, but liver can still function.

Answer 4

Compensated Cirrhosis
cellular regulation is impaired, but liver can still perform essential functions w/o causing major Sxs

Question 5

______ cirrhosis = liver failure with Sxs

Answer 5

Decompensated Cirrhosis

Question 6

What Complication Am I?
A persistent increase in portal vein pressure >5 mm Hg; results from increased resistance to or obstruction (blockage) of the flow of blood thru the portal vein and its branches.

Answer 6

Portal HTN

Question 7

Complications r/t Portal HTN

Answer 7

1. Splenomegaly
2. Caput medusae (prominent abdominal veins)
3. Ascites
4. Esophageal varices
5. Hemorrhoids

Question 8

What can splenomegaly result in?

Answer 8

Thrombocytopenia
(often the first clinical sign of liver dysfunction)

Question 9

EXTRA: Portal HTN results in the formation of collateral circulation. Does the blood running through these new vessels get filtered by the liver?

Answer 9

NOPE

Question 10

Patho of Ascited r/t Liver Disease:
Ascites will continue to worsen. What’s missing and why does the fluid continue to shift? What homeostatic system gets triggered?

Answer 10

Low/no albumin production by the liver = decreased colloid osmotic pressure in circulatory system;
Increased hydrostatic pressure in portal veins → Plasma proteins collect in peritoneal cavity → H2O moves from LOW to HIGH [conc.] of solvents;
RAAS gets triggered by renal vasoconstriction → BIG BELLY

Question 11

A pt with Ascites r/t to Liver disease may have both Edema and ____ at the same time!

Answer 11

Edema AND Hypovolemia!

Question 12

What 4 things should we measure r/t Ascites?

Answer 12

1. Daily wts
2. Breathing (effort, lung sounds)
3. Balance
4. Hernias

Question 13

Interventions for Ascites (Procedure + Nutrition + Drug therapy)

Answer 13

1. Paracentesis
2. Low Na+ diet (1-2 G/day)
3. Vit Sups (multivit, thiamine, folate)
4. Diuretics (furosemide + spironolactone)

Question 14

Name 2 Complications of a Paracentesis

Answer 14

1. Rebound ascites if fluid removal is too fast
2. Peritonitis

Question 15

Renal Vasoconstriction r/t Liver disease aka

Answer 15

Hepatorenal Syndrome

Question 16

Hepatorenal Syndrome is often triggered by (2)

Answer 16

1. GI bleed
2. Hepatic encephalopathy

Question 17

Hepatorenal Syndrome = ____ Prognosis
Name some abnormal labs you might see

Answer 17

POOR PROGNOSIS
U/O <500 mL/day
Increased BUN/Crea

Question 18

What the heck is Hepatopulmonary Syndrome? How do we treat this and what are the 2 Interventions to manage it?

Answer 18

Ascites places pressure on lungs → Dyspnea
Tx: REMOVE THE FLUID (only thing that will help)
Mx:
1. Raise HOB
2. O2 therapy

Question 19

Why is there such a biiiig risk for bleeding r/t Liver disease?

Answer 19

You ain’t got no clottin’ factors bc the liver ain’t makin’ them (prolonged PT/INR + APTT), and ur spleen is tearin’ up your platelets!

Question 20

What test can we do to determine if a pt has esophageal varices?

Answer 20

EGD

Question 21

Drug therapy to PREVENT bleeding r/t esophageal varices

Answer 21

Beta-blockers

Question 22

We can probably guess esophageal varices will cause hematemesis, but you may also see..

Answer 22

Melena (blood in poop; black, tarry stool)

Question 23

What patient teaching should we provide r/t esophageal varices?

Answer 23

1. No heavy lifting
2. Chill exercises only dood
3. Avoid dry, hard foods

Question 24

Where else might we see bleeding that results in chronic, slow blood loss, occult-positive stools, and anemia?

Answer 24

GI bleeding! SMELLYYYY
(due to portal hypertensive gastropathy)

Question 25

If your pt’s esophageal varices explode, what immediate actions do you need to do

Answer 25

1. Position

Question 26

What’s included in the “bleeding support” interventions (drugs + fluids) (6)

Answer 26

1. Vasopressors
2. Ocreotide
3. IV Protonix
4. 0.9% NS
5. Blood products
6. Antibiotics

Question 27

Surgical Interventions for Esophageal varices (4)

Answer 27

1. Endoscopic interventions (Ligation/Banding; Sclerotherapy)
2. TIPS procedure
3. Balloon Tamponade (Blakemore tube)

Question 28

Before we can place a Blakemore tube, what do we need to protect the airway?

Answer 28

INTUBATE THAT SUCKER

Question 29

How long do we use a Blakemore Tube?

Answer 29

TEMPORARILY; only left in until they can get pt to surgery for a TIPS procedure

Question 30

What the heck is a TIPS Procedure?

Answer 30

Connects the portal vein to the hepatic vein;
Shunts blood from portal vein to hepatic vein (decreases pressure); performed in IR

Question 31

Complications of TIPS Procedure (2)

Answer 31

Hepatic Encephalopathy!
(confusion, decreased LOC)

Question 32

If your liver disease pt starts acting confused &/or irritable… what might we suspect and what testing should be done next?

Answer 32

Hepatic Encephalopathy = Increased Ammonia

Question 33

Causes of Hepatic Encephalopathy (6)

Answer 33

1. GI bleed
2. High protein diet
3. Infection
4. Hypovolemia
5. Hypokalemia
6. Constipation

Question 34

Hepatic Encephalopathy Interventions (Nutrition + Drug therapy)

Answer 34

1. MODERATE protein diet
2. Lactulose (PO or enema)
3. Rifamixin (Abx)

Question 35

If our pt with Hepatic Encephalopathy is given lactulose, what else to we need to ensure? (2)

Answer 35

1. HYDRATION (Hypovolemia can result in Ammonia buildup)
2. Prevent skin breakdown