10.1 Liver cirrhosis Flashcards
Two main blood supply of liver
Portal vein
Hepatic artery
Function of liver
Ammonia conversion
Bile formation
Bilirubin excretion
Cholesterol synthesis
Detoxification
Emulsification of fats
Fat metabolism
Glucose metabolism
Protein synthesis
Storage of vitamin, fat and iron
Haemoglobin die -> __-soluble ____ bilirubin -> liver -> __-soluble ____ bilirubin -> excreted in bile
Fat soluble unconjugated
Water soluble conjugated
Symptom related to bilirubin
Jaundice
Pruritus
Clay stool
Tea colored urines
Symptom related to albumin
Edema
Ascites
Increase abdominal girth
Weight gain
Symptom related to ammonia
Change of mental status
Sleep disturbances
Symptom related to blood clotting factors
Easy bruising
Melena
眼白
Sclera
palmar erythema
掌面紅斑
Spider angiomas
蜘蛛血管痣
Muscle atrophy
肌肉萎縮
skin excoriation
scratching
Asterixis
flap tremor
USG
Ultrasonography
What if patient allergic to contrast
Provide steriod cover
ERCP
Endoscopic retrograde cholangiopancreatography
Type of liver cirrhosis
Alcoholic
Post-necrotic
Biliary
Liver enlargement belongs to compensated or decompensated
Compensated
Purpura
Decrease in platelet
紫斑症
Normal liver size
6-12 in midclavicular line
Main clinical manifestation of liver cirrhosis
Liver enlargement
Portal hypertension
Ascites
Varices
Jaundice
Coagulopathy
Spontaneous bacterial peritonitis
Edema
Vitamin deficiency and anemia
Pruritus
Hepatic encephalopathy
Sign and symptoms of Ascites
Increase body weight
Increase abdominal girth
Increase SOB
Shifting if dullness during percussion
Pharmacological management for Ascites
Loop diuretics (lasix)
IV albumin
Management for Ascites
Paracentesis (abdominal tapping)
Advise for Ascites and reason
Stay bed rest
To avoid activation of xxx system and sympathetic nervous systems
Surgical intervention of ascite:
Shunt location and purpose
From portal vein to hepatic vein
To decrease the vascular resistance of liver
S/s of jaundice
Yellowish discoloration of skin and sclera
Clay color stool
Tea color urine
Pruritus, fatigue, anorexia
Types of jaundice
Causes
-Hepatocellular jaundice
Caused by liver failure
-Obstructive jaundice
Caused by obstruction flow of bile ducts
Prolonged PT, INR
Coagulopathy
PT prothrombin time
INR clotting time
Why spontaneous bacterial peritonitis
Infected by intestinal flora
Formation of edema
Decrease albumin (plasma albumin concentration)
Failure to metabolize aldosterone -> increase sodium and water retention
Fluid shift from vascular system to peritoneal space
Pathophysiology of hepatic encepthalopathy
Increase serum ammonia levels
Why provide neomycin and lactulose
Route
Neomycin: to destroy bacteria in GI tract, reduce level of ammonia-forming bacteria in colon, reduce protein breakdown and production of ammonia
Lactulose: to expel the ammonia in feces, promote excretion of ammonia in stool
PO/PR
Antidose for acetaminophen(paracetamol)
mushroom poisoning
N-acetylcysteine
Penicillin G and N-acetylcysteine
Drug for nausea vomiting
Antiemetics
Patient with liver disorder should avoid what drug
Aspirin
Sedative
Nursing management: Diet
High calories, carbohydrates,
Low sodium(reduce edema), fat
Provide oral hygiene to increase appetite and reduce unpleasant smell
Nursing management against Ascites
-Small and frequent meal to prevent fullness and bloating
-Elevate head of bed to reduce discomfort from abdominal distension
Nursing management for pruritus
-Assess skin integrity
-Frequent turning to prevent pressure ulcer and skin breakdown
-soft clothes and bed lining to prevent skin scratching and infection from scratching
-provide tepid water bath, avoid alkaline soap or alcohol-based location
