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AH1 Exam 3 Liver Flashcards

1
Q

When does jaundice occur?

A

when Bilirubin is 3X normal

(0.2-1.2mg/dL)X3=2-3mg/dL

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2
Q

Hep A

A

fecal/oral
crowded conditions, poor personal hygiene, poor sanitation, contaminated food, milk, water, and shellfish.
Infected food handlers, sexual contact, IV drug users
*most infectious during 2weeks PRIOR to symptom onset and infectious through 1-2 weeks AFTER start of symptoms
RNA virus

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3
Q

Hep B

A

blood/blood products, sex, perinatal
infectious for 4-6 months BEFORE and AFTER symptoms appear
DNA virus

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4
Q

Hep C

A

blood/blood products, high risk sex, perinatal
infectious 1-2 weeks BEFORE symptoms appear and throughout clinical course
RNA
good chance infection will be chronic**

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5
Q

Hep D

A

must have HBV first
blood is infectious at all stages of HDV infection
called a delta virus; RNA

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6
Q

Hep E

A

fecal/oral; contaminated water supply in developing countries

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7
Q

hepatitis A IgM

A

indicates acute HAV

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8
Q

hepatitis A IgG

A

indicates past HAV infection and provides lifelong immunity

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9
Q

can live on a dry surface for 7 days and is much more infective than HIV!

A

HBV

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10
Q

rash, angioedema, arthritis, fever, malaise

A

clinical manifestations of activated circulating complement due to antigen-antibody binding from hepatitis that may cause secondary glomerulonephritis and vasculitis

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11
Q

malaise, anorexia, fatigue, nausea, occasional vomiting, and RUQ discomfort

A

acute hepatitis lasts 1-4 mos

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12
Q

malaise, easy fatiguability, hepatomegaly, myalgias and/or arthralgias, elevated AST/ALT
HBsAG > 6 mos

A

chronic hepatitis

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13
Q

HBeAg

A

indicates high infectivity; present in acute infection HBV

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14
Q

Anti-HBe

A

indicates previous infection HBV

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15
Q

HBcAg

A

ongoing HBV infection

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16
Q

HBsAg, anti HBc IgM are positive

A

acute HBV infection

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17
Q

Why should ppl with hepatitis rest?

A

rest reduces the metabolic demands on the liver and promotes cell regeneration. exercise causes protein breakdown which will further elevate ammonia. Liver tissue is destroyed with Hepatitis. Ret and adequate nutrition are necessary for regeneration of the liver tissue

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18
Q

Drug therapy for hepatitis

A 
Chronic HBV
alpha interferon (Intron A)
Pegylated alpha-interferon (PEG-Intron, Pegasys)
Lamivudine (Epivur)
Adefovir (Hepsera)
Entecavir (Baraclude)
telbivudine (Tyzeka)
tenofovir (Viread)

Chronic HCV
PEG-Intron or Pegasys
ribavirin (Rebetol, Copegus)

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19
Q

why cant phenothiazines be used for pts with hepatitis?

A

cholestatic and hepatotoxic

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20
Q

what herb may hep with hepatitis?

A

milk thistle-may lower blood glucose and interfere with P450 enzyme system

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21
Q

What does alpha interferon do?

A

binds to receptors on host cell membrane and blocks viral entry into cells, viral protein synthesis, assembly, and release

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22
Q

Whats the difference between Intron A and PEG-Intron or Pegasys?

A

Intron A has a short half life so it must be given SC 3xweek
Pegylated interferons last longer, give just once weekly, plus clinical responses are better due to higher doses lasting in the serum

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23
Q

What does a nurse need to know about alpha interferon drug therapy?

A

patients receiving alpha interferon should have blood counts and a liver panel performed q4-6weeks

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24
Q

suppress viral replication by inhibiting viral DNA synthesis; reduce viral load, decrease liver damage, and decrease liver enzymes

A

Nucleoside and Nucleotide Analogs (Epivir, Hepsera, Baraclude, Tyzeka, Viread)

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25
Q

loss of HGeAb

A

seroconversion and pt may be able to DC nucleoside and nucleotide analog therapy

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26
Q

Why isnt lamuvide (Epivir) used as first line treatment?

A

resistance develops

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27
Q

arthralgia/myalgia, asthenia (loss of strength), fatigue, HA, fever, nausea, anorexia
depression or irritability, hair thinning, insomnia, itching/dry skin, diarrhea, weight loss, injection site rxn

A

SE alpha Interferon

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28
Q

hemolytic anemia, anorexia, cough, dyspnea, insomnia, pruritis, rash, teratogenicity

A

SE ribavirin (PO BID)

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29
Q

nephrotoxic drugs

A

Hepsera and Viread

cyclosporine, aminoglycoside, vancomycin too!

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30
Q

hepatoxoic drugs

A

Fluothane, INH, Chlorothiazide, methotrexate, methyldopa

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31
Q

blockage of bile flow

A

cholestasis

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32
Q

splenomegaly, large collateral veins, ascites, HTN, gastric and esophageal varices

A

portal htn

33
Q

Why do liver pts develop edema and ascites?

A

liver makes albumin-without albumin, colloidal oncotic pressure is low, and fluid leaves vasculature to go to third space
hyperaldosteronism (damaged hepatocytes cant metabolize aldosterone)–> increased sodium resorption and excessive potassium secretion (hypokalemia happens)

34
Q

hepatic encephalopathy drug therapy

A 
reduce ammonia with lactulose
give antibiotics (neomycin, flagyl, cancomycin, rifaximin) to decrease bacteria in GI tract bc by product of bacterial action on protein in the feces results in ammonia production
35
Q

conservative therapy for cirrhosis

A

rest, b vitamins, avoid alcohol, NSAIDs, Acataminophen

36
Q

how to treat ascites?

A

low sodium diet, diuretics, paracentesis, peritoneovenous shunt

37
Q

why give beta blockers to hepatic patients?

A

to reduce portal HTN

38
Q

why give vasopressin to hepatic patients?

A

hemostatis and control bleeding of esophageal varices

39
Q

Why give vit K to hepatic patients?

A

correct clotting abnormalities

40
Q

Why give H2 blockers to hepatic patients?

A

decrease gastric acidity

41
Q

Why give PPIs to hepatic patients?

A

decrease gastric acidity

42
Q

anemia, thrombocytopenia, leukopenia, decreased serum albumin, decreased potassium, abnormal LFTs, increased INR, decreased platelets, ammonia, bilirubin, abnormal abdominal UA and liver-spleen scan

A

possible diagnostic findings in cirrhosis

43
Q

what may relieve pruritis?

A

Cholestyramine (Questran) or hydroxyzine (Atarax)
baking soda bath
lotion with calamine
antihistamines

44
Q

paracentesis nursing considerations

A

have pt void urine before paracentesis to avoid bladder puncture
pt in high fowlers
after paracentesis, monitor for hypovolemia and electrolyte imbalances and check for dressing bleeding/leakage

45
Q

cardiac dysrhythmias, hypotension, tachycardia, generalized muscle weakness

A

hypokalemia

46
Q

muscle cramping, weakness, lethargy, confusion

A

water excess

47
Q

Cirrhosis: imbalanced nutrition: less than body requirements

A

r/t anorexia, impaired utilization and storage of nutrients, nausea, loss of nutrients from vomiting

48
Q

Cirrhosis: Impaired Skin Integrity

A

r/t peripheral edema, ascites, pruritis

49
Q

Cirrhosis: Dysfunctional family processes

A

r/t abuse of alcohol and inadequate coping skills

50
Q

Cirrhosis: excess fluid volume

A

r/t portal HTN hyperaldosteronism

51
Q

Cirrhosis: potential complication: Hemorrhage

A

r/t bleeding tendency secondary to altered clotting factors and rupture of esophageal or gastric varices

52
Q

Cirrhosis: potential complication: Hepatic Encephalopathy

A

r/t increased serum levels of ammonia due to inability of liver to convert accumulating ammonia to urea for renal excretion

53
Q

why is rest important for hepatic patients?

A

exercise produces ammonia as a by-product of protein metabolism

54
Q

clay colored stools

A

obstructive jaundice (no bilirubin in stools)

55
Q

pruritis is a common problem with jaundice in this phase

A

acute infection of hep a

56
Q

a patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to

a. avoid alcohol for the first 3 weeks
b. use a condom during sexual intercourse
c. have family members get an injection of immunoglobulin
d. follow a low-protein, moderate carb, moderate fat diet

A

b. use a condom during sexual intercourse

57
Q

fetor hepaticus

A

fruity or musty breath resultant of liver’s inability to metabolize and detoxify mercaptan (derived from methionine)

58
Q

dark urine

A

bilirubin in urine–> jaundice

59
Q

what to do if an esophageal varices ruptures?

A

insert esophagogastric balloon tamponade (or sclerotherapy or portal systemic shunts)
vasopressors, vit K, coagulation factors, blood transfusion

60
Q

elevated bilirubin, AST, ALT, alkaline phosphatase, PT and ammonia
decreased Hbg, Bct, electrolytes, albumin

A

cirrhosis lab findings

61
Q

cirrhosis nutritional considerations

A 
may need to restrict fluid to 1500mL/day (edema/ascites)
encourage high biologic protein
low sodium
low potassium
low fat
high carb
62
Q

hepatits nutritional consideration

A

high calorie, high carb, mod proteins and fats

63
Q

Laennec’s Cirrhosis

A

cirrhosis due to alcoholism or malnutrition

64
Q

cachexia

A

a general type of wasting of the body due to malnutrition often seen in cirrhosis

65
Q

Nursing Considerations Liver biopsy

A

percutaneous liver biospy is performed by inserting a needle through the abdominal wall into the liver to obtain a tissue sample. Position pt on right side post procedure to compress the liver against the chest wall to decrease risk of bleeding and bile leakage.

66
Q

Nursing consideration for paracentesis

A

involves the removal of peritoneal fluid for evaluation or to drain excess peritoneal fluid (ascites). Prior to procedure, have the client void to reduce the risk of accidentally rupturing bladder. after procedure, monitor client for peritonitis and peritoneal bleeding

67
Q

Nursing consideration for hepatic angiography

A

catheterization of the hepatic vasculature allows injection of a contrast medium and visualization of the vascular supply of the liver. Vessel pressures can also be measured to assess the degree of portal hypertension. After the procedure, assess VS and insertion site frequently and client should remain on bedrest 24-48 hours.

68
Q

tests that reflect clotting time will be prolonged bc the diseased liver produces less clotting factors. also, the intestine absorbes less vit K bc the liver is producing less of the bile that is necessary for vit K absorption

A

APTT, PT/INR

69
Q

what occurs during an endoscopic sclerotherapy?

A

an endoscope is placed into the patient’s mouth and is passed down the esophagus. Varices are visualized. A chemical solution is injected into the varices to sclerose and harden the area. This helps to prevent bleeding from the varices.

70
Q

how does GI hemorrhage precipitate hepatic encephalopathy?

A

increases ammonia in GI tract

71
Q

how does constipation precipitate hepatic encephalopathy?

A

increase in ammonia from bacterial action on feces

72
Q

how does hypokalemia precipitate hepatic encephalopathy?

A

potassium ions are needed by brain to metabolized ammonia

73
Q

how does hypovolemia precipitate hepatic encephalopathy?

A

increase in blood ammonia by causing hepatic hypoxia, impairment of cerebral, hepatic, and renal fxn due to decreased blood flow

74
Q

how does infection precipitate hepatic encephalopathy?

A

increase in catabolism, increase in cerebral sensitivity to toxins

75
Q

how does metabolic alkalosis precipitate hepatic encephalopathy?

A

facilitation of transport of ammonia across BBB, increase in renal production of ammonia

76
Q

how does paracentesis precipitate hepatic encephalopathy?

A

loss of sodium and potassium ions decrease in blood volume

77
Q

how does dehydration precipitate hepatic encephalopathy?

A

potentiation of ammonia toxicity

78
Q

how does increased metabolism precipitate hepatic encephalopathy?

A

increased workload of liver

79
Q

how does uremia (renal failure) precipitate hepatic encephalopathy?

A

retention of nitrogenous metabolites

Adult Health (18 decks)

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