Assessment and Management if Patients with Hepatic Disorders Flashcards
What is the metabolic functions?
- Glucose metabolism
- Ammonia conversion
- Protein metabolism
- Vitamin and iron storage
- Drug metabolism
- Bile formation
- Bilirubin excretion
What are the liver function studies?
bilirubin and PT
- ALT, ALK
What are some additional diagnostic studies for hepatic disorders?
- Liver biopsy, Ultrasonography
- CT, MRI
What is jaundice?
Yellow- or green-tinged body tissues, sclerae, and skin caused by increased serum bilirubin levels
What is the S&S of jaundice?
- Lack of appetite, nausea, weight loss
- Malaise, fatigue, weakness
- Headache, chills, and fever if infectious in origin
-Dark orange-brown urine and light clay-colored stools - Dyspepsia and intolerance of fats, impaired digestion
Pruritus
What is hepatitis?
Inflammation of the liver
two types: acute viral (spread through viruses) and non viral (spread through toxic and drug induced)
What is hepatitis A?
- spread through fecal contamination
- incubation: 15-45 days
- anti-hav antibody serum after symptoms appear
What is the S&S of hepatitis A?
mild flulike symptoms, low-grade fever, anorexia, later jaundice and dark urine, indigestion and epigastric distress, enlargement of liver and spleen
What is the management of hepatitis A?
-prevention: vaccine
- WASH HANDS
- no effective treatment
- recover in 4-6 weeks
What is hepatitis B?
- transmitted through blood and bodily fluids
- incubation period is 1-6 months
- symptom are similar to hep A
What is the management of hepatitis B?
- prevention is vaccine
- treated with interferon
What is Hepatitis C?
- transmitted through percutaneous
- commonly through people who share needles
What is the S&S of hepatitis C?
- N&V, loss of appetite, jaundice, fatigue, itching, pain in URQ
What is the management of Hepatitis C?
- no prevention
- Prevention of needle sticks for health care workers & measures to reduce spread of infection
- treated with pegylated interferon and ribavirin
What is Hepatitis D?
- Only persons with hepatitis B are at risk for hepatitis D
- Transmission is percutaneously
What is hepatitis E?
Transmitted by fecal-oral route (contaminated water)
- rare
What is hepatitis G?
Transmitted parenterally and sexually
What is toxic and drug induced hepatitis?
Agents producing toxic hepatitis are generally systemic poisons
What is cirrhosis of the liver?
- Liver serves as a reservoir for a large amount of venous blood that the failing heart is unable to pump into circulation
- Liver becomes anoxic
- Resulting in liver cell necrosis and fibrosis
What are the S&S of cirrhosis?
- jaundice, ascites, hepatomegaly, edema, anemia, spider angiomas
- changes in mental responsiveness and memory
What are tar three types of cirrhosis?
- alcohol
- post necrotic
- biliary
What is alcoholic cirrhosis?
- alcohol induced cirrhosis
- makes fatty liver which can be reverses if person stops drinking
- if continues, causes scar formation
What is post necrotic cirrhosis?
- Occurs after massive liver cell necrosis
- complication of acute viral hepatitis or after exposure to industrial or chemical hepatotoxins
-Broad bands of scar tissue cause destruction of liver lobules and entire lobes
What is biliary cirrhosis?
- Develops from chronic biliary obstruction, bile stasis, inflammation
- Diffuse fibrosis of the liver with jaundice as the main feature.
What is the complications of cirrhosis?
- Portal hypertension
- Ascites
- Bleeding esophageal varices
- Coagulation defects
- Hepatic encephalopathy
- Hepatorenal syndrome
- Jaundice
What is portal hypertension?
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system.
- this can potentially result in ascites and esophageal varices
What is ascites?
Accumulation of free fluid containing almost pure plasma within peritoneal cavity
What is the treatment of ascites?
- low sodium diet, bed rest, Paracentesis, TIPS
What is paracentesis?
procedure that uses a hollow needle or plastic tube (catheter) to remove fluid from the abdominal cavity
- used for treatment of ascites
What is bleeding of esophageal varies?
Fragile, thin-walled, distended esophageal veins that are irritated and rupture
What is coagulation defects?
- Decreased synthesis of bile fats in the liver that prevent absorption of fat-soluble vitamins
- Without vitamin k and clotting factors client is susceptible to bleed
What is the treatment of bleeding varices?
- Treatment of shock, Oxygen, IV fluids, electrolytes, and volume expanders, Blood and blood products
- meds to decrease bleeding, improve cardiac circulation and decrease portal pressure
What is hepatic encephalopathy and coma?
A life-threatening complication of liver disease. May result from the accumulation of ammonia and other toxic metabolites in the blood.
End-stage hepatic failure and cirrhosis
What is asterixis?
(liver flap) a coarse tremor characterized by rapid, nonrhythmic extension and flexion in wrist and fingers
What is hepatorenal syndrome?
- Progressive oliguric renal failure
- Associated with hepatic failure
- impaired kidneys and portal hypertension
What is the S&S of hepatorenal syndrome?
Sudden ↓ urinary flow, ↑ BUN and Creatinine, Abnormally ↓ urine sodium excretion, Increase urine osmolarity, patients may require temporary hemodialysis.
What is the lab and diagnostic tests for hepatorenal syndrome?
- Elevated serum liver enzymes and serum bilirubin
- Prolonged PT time
- Enlarged liver on X-ray
What is pancreatitis?
A severe disorder that can lead to death. Acute pancreatitis does not usually lead to chronic pancreatitis
What is acute pancreatitis?
Pancreatic duct becomes obstructed and enzymes back up into the pancreatic duct, causing autodigestion and inflammation of the pancreas
What is chronic pancreatitis?
inflammatory disorder with destruction of the pancreas
What is the S&S of chronic pancreatitis?
- Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting
- May be painless (20%)
- Weight loss (75%)
- Steatorrhea
What is the S&S of acute pancreatitis?
- Rigid/boardlike abd ominous sign
- Nausea and vomiting
- Fever, jaundice, confusion, and agitation may occur
- Ecchymosis
- acute renal failure
- severe abdominal pain
What is the complications of pancreatitis?
-Fluid and electrolyte disturbances
- Necrosis of the pancreas
- Shock
- Multiple organ dysfunction syndrome
- DIC
What is the treatment of pancreatitis?
- Management directed at symptoms an preventing complications
- Pt usually NPO
- Parenteral nutrition - TPN
- NG tube – relieve nausea & vomiting
- Medication to limit pancreatic secretions: H2 Antagonists, Proton pump inhibitors
Why does chronic renal failure cause anemia?
When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells.
Kidney damage=less erythropoietin= less RBC= anemia
What is worse, chronic or acute pancreatitis? Why?
acute, watch urine output
- there is symptoms with acute where chronic has none
