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Adult Nursing Exam 5 > Assessment & Management of Hepatic Disorders > Flashcards

Assessment & Management of Hepatic Disorders Flashcards

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1
Q

How many lobes make up the liver?
Which one is larger?
What separates them?

A

Two lobes
Right is larger
Falciform ligament

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2
Q

How many different functions does the liver have?

A

Around 8 or so

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3
Q

What does the liver metabolize?

A

Carbs
Proteins
Fats

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4
Q

What does the liver store and filter?

A

The liver stores and filters blood.

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5
Q

What do the hepatocytes or liver cells make?

A

Bile

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6
Q

What form of glucose is stored in the liver?

What does the liver do when the glycogen is depleted?

A

Glycogen

Liver can convert protein and fat to glucose. This is called gluconeogenesis.

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7
Q

Which proteins are formed in the liver?

A

Plasma proteins.
Albumin is a big one for oncotic pressure.

But there are others:
globulin, prothrombin, fibrinogen, etc.

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8
Q

Which vitamins are stored in the liver?

A

B2, B6, B12

A, D, E, K, folic acid

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9
Q

What does bile contain that causes jaundice?

What does bile do to fat before it goes to intestines?

A

Bilirubin

Bile emulsifies the fat

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10
Q

What hormones does the liver have to do with?

A

Sex hormones

Aldosterone

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11
Q

Which enzyme stimulates gallbladder contraction, Oddi sphincter to open, and releases pancreatic juices all in order to secrete bile?

A

CCK-PZ

cholecystokin-pancroenzymin

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12
Q

What is ammonia converted to by the liver?

A

Urea

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13
Q

What are the liver serum enzyme labs we should pay attention to?

A 
AST
ALT
GGT
GGTP
LDH
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14
Q

What other serum values should we look out for with the liver?

A 
Ammonia
Alkaline Phosphate
Protein
Bilirubin (urine as well tho)
Creatinine & BUN
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15
Q

Other lab values?

A 
Cholesterol 
Prothrombin time
CBC
WBC
platelets
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16
Q

Why would they do a biopsy of the liver?

A

Cancer

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17
Q

What diagnostics could be done for the liver?

A

CT
MRI
EGD
TIPS or Transjugular intrahepatic portosystemic shunt (it helps relieve portal hypertension)

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18
Q

What side should we place the patient on if they are having hepatic pressure?

A

Their right side for hepatic issues.

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19
Q

What is Jaundice?

What substance is the cause of Jaundice?

A

Yellow/green colored body tissue & possible discoloration of the sclera or eyes. (could also be deep orange)

Bilirubin accumulation

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20
Q

Four types of Jaundice?

A

Hemolytic
Heptocellular
Intrahepatic obstruction
Hereditary hyperbilirubinemia

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21
Q

T/F

Immature kidneys cause jaundice in newborns.

A

False.

It is the immature LIVER that will cause this to occur in newborns.

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22
Q

Main cause of Hepatocellular Jaundice?

A

Damaged Liver cells cause Hepatocellular jaundice.

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23
Q

Hepatocellular Jaundice symptoms

How ill will they present?
What will their weight look like?
What will energy levels be like?
What will an infectious origin appear as?

A

Hepatocellular Jaundice:

They will present mild or severely ill.
Due to loss of appetite, they will appear thin.
They will be very tired and fatigued.
If infectious: headache, chills, and fever.

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24
Q

(Intrahepatic) Obstructive Jaundice Symptoms

UO appearance? Stool appearance?
GI symptoms?
Skin?
How to treat the jaundice?

A

Obstructive Jaundice:

UO orange-brown in color. Stool is clay colored.
GI will have impaired digestion; especially of fat.
Pruritus of the skin
Remove the stone

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25
Q

How can you help pruritus?

A

Warm bath or fan
Benadryl.. but pay attention to liver enzymes.
Topical meds are much better.

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26
Q

What is portal hypertension?

What does it contribute to?

A

High BP in veins that carry blood from intestines to liver

Ascites
Varices: rectal or esophageal. Up or down really.

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27
Q

Management of portal hypertension?

A

Not anti-hypertensives bc this is not a systemic problem.

Do re-routing with stents or correct underlying cause.

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28
Q

Ascites results from?

A
  • The increased portal hypertension causing increased capillary pressure and and obstruction of venous blood.
  • Aldosterone changes also increase retention of fluid.
  • Albumin gets pulled into peritoneal cavity
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29
Q

How to monitor ascites?

A

Measure girth
Takes weight daily
Percuss and fluid shift checks
Monitor F&E

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30
Q

How to specifically treat ascites?

Diet
Meds
Activity
Procedure

A

Ascites Treatment:

Put them on a low sodium diet
Meds like Diuretics & salt poor albumin (they need to give them protein to improve oncotic pressure but not anymore salt)
Bedrest
Paracentesis, TIPS

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31
Q

What is a TIPS?

A

TIPS is an ascites procedure that can be done. Stands for transjugular intrahepatic portosystemic + shunt

Putting a stent in liver where the hepatic and portal veins connect in order to reroute the blood flow.
Placing the shunt decreases congestion.

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32
Q

What will ascites look like?

A

Striae (sort of like stretch marks)
Distended veins
Umbilical hernia from extra pressure

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33
Q

What are esophageal varices?

A

Essentially collateral circulation developing due to portal hypertension. Rupture and bleed easily.

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34
Q

Esophageal varices symptoms?

A

Esophageal varices symptoms:

Hematemesis (bleeding)
Melana (dark tarry stool)
Decrease BP – shock or vascular collapse can occur.

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35
Q

How to manage esophageal varices: give the explanation

Lavage?
Tamponade?
Shock complications?

A

Managing esophageal varices explanation:

Saline Lavage (taking fluids out or washing out something) or ice saline due to vasoconstriction

Balloon Tamponade to provide internal pressure
BUT the tissue is fragile so be aware of possible damage. Don’t leave in too long bc it can cause necrosis.

Shock can happen due to bleeding. Need to administer oxygen, IVF, and blood transfusions to return back to normal.

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36
Q

How to manage esophageal varices: give the explanation

Check VS

H&H

Cognitive status

Why might you check UO?

Maintain airway

A

Managing esophageal varices explanation:

Check Vitals for a good baseline especially since this involves someone possibly losing blood.

Check the H&H bc this lab is associated with blood loss

Alterations in cognition can indicate lack of perfusion to the cerebral areas.

UO is an indicator that the kidneys are at least being perfused.

Maintain the airway because with the tamponade, this is a balloon going down the esophagus. It can make breathing difficult for this with breathing patterns or anxiety. Can also make breathing hard if placed incorrectly.
You can reposition the patient, check the tubing, and GI suctioning if they need it.

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37
Q

How to manage esophageal varices: give explanation

Why might they give vasoconstricting medications?

A

Managing esophageal varices explanations:

Vasoconstriction meds help the varices constrict so that BP goes back up and control bleeding

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38
Q

Surgical methods for esophageal varices?

TIPS
Endoscopic sclerotherapy
Esophageal Band
Shunt

A

TIPS to reduce the portal hypertension that caused the varices in the first place
Endoscopic sclerotherapy will help stop bleeding by using a sclerosing agent.
Esophageal Banding cuts off blood flow.
Shunt is for drainage and decongesting

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39
Q

What is portal encephalopathy?
What dietary food group can make this worse?

Other problems that can occur?

A

Loss of neurological from liver not being able to remove ammonia and other toxins from the blood

Protein can make it worse.

all sorts of issues. Could have GI bleed or ascites

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40
Q

Neurological symptoms to look for with portal encephalopathy?

A

Confusion
Lethargic
LOC alterations

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41
Q

Management of Encephalopathy and Coma?
Assess?
Precautions?
Labs to monitor?

A

Assess neuro status
Seizure precautions
Monitor Ammonia and Potassium
F&E in general

42
Q

Constructional Apraxia

A

A symptom of encephalopathy
Cannot copy or recreate something based off a model .
Unable to build a lego version of something

43
Q

Asterexis meaning?

What is it a symptom of?

A

Cannot hold hand in dorsal flexion. It moves down.

A neuro symptom of Encephalopathy

44
Q

Patient teaching of encephalopathy?

A

Don’t let them sign important papers

May need DPOA for legal issues.

45
Q

Most common medication to get ammonia down?

A

Lactulose is used to get ammonia down. It is a laxative and can be used as one too. But overall, we want a bowel movement to excrete the ammonia.

46
Q

Why would they use IV glucose to help with ammonia?

Dietary restrictions they can do? Supplements?

A

IV glucose can metabolize protein and therefore cut down on the increase of ammonia

Cut down on protein for diet. Talk to dietician. They will need some protein but not a lot usually. May need amino acid supplement

47
Q

What ways can they remove more ammonia from the gut?

A

Suction
enemas
oral antibiotics

48
Q

Considering that the body cannot clear the ammonia, can it clear medications?

A 
No. Discontinue ..
Sedatives
Analgesics
Tranquilizers. 
And do not give Tylenol or Acetaminophen

If we have to give pain meds - we need to really balance it.

49
Q

Monitoring for stages of coma and encephalopathy

stage 1

stage 4

A

This is really a staging of 1 to 4.
1 being normal LOC
4 is being not responding to painful stimuli

Strickert said you don’t need to know individual stages all that much.

50
Q

T/F

Cirrhosis is a typical reason why patients have liver issues

A

True.

Cirrhosis is mainly due to alcohol. It just means scarring of the liver.

51
Q

Why do cirrhosis patients sometimes have nutritional deficiencies?

A

Alcoholic patients have nutrition deficiencies because alcohol is where they get their calories but there is no nutritional benefit from it

52
Q

Why are patients with liver problems anemic a lot?

A

Most likely due to the bleeding and hemorrhaging from their diagnosis

53
Q

What vitamins might they need?

A

Fat soluble vitamins

Especially vitamin B for cirrhosis or alcoholics

54
Q

Should patients with encephalopathy or other liver issues be given carbs?

What size of meals do you give the patient?

A

Yes. This food group is actually a group they rely on for energy.
But make sure you check BG bc liver issues can affect pancreas.

Give small, frequent meals and snacks.

55
Q

Why might a patient have to be on low sodium and fluid diet with liver issues?

A

Due to possible ascites.

56
Q

Acquired (adaptive) Immunity results because of what?

Most common type?
Another type?

What cells are involved?

How long does it last?

A

Acquired immunity results due to a prior exposure to an antigen.

Common one is from a vaccination.
Exposure to certain disease like Measles.

T-cells and B-cells are involved.

Hard to say but you may have to get more shots and boosters.

57
Q

What is Active Immunity?

A

When the immune system develops a defense on its own & lasts for life

58
Q

Passive Immunity?

Example?

A

Temporary
Gamma globulin injection
Antibodies given to the baby from breastfeedig

59
Q

Innate (natural) immunity

Examples?

A 
Immunity tools present from birth. 
Surfactant in lungs
Skin
Mucous Membranes
WBCs
Cough reflex
Stomach acid
nasal hairs

These are not things that the immune system picked up and learned from as they got older. They were born with these.

60
Q

Definition of Hepatitis?
Two MAJOR categories?

Seriousness?

A

Inflammation of the liver.
Viral: ABCDE
Toxic

Can be acute or chronic

61
Q

What is toxic hepatitis caused by?

A 
Inflammation is caused by something that has been ingested. 
Alcohol
Chemicals
Drugs
Meds 
Supplements 
((mushrooms even)
62
Q

How soon is the onset of toxic hepatitis?

What can this lead to?

What treatment is needed?

A

It can go either way.
Within hours, days, months

Can lead to cirrhosis or liver failure

Liver transplant

63
Q

Common symptoms of Toxic Hepatitis?

Labs to check?

A

Very similar to other liver issues.

Jaundice
Weight loss
Dark urine

Very similar labs.

Bilirubin
Liver enzymes

64
Q

Meds that can cause toxic hepatitis?

A

Acetaminophen (tylenol)
Statins
Dilantin
Augmentin

65
Q

Supplements that can cause toxic hepatitis?

A

Aloe Vera
Ephedra used for weight loss
Blach Cohosh for menopause

66
Q

Chemicals that can cause toxic hepatitis?

A

Carbon Tetrachloride

Vinyl Chloride

67
Q

Risk factors of toxic hepatitis?

A

Ingesting or working around something harmful

Already having liver issues like Cirrhosis, chronic hepatitis, or non-alcoholic fatty liver disease rt abdominal obesity

Aging

68
Q

Viral Hepatitis symptoms?

A

Similar to the other liver issues

Jaundice
Pruritus
RQ pain
Dark urine/clay stool
Flu like symptoms
69
Q

Labs done for viral hepatitis?

A

serum liver ALT, AST, ALP

serum bilirubin

70
Q

Diagnostic Procedures for viral hepatitis?

A

Xray for hepatomegaly size, ascites, or spleen enlargment

Biopsy for possible infection or cancer

71
Q

How is Hepatitis A transferred?

At risk people?

A

Fecal matter

  • drinks/water/food
  • sex
Travelers
Sexual partners
Caregivers
Drug users
Natural Disaster population
Foreign/third world countries
72
Q

How is Hep A treated?

Vaccine?

Any major complications?

A

Well it usually resolves by itself.
Really need to focus on prevention.

Yes there is a vaccination. Can even give it 2 weeks after exposure.
Gamma Globulin to boost passive immunity/recovery

No major complications

73
Q

Types of Hepatitis transmission through blood/bodily fluids? 3

Other Hepatitis caused be fecal matter + raw shellfish + animals/zoonotic?

A

Hep B
Hep C
Hep D

Hep E : fecal matter + raw shellfish + animals/zoonotic

74
Q

Hep B
Hep C
Hep D

likely causes?

A 
Infants born to infected moms
Sex
Injection drug use
Blood transfusions 
Healthcare workers bc of exposure
Caregivers bc of exposure
75
Q

Hep B
Hep C
Hep D
Treatment?

Chronic Hep B and Hep C treatment?

A

Supportive Treatment like comfort and nutrition fluids

Frequent monitoring for cirrhosis, liver cancer, and further disease
Antiviral drugs

76
Q

Can antiviral meds cure hepatitis?

A

Sort of. They can cure certain strands but not each of them.

77
Q

Which Hepatitis do you have to get before getting Hep D?
What is bad about Hep D?
Transplant?

A

Hep B and Hep D go together

High risk of progression
Transplant more likely due to progression.

78
Q

Prevention of
Hep B
Hep C
Hep D?

A

Vaccines only for Hep B.
But by getting Hep B vaccine you protect yourself from Hep D.

No Hep C vaccine tho.

79
Q

What type of immunity is Hep B vaccination?

What type is the Hep B immune Globulin?

A

Active immunity so long

Immune globulin is passive immunity. so short.

80
Q

Can Hep E progress?
Where is it most common in world?
Is it clinically distinguishable?

Who is at risk?

Any treatment available?

A

Yes but rare.
Common is East & south asia

No, need to see specific antibodies in blood to know

Travelers are at risk. Avoid tap water

No treatment available that alters the course. But supportive therapy is there.

81
Q

When will these patients be in the hospital for Hepatitis?

Care precautions?

Diet?

What type of side effects with interferon therapy?

A

Only be in hospital if they are acutely ill

Yes, contact precautions.

High carbs and calories
Low fat and protein
Small meals

Flu symptoms/side effects

82
Q

What is Cirrhosis?
Can it be reversed?

Loss of function?

A

Scarring of the liver; fibrosis that is progressive
Damage is irreversible

Yes, loss of function. Alters blood fluid and impairs hepatocytes.

83
Q

Cirrhosis risk factors

6

A

alcohol

Hep B, C, D

Steatohepatitis (fatty liver disease)

Drugs/Toxins

Chronic biliary cirrhosis (this just means the obstruction causes it)

Cardiac cirrhosis from right HF leading to necoris and fibrosis

84
Q

Cirrhosis symptoms

similar to others

A

Similar to other liver stuff.

Jaundice
Pruritus
Weight loss
Confusion

GI bleed
Ascites
Edema

Asterexis
Spider angiomas or spider veins

85
Q

Labs

A

serum enzymes increased

Bilrubin increased

Proteins increases

CBC decreases due to anemia

PT/INR due to decrease prothrombin

Ammonia increase

Serum creatinine increase due to rt kidney function

86
Q

Meds that reduce ammonia?

A

Neomycin

Flagyl

87
Q

What is nonalcoholic fatty liver disease?

A

Build up of fat in the liver that is not due to alcohol

88
Q

What does a non-alcoholic fatty liver disease cause?

A

Increase in live enzymes

89
Q

3 types of NAFLD

A

Nonalcoholic fatty liver
Nonalcoholic steatohepatitis
Nonalcoholic fatty liver associated cirrhosis disease

90
Q

What happens in nonalcoholic fatty liver NAFLD?

A

In nonalcoholic fatty liver NAFLD:

liver has trouble breaking down fats so it accumulates

91
Q

What happens in nonalcoholic steatohepatitis NAFLD?

A

In nonalcoholic steatohepatitis the fat causes inflammation

92
Q

What happens in nonalcoholic fatty liver disease associated with cirrhosis?

A

With NAFLD with cirrhosis the inflammation causes scarring and then leads to liver failure

93
Q

risk factors of NAFLD

A

metabolic syndrome

94
Q

symptoms of NAFLD

What lab is best to check?

A

Mostly asymptomatic but
jaundice, anorexia, pruritus, and ascites can develop.

Check liver enzymes bc they will be elevated.
protein; albumin
ammonia levels

95
Q

NAFLD treamtnet

A 
no specific meds
prevent progression
weight loss and diet control
vaccinations for hepaitis 
avoid toxins
96
Q

Liver cancer is usually due to?

A

Hep B
Hep C
Cirrhosis

97
Q

T/F Cancer generally starts in the liver

A

False. Cancer usually only travels to liver

98
Q

risk factors for liver cancer

A

Cirrhosis
Hep B or C
Alcoholic liver disease
hemochromatosis ; can’t breakdown iron

99
Q

Liver cancer symptoms

A 
ache in RUQ
weight loss
jaundice
ascites
pruritus 
hepatomegaly
100
Q

Best labs/diagnostics for liver cancer

A

Elevated AFP
Elevated CEA
Biopsy
Imaging

101
Q

What to labs to monitor for liver cancer

A

blood transfusions
H&H
aPTT
PT/INR

102
Q

Nonsurgical methods for live cancer treatment

A

radio-frequency or cryoablation
sclerosing agents
chemo
radiation

Adult Nursing Exam 5 (6 decks)

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