care of pt. with liver problems Flashcards
(35 cards)
cirrhosis
- Characterized by widespread fibrotic (scarred) bands of connective tissue
- Tissue become nodular
- Nodules block blood and lymph flow
- Liver shrinks in size and hardens
types of cirrhosis
- post-necrotic
- laennec’s (alcoholic)
- billiary
complication of cirrhosis
- portal hypertension
- ascites
- esophageal varices
- billiary obstruction
- hepatic enecphalpathy
- hepatic encephalopathy
- hepaorenal syndrome
- spontaneous bacterial peritonitis
portal hypertension
a persistent INCREASE in pressure within the portal vein greater than 5 mm hg
ascites
collection of FREE FLUID within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension
esophageal varices
occur when fragile, thin-walled esophageal veins become distended and tortuous from increased pressure
- severe bleeding= medical emergency
billiary obstruction
When the bile duct becomes blocked
hepatic encephalopathy
complex cognitive syndrome that results from liver failure and cirrhosis
ciirhosis history
- Age, gender, employment history (especially of exposure)
- **Needlestick injury
- Sexual, family, social histories
cirrhosis physical assessment & s/s
- Fatigue, weight change, GI symptoms
- abdominal pain
Abdominal assessment
physiological effects of cirrhosis
- ascites, splenomegaly, testicular atrophy, and leukopenia
cirrhosis lab assessment
- **AST, ALT, LDH: elevated–> shows hepatic inflammation
- Alkaline
- phosphatase
GGT
**Serum bilirubin: elevated
**Serum albumin: low
**PT/INR
CBC
**Ammonia level: advanced chirrosis
imaging assessment cirrhosis
- xrays
- ct
- mri
cirrhosis anaylyze and prioritize hypotheses
- Fluid overload due to third spacing of abdominal and peripheral fluid
- Potential for hemorrhage due to portal hypertension
- Acute confusion and other cognitive changes due to increased serum ammonia levels and/or alcohol withdrawal
- Pruritis due to increased serum bilirubin and jaundice
managing fluid volume cirrhosis
Treat ascites, consider nutrition therapy (decrease sa), drug therapy, paracentesis, and respiratory support (02)
preventing hemmorrhage cirrhosis
- Monitor for esophageal varices by endoscopy
- because massive esophageal bleeding can cause rapid blood loss, emergency interventions are needed
- Prevent bleeding and infection, non-selective beta blocking agent to prevent bleeding, antibiotics used to prevent infection
- Endoscopic therapies include ligation of the bleeding veins or endoscopic sclerotherapy
- Transjugular intrahepatic portal-systemic shunt (TIPS)- procedure used for patient who have not responded to other modalities for hemorrhage or long-term ascites
- NGT, Packed RBCS, fresh frozen plasma, Dextran, albumin, and platelets may be needed
- Monitor vs every hour, PT, PTT, and INR
preventing or managing confusion in cirrhosis
Slow or stop increase of ammonia in the blood, assess and monitor neuro status, nutrition counseling and protein in diet, lactulose used to excrete ammonia in stool, nonabsorbable antibiotics if lactulose does not help
managing pruritus IN CIRRHOSIS
Avoid being too warm, moisture skin, avoid irritants to skin, cool compress and/or corticosteroid creams
cirrhosis evaluating outcomes
- Have a decrease in or have no ascites
- Have electrolytes within normal limits
- Not have hemorrhage or will be managed immediately if bleeding occurs
- Not develop encephalopathy or will be managed immediately if it occurs
- Successfully abstain from alcohol or drugs (if disease is caused by one or more of these substances)
hepatitis
viral HAV HBV HCV HDV HEV
HAV
- shellfish
- contaminated water
HBV
- sex
- sharing needs
- razors
- needsticks
- blood transfuion
- hemodilaysis
- blood
- birth
HCV
- needle
- blood
- hemodilaysis
- prisoners
- drugs
HDV
- rna virus
- iv drugs
