Chapter 58 Flashcards
Effects of portal hypertension on the body?
ascities
esophageal varices
prominent abdominal veins
hemorrhoids
Early symptoms of lover disease?
fatigue
change in weight
nausea/vomiting
RUQ abdominal pain
Late symptoms of liver disease?
GI bleeds jaundice Pruritus Ascites Spontaneous Bruising
AST
UP or DOWN?
UP
ALT
UP or DOWN?
UP
LDH
UP or DOWN?
UP
GGT
UP or DOWN?
UP
Alkaline phosphate
UP or DOWN?
UP
Direct bilirubin
UP or DOWN?
UP
Indirect bilirubin
UP or DOWN?
UP
Urine bilirubin
UP or DOWN?
UP
Urine urobilinogen
UP or DOWN?
UP
PT/IRN
UP or DOWN?
prolonged, so UP
Fecal urobilinogen
UP or DOWN?
Down
Albumin
UP or DOWN?
Down
Protein
UP or DOWN?
Down
Nursing care after Liver biopsy?
Immediately after
turn patient on right side with pillow under costal margin
Remain in that position for several hours
Do not cough or strain
Vitals taper – Q15x4, Q30x2
No heavy lifting for one week
What does the patient need to do prior to a Abdominal Paracentesis?
Void before procedure
Vitals prior to procedure
Risk from a Abdominal Paracentesis?
- May cause respiratory distress called hepatopulmonary syndrome
- Dyspnea, intra-abdominal pressure, crackles in lungs
Drugs to help prevent esophageal varices?
Beta-Blockers (propranolol) to decrease heart rate and hepatic venous pressure
What is a Sengstaken-Blakemore tube used for?
applys pressure to bleeding via a balloon on a stick
Risk of Sengstaken-Blakemore tube?
Risk for aspiration, asphyxia, and esophageal perforation
Drugs used to decrease bleeding and portal pressure?
Vasopressin Nitro Somatostatin Octreotide Propanolol Nadolol
What does a EVL endoscopic variceal ligation accomplish?
Stops the bleeding by applying rubber bands
Risk of TIPS?
stenosis of the stent and thrombosis
Indication for TIPS procedure?
hemmorhage or chronic ascites
Diet for hepatic encephalopathy?
High carb
High protein
low fat
What are the symptoms of hepatic encephalophathy?
sleep disturbance
mood disturbance
mental status changes
speech problems
Drugs to avoid for a patient with a history of hepatic encephalophathy?
opiods
sedatives
barbiturates
Drugs to reduce ammonia levels?
Lactulose
non absorable antibiotics
Why give lactulose?
promote excretion of ammonia in the stool
reduce confusion
2 to 3 soft stools per day
Why give nonabsorbable antibiotics?
acts as an intestinal antiseptic
destroys normal flora to decrease protein breakdown which reduces the ammonia produced
Drugs in the nonabsorbable antibiotics catagory?
Rifaximin
Neomycin
HAV transmission?
Ass to mouth
Incubation period for HAV?
15 - 30 days
Vaccine for HAV?
YEs
HBV transmission?
Blood, saliva, semen, vaginal secretions
HBV incubation period?
1 to 6 months
Symptoms of HBV?
nausea/vomiting fever fatigue RUQ pain Dark urine Light stool joint pain jaundice
Treatments for HBV
antivirals
immunomodulators
rest to reduce strain on liver
HCV transmission?
injection drug use
sexual
transfusions
Teaching for HBV and HCV???
- Cannot donate blood, body organs, tissue, semen
- Do not share tooth brushes or razors
- No illegal drugs and no sharing of needles
- No alcohol
- Cover open wounds and sores
- Transmission rare in monogamous sexual partners
What heps are there vaccines for?
HAV and HBV
WHich heps are chronic carriers?
HBV and HCV
contraindication for liver transplant?
cardiovascular disease pulmonary disease active alcoholism metastatic disease non-compliant
What does MELD determine?
severity of liver disease for ranking on transplant list.
Primary rejection timeframe
within 30 days
Secondary rejection timeframe
after 30 days
symptoms of liver transplant rejection
Fever Decreased quality/quantity bile (should be viscous like motor oil) Elevated liver function tests Malaise/fatigue/confusion Increased ascites RUQ tender Urine dark/Stool clay colored Jaundice rise in ALT and AST elevated alkaline phosphatase prolonged PT/INR
indications for infection from liver transplant
Fever/chills Decreased quality/quantity bile Elevated liver function tests Malaise Nausea/vomiting/diarrhea Swelling or redness of any area
