Cirhosis & Hepatic Coma

Question 1

Cirrhosis happens when liver cells are destroyed and are replaced with____ which affect the liver’s circulation.

this causes increased____ in the liver.

Answer 1

• connective/ scar tissue (liver’s circulation is fkd up)
• increased blood pressure

Question 2

When you have high blood pressure in your liver, it’s known as____

Answer 2

Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver.

If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area (belly button). Varices can rupture and bleed, resulting in potentially life-threatening complications.

Question 3

the patient will exhibit a firm,___ liver upon palpation.

-when doing an abdominal are you suppose to feel the liver?

Answer 3

nodular

no; this liver can be so big, it can cover the entire abdomen.

Question 4

why do they feel abdominal pain?

Answer 4

enlarged liver has a capsule that is filled with nerves around it, so when it gets bigger, it pushes on those nerves

Question 5

chronic dyspepsia is just a fancy word for_

Answer 5

GI upset

Question 6

why would this patient experience splenomegaly?

Answer 6

their immune system has kicked in (if your liver is messed up, it’s not filtering like it used to, so the spleen is trying to compensate and help)

Question 7

why would they have a decreased serum albumin?

what will they most likely experience?

Answer 7

most alcoholic have low albumin because they’d rather drink than eat, but YOUR LIVER makes albumin also. this patient will most likely experience ascites because they don’t have the protein to keep the fluid in the vascular space.

Question 8

what is the job of albumin in the vascular space?

Answer 8

it holds on to fluid

Question 9

ANY PATIENT WITH unexplained swelling, they may have a low__ level.

Answer 9

albumin

Question 10

why would anemia occur?

Answer 10

liver is sick and that can lead to hemorrhage

Question 11

liver enzymes would be___

Answer 11

elevated

Question 12

ANYTIME YOUR LIVER IS SICK, WHAT CHEMICAL CAN BUILD UP IN THE BLOOD?

and it acts like a___ WHICH CAN LEAD TO?

Answer 12

AMONIA

• acts like a sedative HEPATIC ENCEPHALOPATHY/ COMA (The loss of brain function when a damaged liver doesn’t remove toxins from the blood)

Question 13

TREATMENT:

why daily weights?

Answer 13

• they usually have ascites which is a fluid problem

Question 14

why do liver people need rest?

Answer 14

they have toxins building up in their bodies

Question 15

would it be appropriate to give this patient an IM injection?

Answer 15

no; bleeding risk

Question 16

would it be appropriate to give this patient an aspirin?

Answer 16

no; bleeding risk

Question 17

if this patient has ascites, what must we make sure we do every day?

Answer 17

measure abdominal girth

Question 18

since this patient will most likely get jaundiced, you’ll first see it in the sclera. by the time their skin turns yellow, what will you see this patient do first?

Answer 18

-itching (give them good skin care and put mittens )

Question 19

why would you want to avoid narcotics?

Answer 19

• when it comes to liver people and drugs, it’s like giving them a double dose. their liver cannot metabolize the drug.

Question 20

why would you want to avoid giving them protein?

Answer 20

it will increase their serum ammonia levels

Question 21

anytime your ammonia levels go up, your__ will go down.

Answer 21

LOC ( decreased mental status, difficult to awake, motor coordination)

Question 22

why would they need a low sodium diet?

Answer 22

they have ascites

Question 23

How does protein lead to a hepatic coma?

Answer 23

protein transforms into ammonia, and the liver is SUPPOSE to convert it to urea (because the urea can be excreted through the kidneys without difficulty. since the liver is impaired, it can’t make this conversion, so the ammonia gets built up in the blood.

Question 24

why would asterixis occur?

Answer 24

as a result of high amonia

Question 25

if you have high amonia:

____ reflexia

_____ EKG

Breath becomes ___

Answer 25

hypo

slow

fetor (breath smells like amonia [smells like wine, acetone, or fresh cut grass]… am I smellin “fetor” amonia?)

Question 26

When a patient is in a hepatic coma, which 2 drugs are the favorites? why?

Answer 26

- neomycin and lactulose

because they decrease amonia levels

Question 27

Blood increases___ levels, which is bad because liver people tend to be___ bleeders.

Answer 27

amonia

GI