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235 Med surg > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

Function of liver

A
  • 🩸 glucose regulation
  • bile drainage
  • synthesis/storage of amino acids, protein, vitamins and fats
  • detoxification
  • 🩸 circulation and filtration
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2
Q

What is cirrhosis

A
  • End-stage liver disease
  • Extensive degeneration and destruction of liver cells
  • Results in replacement of liver tissue by fibrous and regenerative nodules
  • Usually happens after decades of chronic liver disease

Typically see nutritional deficiencies with reduced protein intake
- contributes to liver destruction

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3
Q

Who is at risk

A

•Affects men more

- 40-60 years of age

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4
Q

What causes cirrhosis

A
  • Excessive alcohol is the major factor

- or hepatitis C

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5
Q

What happens to the liver in cirrhosis

A
  • Liver inflammation progresses to necrosis and finally fibrotic scarring.
  • Liver cells try and regenerate however the process is disorganized.
  • Results in abnormal blood vessel and bile duct architecture.
  • The overgrowth of new and fibrous connective tissue distorts the liver’s normal lobular structure, resulting in an irregular shape and impeded blood flow.
  • Eventually this disorganized and irregular liver generation, poor cellular nutrition, and hypoxia results in decreased liver function.
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6
Q

Cirrhosis early signs

A

Fatigue and enlarged liver

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7
Q

Cirrhosis late signs
(start of decompensation)

3 main signs and others ?

A

1) jaundice
2) peripheral edema
3) ascites

Other
•Skin lesions, hematologic problems , endocrine problems , and peripheral neuropathies
•Liver becomes smaller, nodular

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8
Q

Jaundice in cirrhosis results from

A

•Overgrowth of connective tissue in liver compresses bile ducts

  • Leads to obstruction
  • Increase in bilirubin in vascular system
  • May be minimal or severe
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9
Q

2 Skin conditions in cirrhosis

What causes them?

A

1) Spider angiomas (telangiectasia): abnormal collection of blood vessels near the surface of the skin
2) Palmar erythema: redness of palms

Due to increase in circulating estrogen due to inability of liver to metabolize steroid hormones

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10
Q

Endocrine disorders (late sign of cirrhosis)

A

1) In men—gynecomastia, loss of axillary and pubic hair, testicular atrophy, impotence and loss of libido
2) in women—amenorrhea or vaginal bleeding
3) Hyperaldosteronism in both sexes

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11
Q

Peripheral neuropathy (late sign of cirrhosis)

A

•Common finding in alcoholic cirrhosis 🍺
- From dietary deficiencies of thiamine, folic acid, and cobalamin

•Sensory symptoms may predominate

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12
Q

Portal hypertension

A complication- what does it cause?

A

•Increased venous pressure in portal circulation

It causes: 
•Splenomegaly
•Large collateral veins
•Ascites
•Gastric and esophageal varices
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13
Q

Varicosities

Complication of cirrhosis

A

1) Esophageal varices: complex of tortuous enlarged veins at lower end of esophagus
2) Gastric varices: dilated veins by upper part of stomach

•Both are very fragile, bleed easily;
Most life-threatening complication

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14
Q

Peripheral edema

Complication of cirrhosis

A

-caused by increase pressure from portal vein HTN

Occur in lower extremity 🦶🏻

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15
Q

Ascites

Complication of cirrhosis

A
  • accumulation of serous fluid in peritoneal or abdominal cavity

Painful
Don’t eat well- small frequent meals
Hyperaldosteronism

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16
Q

Hepatic encephalopathy (HE)

Complication of cirrhosis

What causes this to happen and 4 signs?

A

•Liver unable to convert increased ammonia to urea

  • Ammonia crosses blood-brain barrier
  • Ammonia can be neurotoxic

1) Changes in neurologic and mental responsiveness
2) Inappropriate behavior
3) Sleep disturbances, trouble concentrating
4) Impaired LOC—hepatic coma

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17
Q

Complications causes by Hepatic encephalopathy

A

•Asterixis: flapping tremors (arms and hands when extended forward) means trending towards coma
- Impairment in writing

  • Apraxia: lost ability to carry out purposeful movement (flip comb and brush hair with wrong side)
  • Fetor hepaticus: musty sweet smell of breath
18
Q

Hepatorenal syndrome

Complication of cirrhosis

What are the signs?

A 
•Development of renal failure in pts with advanced liver disease
•S/S: 
1) azotemia- Elevated levels of urea
2) oliguria
3)  intractable ascites
•No structural abnormality of kidneys
19
Q

Diagnostic Liver enzyme tests

A

1) aspartate aminotransferase (AST)
2) alanine aminotransferase (ALT)
- (will be increased)

20
Q

Diagnostic lab values

A
  • bilirubin, ammonia 🔼
  • Total protein, albumin 🔽
  • Cholesterol 🔽
  • Prothrombin time (prolonged)
21
Q

Diagnostic studies for cirrhosis

A
  • Ultrasound- detects the difference in density of parenchymal cells and scar tissue)
  • CT, MRI, radioisotope liver scan- give information about liver size, hepatic blood flow and obstruction.
  • Liver biopsy- confirms diagnosis
22
Q

Care of patient with cirrhosis

A

1) Rest
2) Administration of B-complex vitamins
- liver not metabolizing them so malnourished
3) Avoidance of alcohol!!
4) Minimization or avoidance of aspirin, acetaminophen, and NSAIDs
- risk of bleed

Goal is to slow the progression and prevent complications.

23
Q

Acute care of ascites

3 things the nurse can do/ give ?

A

1) Sodium restriction
- 2g/day (water follow salt)
2) Diuretics
3) Albumin
- helps blood volume (volume expander)

24
Q

Most important management of Esophageal and gastric varices is to:

A

Prevent bleeding/hemorrhage

25
Q

Acute Bleeding Varices care/ treatment

What’s the supportive care ( what can the nurse give that the doctor proscribed)

A

stabilize patient, manage airway, start IV therapy and blood products

Supportive measures for acute bleed:
•Fresh frozen plasma
•Packed RBCs
•Vitamin K
•Zantac*
26
Q

Long Term Care: Bleeding Varices

Decompensated cirrhosis

Medications ?

A

Each bleed increases the chances for another
Medications:
•Beta-blockers: Propranolol(Inderal)

27
Q

Medications for Hepatic Encephalopathy

Reduce ammonia formation:

A
  • Lactulose (Cephulac), which traps ammonia in gut and as a laxative excretes it (pts often will have many BMs/day)
  • Rifaximin (Xifaxan) antibiotic given to those unresponsive to Lactulose.
28
Q

Nutritional Therapy for Cirrhosis

A

High Calories & Carbs
Low fat
Small, frequent meals

•Protein supplements for malnutrition
- Restrict protein IF hepatic encephalopathy cannot be managed with Lactulose
•Low-sodium and fluid restriction for patients with ascites and edema
•1-2 cups of probiotic yogurt TID reduces intestinal flora imbalance by 🔽 E Coli counts
•Water soluble forms of fat-soluble vitamins A, D, and E
•Folic acid and iron to prevent anemia.
•Enteral or parenteral nutrition if vomiting or eating poorly.

29
Q

Nursing Management of Pruritis secondary to Jaundice

Measures to relieve pruritus?

A
  • Cholestyramine or Hydroxyzine
  • Baking soda or Alpha Keri baths (oil)
  • Lotions, soft or old linen
  • Temperature control
  • Short nails; rub with knuckles to avoid bleeding
30
Q

Nursing management ascites

What to measure ?

A

Daily weight
I&O
Abdominal girth measurements (umbilicus)

Monitor for edema
Monitor for oliguria

31
Q

Paracentesis nurses responsibility

How to have them sit?
What to monitor ?

A
  • High Fowler’s position or sitting on side of bed
  • Monitor for
    • hypovolemia / electrolyte imbalances
    • BP and heart rate
    • dressing for bleeding/leakage
32
Q

Risk of Bleeding secondary to Varices

What to look for ?

A

•Hematochezia: blood in stool
•Hematemesis: blood in vomit 🤮
- throwing up! Not coughing which would be from 🫁

33
Q

Management of altered LOC secondary to hepatic encephalopathy

What to assess for ?

A

1) Maintain safe environment
- Prevent falls and injuries
2) Assess carefully (LOC)
- Sensory and motor abnormalities
- Fluid/electrolyte imbalances
- Acid-base imbalances
- Response to treatment measures like meds
- Assess neurologic status every 2 hour
3) Minimize constipation
4) Encourage fluids

34
Q

DC Planning

What do they need to know?

A
  • Proper diet
  • Rest
  • Avoiding potentially hepatotoxic OTC drugs like Tylenol
  • Abstinence from alcohol
35
Q

Decompensated cirrhosis *

6 major complications

A
  • portal hypertension
  • esophageal and gastric varices**
  • peripheral edema
  • abdominal ascites
  • hepatic encephalopathy
  • hepatorenal syndrome
36
Q

Nursing care for Dyspnea

A

Semi or high fowlers
C&DB
Rest

37
Q

Skin care

A

Special mattress to relive pressure
Turn q2h
ROM
Elevate lower extremity

38
Q

Drug therapy for varices bleeding

A

•Octreotide
(used more often due to fewer side effects).
•Vasopressin

produces vasoconstriction, decreases portal blood flow, and decreases portal HTN

39
Q

Acute surgery for bleeding varices

A

Endoscopic therapy

  • *Endoscopic variceal ligation(EVL)
    • a rubber band around vein to cut off blood supply
  • Sclerotherapy-solution is injected directly into a vein, causing the lining of the blood vessel to swell and stick together
  • Balloon tamponade
40
Q

Long term care of bleeding varices

Surgery?
Non surgical?

A

Surgery:
•Repeated EVL (Endoscopic variceal ligation)
•Portosystemic shunts–goal is to decrease portal HTN (after 2nd bleed)
•portacaval and distal splenorenal shunt*

Nonsurgical:
•trans-jugular intrahepatic portosystemic shunt (TIPS)

235 Med surg (12 decks)

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