Cirrhosis

Question 1

Early manifestations of Cirrhosis (6)

Answer 1

Insidious

Weight loss

Weakness

GI disturbances
Anorexia, N/V, flatulence, change in bowel habits

Hepatomegaly

RUQ pain/palpable liver

Question 2

Late manifestations of cirrhosis

Answer 2

Jaundice

decreased serum albumin & PT (2 proteins manufactured by liver)

Portal hypertension

Ascites

Splenomegaly

Spider angiomas & caput
medusae

Esophageal & anorectal varices

Hepatic encephalopathy
Asterixis (liver flap)

Question 3

Spider angioma is due to what

Answer 3

engorged microvasculature

Question 4

Hepatic encephlopathy is primarly caused by what

Answer 4

excessive serum ammonia (which is normally converted to urea) crossing the blood brain barrier

Question 5

What is hepatic encephalopathy

Answer 5

Reversible neuropsychiatric manifestation of impaired liver function

Question 6

Asterixis (Liver flap) indicates what

Answer 6

elevated ammonia levels

Question 7

Nursing Care in patients with Cirrhosis

Answer 7

Measures to promote rest

Measures to manage ascites/excess fluid volume:
Assess/measure abdominal girth*
Sodium restriction/possibly fluid restriction
Diuretics (Spironolactone & loops)
Fluid removal:
	Paracentesis*
	Portosystemic shunt (TIPS)*
IV albumin
Patient & family teaching

Question 8

How does a nurse measure abdominal girth

Answer 8

Bring tape around patient and take measurement at level of umbilicus.

Before removing tape, mark the abdomen along the sides of the tape (sides & midline)

Question 9

What is the goal of paracentesis

Answer 9

relieve respiratory distress

Question 10

Nursing care before paracentesis performed

Answer 10

Informed consent

Baseline V.S.

Void beforehand

Position supine or high-fowler’s (HCP preference)

Question 11

What is a Transjugular intrahepatic portal-systemic shunt (TIPS)

Answer 11

Non-surgical procedure used to control long-term ascites & reduce variceal bleeding

Question 12

Measures taken to enhance nutrition in cirrhosis

Answer 12

High calorie w/ high CHO & moderate/low fat

Protein restriction only w/ severe encephalopathy

Low sodium if FVE/ascites

Question 13

Bleed precautions to manage with varices (10)

Answer 13

Monitor platelets, PT, PTT

Assess oral cavity

Monitor for ecchymosis, purpura & petechiae

Protect from falls

No ASA, alcohol, spicy foods, bulky foods; no injections

Avoid vigorous nose-blowing, straining w/ BM’s

Stool softeners

Soft toothbrush; avoid rectal temps/enemas

Apply pressure to any bleeding x 5 mins

Patient teaching r/t above

Question 14

What procedure can be performed with an active varices bleed

Answer 14

Endoscopic Sclerotherapy & Variceal Banding

Question 15

What is the process with Endoscopic Sclerotherapy & Variceal Banding

Answer 15

Varices injected with a sclerosing agent via a catheter.

Varices may also be managed by endoscopic variceal ligation (banding):

Involves application of a small “O” bands around the base of the varices to decrease the blood supply to the varices.

Patient unaware of bands; cause no discomfort

Question 16

what is a balloon tamponade

Answer 16

used for active bleed in esophageal varices emergency by placing a tube with an attached balloon through the nasal passage and inflating the balloon against the varices placing pressure on the bleeding.

Question 17

Goal in managing hepatic encephalopathy

Answer 17

Reduce ammonia formation & maintain safe environment (ammonia is CNS depressant)

Question 18

End stage Hepatic encephalopathy nursing care

Answer 18

Restrict protein intake (20-40 g/daily); otherwise ↑ calorie (particularly carbohydrates)

Control GI bleeding
(another source of protein)

Avoid constipation 
(constipation ↑’s ammonia in feces)

Medications: Lactulose (“titrate to 2-4 stools/day”) & Neomycin

Assess EMV (Glasgow Coma Scale) regularly

Safety precautions

Patient & family teaching