Cirrhosis Flashcards
What is Cirrhosis?
Chronic, irreversible liver damage due to prolonged injury
How do you differentiate between compensated and decompensated cirrhosis?
- Compensated cirrhosis: can still perform its functions, and the patient has no signs of liver failure and often asymptomatic (continue to monitor)
- Decompensated cirrhosis: can no longer compensate for damage, leading to symptoms like ascites, jaundice, encephalopathy, or bleeding (may need transplant)
compensated = early, decompensated = late
What causes portal hypertension?
increased pressure in the portal vein due to liver scarring from cirrhosis, which obstructs blood flow
portal vein delivers blood to liver
What can portal hypertension lead to in cirrhosis?
- ascites (fluid buildup)
- capcut medusae (dilated veins)
- hepatic encephalopathy (toxin buildup)
- splenomegaly (enlarged spleen)
- varices (enlarged veins)
How is ascites managed?
- Diuretics (spironolactone, furosemide)
- Paracentesis (fluid removal)
How are esophageal varices managed?
- Balloon tamponade (stops bleeding using compression)
- Beta-blockers (propranolol, nadolol)
- Endoscopic banding/sclerotherapy (prevents bleeding)
When and why is balloon tamponade used in variceal bleeding?
emergency situations to compress and stop bleeding from ruptured esophageal varices
What is endoscopic banding, and how does it work for esophageal varices?
a rubber band is placed around the varices, cutting off blood flow to the varices (prevents further bleeding)
What are the clinical manifestations of ruptured esophageal varices?
- Hematochezia (bright red blood in stools)
- Melena (black, tarry stools)
- Tachycardia (increased heart rate)
- Hypotension (low blood pressure)
- Pale, cool, clammy skin
What are the priorities in managing ruptured esophageal varices?
- ensure airway
- high-fowler’s position
- oxygen therapy
- prepare for intubation
- monitor VS and bleeding
What is paracentesis?
fluid is removed from the peritoneal cavity using a needle or catheter
sterile technique
When is paracentesis indicated?
- Ascites (especially with cirrhosis)
- Fluid buildup
- Diagnostic purposes
What are the nursing considerations for paracentesis?
- Monitor vital signs for hypotension (fluid loss)
- Check for signs of infection (fever, redness, pain)
- Monitor for complications (bleeding and swelling)
- Educate patient
How does liver dysfunction affect clotting mechanisms?
- liver produces clotting factors
- when impaired, there aren’t enough clotting factors
- increased risk of bleeding
What are the symptoms of clotting abnormalities in liver disease?
- Easy bruising, petichiae
- Prolonged bleeding times
- Gum bleeding, nosebleeds
- Hemorrhagic complications (GI bleeding)
What are key lab findings in liver disease?
- Elevated liver enzymes (AST, ALT, ALP, GGT)
- Elevated bilirubin (can cause jaundice)
- Low albumin (due to reduced protein production)
in end stage: AST and ALT may be normal
What are the dietary guidelines for liver disease, specifically for ascites and hepatic encephalopathy?
- High calorie and carbohydrates
- Protein intake may be limited (1-1.2 g/kg/day) (reduce ammonia production for hepatic encephalopathy)
- Limit sodium to 2g/day (manage ascites and edema)
- Monitor fluids (restrict if ascites severe)
What are common findings in liver dysfunction?
- Jaundice (yellowing of skin/eyes)
- Ascites (abdominal swelling)
- Edema (swelling, especially in the legs)
- Bruising or petechiae (small red dots from clotting issues)
How do you assess jaundice in patients with darker skin tones?
- sclera
- mucous membranes
- palms of hands and soles of feet
