Cirrhosis Flashcards
What is Laennec’s (Alcoholic) portal cirrhosis?
Scar tissue out #’s normal cells and the liver is unfunctional; results of alcohol or nutritional probs
Postnecrotic cirrhosis is what?
Complication of hepatitis/hepatoxins
What is biliary cirrhosis?
Chronic biliary obstruction/infection and scarring from diseases of the bile duct
What is cardiac cirrhosis?
From long standing right CHF
What is the primary risk factor for cirrhosis?
Alcohol consumption
What are other risk factors?
Malnutrition: low protein intake, high phosphate intake; occupation exposure; men between ages 40-60
What are the early clinical manifestations of?
Liver enlargement/fatty liver, vascular changes, abnormal labs: Tiny increases in ALT/AST/LDH/PT and decreased albumin
How do you get rid of a enlarged/fatty liver?
Quit drinking, exercise and maintain a healthy diet
What are the advanced stages severe complications?
Ascities, GI varices, encephalopathy and portal HTN
Where are the 3 main places ascities can accumulate?
Esophagus, rectum and stomach
What is encephalopathy caused by? And some s/s?
Ammonia; Confusion, mental deterioration, somnalence
What is portal HTN?
Increase pressure of blood flow around the liver
What of the liver cannot be reversed?
Fibrosis (thickening/scarring of CT)
What anti-inflammatory is often used for the pharmacological management of cirrhosis?
Colchicine
What potassium sparing diuretic is used for the pharmacological management of cirrhosis?
Aldactone
What meds can cause liver damage?
Barbiturates, tylenol and sedatives
What other meds can be used for the pharmacological management of cirrhosis?
Vit. K, antacids and H2 receptor blockers
What is the nutritional therapy for cirrhosis?
Protein, high calories, moderate fat, decrease sodium, limit fluids and vit/mineral supplements
How much salt can a person w/ cirrhosis intake?
2g/day
What vitamin/mineral supplements can be used for nutritional therapy?
B complex, fat soluble vitamins and Mg
What other supportive therapy is used in the treatment for cirrhosis?
Rest: semi-fowlers position, O2 therapy and actions to prevent immobility
What’s the major risk factor of portal HTN?
Hemorrhage
What is the non-surgical managements of portal HTN?
Endoscopic screening, non-selective beta blockers
If a pt is a high risk for bleeding what non-selective beta blocker is used?
Propanolol Hydrochloride (Inderal)
What other common non-selective beta blocker is used to treat portal HTN?
Nadolol (Cogard)
What is ascities?
Accumulation of fluid in the peritoneal cavity
What surgical procedure can be used for portal HTN?
Transjugular intrahepatic portosystemic shunt (TIPS)
What is TIPS?
Stent placed b/t hepatic and portal vein to decrease pressure and prolong life
Frequent complication of portal HTN, fluid leaks from GI organs, fluid leaks from vascular system and sodium and water retention are all causes of what?
Ascities
What are the dietary modifications to manage ascities?
Low sodium diet and the use of salt substitutes w/o ammonia
What diuretics are used to manage ascities?
Spirnalactone (Aldactone)
What nursing care is done to measure salt-poor albumin?
Daily weights, monitor F/E, I/O, measuring abd girths
What surgical procedure can be performed to manage ascities?
LaVeen shunt
What is a LaVeen Shunt?
A tube inserted from the liver to the heart to help blood flow when you breathe
What are complications of a LaVeen Shunt?
CHF, infection, repeated clotting
What should be monitored in a pt w/ ascities?
H/H and coagulation studies
What is the most advanced stage of hepatic encephalopathy?
Hepatic coma
What is the management for heaptic encephalopathy?
Remove offending agent, reduce/restrict protein intake, reduce intestinal bacteria, and reduce serum ammonia levels
What is admin. to reduce intestinal bacteria in hepatic encephalopathy?
Flagyl, enemas, neomycin, sulfasuxidine, sulfathaladine
What is admin. to reduce ammonia levels?
Lactulose: flushes out ammonia through diarrhea
What are the side effects of Lactulose?
Intestinal bloating and cramping
What should you dilute lactulose w/ if given PO?
Fruit juice
What are varices?
Enlarged, thin-walled veins that form and may rupture or cause massive hemorrhage
