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Complex care > Cirrhosis of the liver (Study Guide) > Flashcards

Cirrhosis of the liver (Study Guide) Flashcards

1
Q

normal liver function

A

carb, fat, protein metabolism, immune system function, detoxifies, steroid metabolism, bile synthesis, storage of glucose, vit., amino acids

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2
Q

patho of cirrhosis

A
  • liver attempt’s to regenerate
  • abnormal blood vessels/bile duct architecture
  • overgrowth of fibrous connective tissue distorts lobular of structure of the liver
  • irregular/disorganized/poor nutrition/hypoxia = decreased liver function.
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3
Q

what actually happens to the liver’s structure and during cirrhosis?

A

scarring and fibrosis due to the chronic progressive disease of the liver due to extensive degeneration and destruction of liver cells

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4
Q

how does cirrhosis affect neuro

A

HE, peripheral neuropathy

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5
Q

how does cirrhosis affect GI

A

anorexia, dyspepsia, and slash V, change in bowel habits, abdominal pain, esophageal varices, gastritis, hemorrhoids

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6
Q

how does cirrhosis affect repro

A

amenorrhea, testicular atrophy, gynecomastia

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7
Q

how does cirrhosis affect Integ

A

jaundice, spider angioma, purpura, petechiae

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8
Q

how does cirrhosis affect hem

A

anemia, thrombocytopenia, leukopenia, coagulation disorders, splenomegaly

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9
Q

how does cirrhosis affect metabolic

A

hypokalemia, hyponatremia, hypoalbuminemia

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10
Q

how does cirrhosis affect CV

A

fluid retention, peripheral edema, ascites

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11
Q

what are the early signs of cirrhosis

A

your liver cannot metabolize carbs, fats, proteins so you have GI disturbances, enlarged liver or spleen, fatigue

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12
Q

what are late signs of cirrhosis

A

Hepatocellular failure with portal hypertension, jaundice from the decreased ability to excrete bilirubin, edema, ascites

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13
Q

what causes jaundice in cirrhosis

A

the decreased ability to excrete bilirubin

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14
Q

comp of cirrhosis

A

portal hypotension
esophageal varices
peripheral edema and ascites
hepatic encephalopathy

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15
Q

portal hypotension and varices

A
  • come from increased venous pressure in the portal vein –> collateral circulation to develop in the lower esophagus and anterior abd. (varices) –> they are enlarged and swollen and they dont handle pressure well so they can rupture and bleed easily
  • if ruptures = most life threatening complication
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16
Q

care for portal hypotension and varices

A
  • meds to decrease BP (beta blocker, sandostatin or vasopressin
  • sclerotherapy or band litigation ( band around varices so when they rupture it doesnt cause a huge problem)
  • balloon tamponade
  • transjugular intrahepatic portosystemic shunt (TIPS) which re routes the blood flow but could have HE as post op comp
  • Teach them to: avoid ETOH, aspirin, NSAIDS
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17
Q

Balloon tamponade

A
  • needs to be NPO when inflated

- temporary stabilization if bleed has happened

18
Q

peripheral edema

A

-Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen. Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites).

19
Q

ascites

A
  • accumulation of serous fluid in the peritoneal cavity (abdomen)
    • increased proteins to lymph due to portal hypertension which pulls fluid into cavity
    • hypoalbuminemia
    • hypoaldosteronism - increases water retention
  • at risk for bacterial peritonitis
20
Q

care for edema and Ascites

A
  • sodium restriction (2g/day)
  • diuretics (watch INO)
    - sprinolactone: K+ sparing and antagonist to aldosterone
    - lasix
    - tolvaptan for hyponatremia that will increase H20 excretion and increase Na+
  • paracentesis: for pain and difficulty breathing
  • TIPS
  • Monitor for signs of infection and peritonitis (fever, pain, altered mental status)
  • IV albumin to maintain intravascular volume and increase plasma colloid osmotic pressure
21
Q

Hepatic encephalopathy

A
  • increase in ammonia due to bacterial and enzymatic deamination
  • ammonia is not converted to urea
  • signs: changes in mental status
22
Q

GI hemorrhage leading to HE

A

Increase in ammonia in GI tract

23
Q

things that can lead to HE

A
  1. GI hemorrhage
  2. constipation
  3. hypokalemia
  4. Hypovolemia
  5. infection
  6. cerebral depressants
  7. metabolic alkalosis
  8. paracentesis
  9. dehydration
  10. increased metabolism
  11. uremia (renal failure)
24
Q

constipation

A

Increase in ammonia from bacterial action on feces

25
Q

HYPOKALEMIA

A

-Potassium is needed by brain to metabolize ammonia

26
Q

hypovolemia

A

Increase in blood ammonia because of hepatic hypoxia. Impairment of cerebral hepatic, and renal function because of decreased blood flow

27
Q

infection

A

Increase in catabolism and increase in cerebral sensitivity to toxins

28
Q

cerebral depressants (opioids)

A

Decrease in metabolism by liver, causing higher drug levels and cerebral depression

29
Q

metabolic alkalosis

A

Facilitation of transport of ammonia across blood brain barrier. Increase in renal production of ammonia

30
Q

paracentesis

A

Loss of sodium and potassium ions. Decrease in blood volume

31
Q

dehydration

A

Potentiates of ammonia toxicity

32
Q

increased metabolism

A

Increase in workload of the liver

33
Q

uremia

A

Retention of nitrogenous metabolites

34
Q

Care for HE

A
  • reduce ammonia using lactulose or rifaximin (usually both given together)
  • avoid constipation so the ammonia levels dont build up
35
Q

how does lactulose reduce ammonia

A

-it traps the ammonia in the gut then helps expel it in the stool

36
Q

how does rifaximin reduce ammonia

A

antibiotic

37
Q

DX of cirrhosis

A
  • increased AST and ALT
  • increased GGT
  • increased ammonia
  • prolonged PT, PTT (have clotting issues)
  • liver ultrasound: not reliable may be good for initial evaluation
  • endoscopy to look for varices
  • liver biopsy definitive
38
Q

overall goals of care for cirrhosis

A
  • no cure

- slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis

39
Q

What are the potential treatments for bleeding esophageal varices

A

balloon tamponode, band litigation, sclerotherapy, TIPS

40
Q

nursing priorities for cirrhosis

A
  • nutrition
  • atarax to relieve jaundice and pruritus
  • daily weight and measure girth of abd
  • monitor labs for hypokalemia and hyponatrmia
41
Q

conservative therapy for cirrhosis

A
  • rest
  • admin of vit b
  • avoid alcohol
  • minimize or avoid aspirin, acetaminophen, and NSAIDS
42
Q

diet for cirrhosis

A

low sodium and fat, restrict protein maybe (rare), high calories, decrease alcohol

Complex care (9 decks)

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