Cirrhosis of the liver (Study Guide) Flashcards
normal liver function
carb, fat, protein metabolism, immune system function, detoxifies, steroid metabolism, bile synthesis, storage of glucose, vit., amino acids
patho of cirrhosis
- 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.
what actually happens to the liver’s structure and during cirrhosis?
scarring and fibrosis due to the chronic progressive disease of the liver due to extensive degeneration and destruction of liver cells
how does cirrhosis affect neuro
HE, peripheral neuropathy
how does cirrhosis affect GI
anorexia, dyspepsia, and slash V, change in bowel habits, abdominal pain, esophageal varices, gastritis, hemorrhoids
how does cirrhosis affect repro
amenorrhea, testicular atrophy, gynecomastia
how does cirrhosis affect Integ
jaundice, spider angioma, purpura, petechiae
how does cirrhosis affect hem
anemia, thrombocytopenia, leukopenia, coagulation disorders, splenomegaly
how does cirrhosis affect metabolic
hypokalemia, hyponatremia, hypoalbuminemia
how does cirrhosis affect CV
fluid retention, peripheral edema, ascites
what are the early signs of cirrhosis
your liver cannot metabolize carbs, fats, proteins so you have GI disturbances, enlarged liver or spleen, fatigue
what are late signs of cirrhosis
Hepatocellular failure with portal hypertension, jaundice from the decreased ability to excrete bilirubin, edema, ascites
what causes jaundice in cirrhosis
the decreased ability to excrete bilirubin
comp of cirrhosis
portal hypotension
esophageal varices
peripheral edema and ascites
hepatic encephalopathy
portal hypotension and varices
- 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
care for portal hypotension and varices
- 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
Balloon tamponade
- needs to be NPO when inflated
- temporary stabilization if bleed has happened
peripheral edema
-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).
ascites
- 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
care for edema and Ascites
- 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
Hepatic encephalopathy
- increase in ammonia due to bacterial and enzymatic deamination
- ammonia is not converted to urea
- signs: changes in mental status
GI hemorrhage leading to HE
Increase in ammonia in GI tract
things that can lead to HE
- GI hemorrhage
- constipation
- hypokalemia
- Hypovolemia
- infection
- cerebral depressants
- metabolic alkalosis
- paracentesis
- dehydration
- increased metabolism
- uremia (renal failure)
constipation
Increase in ammonia from bacterial action on feces
HYPOKALEMIA
-Potassium is needed by brain to metabolize ammonia
hypovolemia
Increase in blood ammonia because of hepatic hypoxia. Impairment of cerebral hepatic, and renal function because of decreased blood flow
infection
Increase in catabolism and increase in cerebral sensitivity to toxins
cerebral depressants (opioids)
Decrease in metabolism by liver, causing higher drug levels and cerebral depression
metabolic alkalosis
Facilitation of transport of ammonia across blood brain barrier. Increase in renal production of ammonia
paracentesis
Loss of sodium and potassium ions. Decrease in blood volume
dehydration
Potentiates of ammonia toxicity
increased metabolism
Increase in workload of the liver
uremia
Retention of nitrogenous metabolites
Care for HE
- reduce ammonia using lactulose or rifaximin (usually both given together)
- avoid constipation so the ammonia levels dont build up
how does lactulose reduce ammonia
-it traps the ammonia in the gut then helps expel it in the stool
how does rifaximin reduce ammonia
antibiotic
DX of cirrhosis
- 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
overall goals of care for cirrhosis
- no cure
- slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis
What are the potential treatments for bleeding esophageal varices
balloon tamponode, band litigation, sclerotherapy, TIPS
nursing priorities for cirrhosis
- nutrition
- atarax to relieve jaundice and pruritus
- daily weight and measure girth of abd
- monitor labs for hypokalemia and hyponatrmia
conservative therapy for cirrhosis
- rest
- admin of vit b
- avoid alcohol
- minimize or avoid aspirin, acetaminophen, and NSAIDS
diet for cirrhosis
low sodium and fat, restrict protein maybe (rare), high calories, decrease alcohol
