Exam 3 Flashcards
Hepatic artery
Brings blood into the liver for filtration
Where does filtered blood go after liver
Returns to right heart through hepatic vein
Portal vein
Brings nutrient-rich blood from GI to liver
Hepatocytes
Liver cells that perform liver functions
Causes of impaired liver function
Cirrhosis
Portal hypertention
Hepatitis, liver infections
Wilson’s disease
Autoimmune disorders -
Liver cancer
Fatty liver disease (nonalcoholic fatty liver or nonalcoholic steatohepatitis)
Risk factors for liver disease
ETOH use
Multiple medication use
Foreign travel
Hepatitis risk
Liver function dx
Abdominal xray - liver enlargement
Cholangiogram - picture of bile ducts
Liver scan - IV contrast detects liver cycts/masses
Liver biopsy - evaluates damage and extent of liver cancer
Manifestations of liver dysfunction
Jaundice
Portal hypertension
Ascites
Hepatic encephalopathy
Nutritional deficits
What is produced from liver impairment
Ammonia
Complications of liver disorders
Portal hypertension
Esophageal varices
Fluid volume overload - ascites
Hepatic encephalopathy
Portal hypertension patho
Portal vein narrows d/t scar tissue
Restricts blood flow to liver
What does an enlarged spleen (splenomegaly) causes
Decreased platelets and WBC’s
Impaired liver s/sx
Fatigue
Increased peripheral venous pressure
Ascites
Enlarged liver and spleen
JVD
Anorexia, GI distress
Weight gain, dependent edema
How to dx ascites
Fluid wave test
Shifting dullness in abdomen
Striae or blood vessel engorgement in abdomen
What can ascites lead to
Hypokalemia
Dehydration
Spontaneous peritonitis
Management of ascities
Low sodium diet
Diuretics
Bed rest
Paracentesis - remove fluid
TIPS (transjugular intrahepatic portosystemic shunt) or peritoneovenous shunt (PVS)
Second line therapy for ascites/varices if diet/fluid modifications are ineffective
Bypass injured liver to decrease fluid retention
Improves fluid and sodium retention
Improves diuretic response
Ascites nursing management
Abd girth, daily wts
Monitor for fluid and electrolyte imbalances - respiratory complications
Sodium restriction - 2g/day
Diuretics - spironolactone
Bed rest, raise HOB
Surgery - shunt
Hepatic encephalopathy patho
Unable to detoxify ammonia and other toxins in the brain
Hepatic encephalopathy risk factors
Cerebral depressants (opioids)
Constipation
Dehydration
Hypokalemia
Infection
Paracentesis
TIPS
Hepatic encephalopathy s/sx
Altered MS d/t ammonia buildup
Early s/sx: mental changes, motor disturbances
Causes of hepatic encephalopathy
Damages liver cells - unable to filter blood
Collateral circulation all unfiltered blood to return to circulation
Ammonia is the major cause of MS change
Hepatic encephalopathy dx
Medical hx
S/sx
Ammonia level
Physical exam
Hepatic encephalopathy s/sx
Confusion
Alteration in mood/sleep
Reversal of sleep/wake cycle
Seizures, coma
Asterixis: flapping hands
Loss of DTR - late stage
Stage 1 hepatic encephalopathy
Normal LOC
Lethary, euphora
Reversal of day/night sleep pattern
Impaired writing
Normal EEG
Stage 2 hepatic encephalopathy
Increased drowsiness, disorientation
Inappropriate behavior, mood swings, agitation
Asterixis
Fetor hepaticus
Abnormal EEG
Stage 3 hepatic encephalopathy
Stupor, difficult to arouse
Excessive sleeping
Confusion
Incoherent speech
DTR
Stage 4 hepatic encephalopathy
Comatose
May not respond to painful stimuli
Hepatic encephalopathy tx
Lactulose - clear MS
Protein restriction
IV glucose
Remove sedatives
Esophageal varices patho
Increase pressure in portal vein
enlarging vessels in esophagus and
gastric veins and weakens = potential
rupture
Esophageal varices complication
Medical emergency if rupture
Manifestations of esophageal varices
Hematoemesis
Melena
General deterioration
Shock
Esophageal varices tx of rupture
Shock - oxygen, secure airway
Vasopressin, octreotide to decrease bleeding
Nitroglycerin - reduce coronary vasoconstriction
Propranolol/nadolol - decrease portal pressure
Balloon tamponade - last resort
Esophageal varices how to prevent rupture
Endoscopic sclerotherapy
Endoscopic variceal ligation (esophageal banding therapy)
Transjugular intrahepatic portosystemic shunt
Surgical - bypass, devascularization and transection
THE LIVER IS SCARRED
T - tremors
H - hepatic foetor (musty breath)
E - eye and skin yellowing
(jaundice)
L- loss of appetite
I- increased bilirubin and ammonia
V- varices
E- edema
R- reduced platelets and WBCs
I- itchy skin
S- spider angiomas
S- splenomegaly
C- confusion
A- ascites
R- redness on palms
R- renal failure
E- enlarged breast in men
D- deficient in vitamin B12, A, C, D,
E, K
What level of bilirubin is jaundice
Over 2 mg/dL
Types of jaundice
Hemolytic
Hepatocellular
Obstructive
Why does edema occur with liver impairment
Decreased albumin production
Decreased oncotic pressure
- Monitor for skin breakdown
Why does bleeding occur with liver impairment
Decreased synthesis of coagulation factors
- Increased risk for bleeding
- Avoid injury
Complications of bleeding d/t liver impairment
Ruptured variceal bleed
Hemorrhagic stroke
What causes excess fluid volume from liver impairement
Decreased albumin production leads to third spacing
RAAS activation from decreased intravascular volume causes increased sodium and water retention
Excess fluid volume d/t liver impairment complications
Ascites leads to decreased ventilation
Fluid overload into pulmonary and venous system
Weeping and skin breakdown
What causes activity intolerance/fatigue in liver impairment
Vitamin deficiency
Chronic illness
Decreased appetite
Diet for liver impairment
High calorie, sodium restriction
Small, frequent meals
Supplement vitamins, minerals, B complex, water soluble forms of fat-soluble vitamins
Liver cancer manifestations
Dull persistent pain, RUQ, back, or epigastrium
Weight loss, anemia, anorexia, weakness
Jaundice, bile ducts occluded, ascites, or obstructed portal veins
Surgical tx for liver cancer
Surgical removal for hepatocellular carcinoma (HCC)
Types of surgery for liver cancer
Lobectomy
Cryosurgery - ablation of liver tissues
Liver transplant
Liver biopsy
Needle biopsy to sample tumor tissue
Some sedation, remain NPO
Liver biopsy post op considerations
Vitamin K - control bleeding
Right side for 1-2 hours, elevate HOB
Bedrest for 24h
Report new onset of severe pain
