Exam 3 Flashcards by Morgan Sowder

Hepatic artery

Brings blood into the liver for filtration

How well did you know this?

Not at all

Perfectly

Where does filtered blood go after liver

Returns to right heart through hepatic vein

How well did you know this?

Not at all

Perfectly

Portal vein

Brings nutrient-rich blood from GI to liver

How well did you know this?

Not at all

Perfectly

Hepatocytes

Liver cells that perform liver functions

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

Risk factors for liver disease

ETOH use
Multiple medication use
Foreign travel
Hepatitis risk

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Manifestations of liver dysfunction

Jaundice
Portal hypertension
Ascites
Hepatic encephalopathy
Nutritional deficits

How well did you know this?

Not at all

Perfectly

What is produced from liver impairment

Ammonia

How well did you know this?

Not at all

Perfectly

Complications of liver disorders

Portal hypertension
Esophageal varices
Fluid volume overload - ascites
Hepatic encephalopathy

How well did you know this?

Not at all

Perfectly

Portal hypertension patho

Portal vein narrows d/t scar tissue
Restricts blood flow to liver

How well did you know this?

Not at all

Perfectly

What does an enlarged spleen (splenomegaly) causes

Decreased platelets and WBC’s

How well did you know this?

Not at all

Perfectly

Impaired liver s/sx

Fatigue
Increased peripheral venous pressure
Ascites
Enlarged liver and spleen
JVD
Anorexia, GI distress
Weight gain, dependent edema

How well did you know this?

Not at all

Perfectly

How to dx ascites

Fluid wave test
Shifting dullness in abdomen
Striae or blood vessel engorgement in abdomen

How well did you know this?

Not at all

Perfectly

What can ascites lead to

Hypokalemia
Dehydration
Spontaneous peritonitis

How well did you know this?

Not at all

Perfectly

Management of ascities

Low sodium diet
Diuretics
Bed rest
Paracentesis - remove fluid
TIPS (transjugular intrahepatic portosystemic shunt) or peritoneovenous shunt (PVS)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Hepatic encephalopathy patho

Unable to detoxify ammonia and other toxins in the brain

How well did you know this?

Not at all

Perfectly

Hepatic encephalopathy risk factors

Cerebral depressants (opioids)
Constipation
Dehydration
Hypokalemia
Infection
Paracentesis
TIPS

How well did you know this?

Not at all

Perfectly

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