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Med-Surg II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Hepatic artery

A

Brings blood into the liver for filtration

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2
Q

Where does filtered blood go after liver

A

Returns to right heart through hepatic vein

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3
Q

Portal vein

A

Brings nutrient-rich blood from GI to liver

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4
Q

Hepatocytes

A

Liver cells that perform liver functions

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5
Q

Causes of impaired liver function

A

Cirrhosis
Portal hypertention
Hepatitis, liver infections
Wilson’s disease
Autoimmune disorders -
Liver cancer
Fatty liver disease (nonalcoholic fatty liver or nonalcoholic steatohepatitis)

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6
Q

Risk factors for liver disease

A

ETOH use
Multiple medication use
Foreign travel
Hepatitis risk

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7
Q

Liver function dx

A

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

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8
Q

Manifestations of liver dysfunction

A

Jaundice
Portal hypertension
Ascites
Hepatic encephalopathy
Nutritional deficits

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9
Q

What is produced from liver impairment

A

Ammonia

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10
Q

Complications of liver disorders

A

Portal hypertension
Esophageal varices
Fluid volume overload - ascites
Hepatic encephalopathy

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11
Q

Portal hypertension patho

A

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

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12
Q

What does an enlarged spleen (splenomegaly) causes

A

Decreased platelets and WBC’s

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13
Q

Impaired liver s/sx

A

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

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14
Q

How to dx ascites

A

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

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15
Q

What can ascites lead to

A

Hypokalemia
Dehydration
Spontaneous peritonitis

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16
Q

Management of ascities

A

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

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17
Q

Second line therapy for ascites/varices if diet/fluid modifications are ineffective

A

Bypass injured liver to decrease fluid retention
Improves fluid and sodium retention
Improves diuretic response

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18
Q

Ascites nursing management

A

Abd girth, daily wts
Monitor for fluid and electrolyte imbalances - respiratory complications
Sodium restriction - 2g/day
Diuretics - spironolactone
Bed rest, raise HOB
Surgery - shunt

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19
Q

Hepatic encephalopathy patho

A

Unable to detoxify ammonia and other toxins in the brain

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20
Q

Hepatic encephalopathy risk factors

A

Cerebral depressants (opioids)
Constipation
Dehydration
Hypokalemia
Infection
Paracentesis
TIPS

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21
Q

Hepatic encephalopathy s/sx

A

Altered MS d/t ammonia buildup
Early s/sx: mental changes, motor disturbances

22
Q

Causes of hepatic encephalopathy

A

Damages liver cells - unable to filter blood
Collateral circulation all unfiltered blood to return to circulation
Ammonia is the major cause of MS change

23
Q

Hepatic encephalopathy dx

A

Medical hx
S/sx
Ammonia level
Physical exam

24
Q

Hepatic encephalopathy s/sx

A

Confusion
Alteration in mood/sleep
Reversal of sleep/wake cycle
Seizures, coma
Asterixis: flapping hands
Loss of DTR - late stage

25
Q

Stage 1 hepatic encephalopathy

A

Normal LOC
Lethary, euphora
Reversal of day/night sleep pattern
Impaired writing
Normal EEG

26
Q

Stage 2 hepatic encephalopathy

A

Increased drowsiness, disorientation
Inappropriate behavior, mood swings, agitation
Asterixis
Fetor hepaticus
Abnormal EEG

27
Q

Stage 3 hepatic encephalopathy

A

Stupor, difficult to arouse
Excessive sleeping
Confusion
Incoherent speech
DTR

28
Q

Stage 4 hepatic encephalopathy

A

Comatose
May not respond to painful stimuli

29
Q

Hepatic encephalopathy tx

A

Lactulose - clear MS
Protein restriction
IV glucose
Remove sedatives

30
Q

Esophageal varices patho

A

Increase pressure in portal vein 
enlarging vessels in esophagus and
gastric veins and weakens = potential
rupture

31
Q

Esophageal varices complication

A

Medical emergency if rupture

32
Q

Manifestations of esophageal varices

A

Hematoemesis
Melena
General deterioration
Shock

33
Q

Esophageal varices tx of rupture

A

Shock - oxygen, secure airway
Vasopressin, octreotide to decrease bleeding
Nitroglycerin - reduce coronary vasoconstriction
Propranolol/nadolol - decrease portal pressure
Balloon tamponade - last resort

34
Q

Esophageal varices how to prevent rupture

A

Endoscopic sclerotherapy
Endoscopic variceal ligation (esophageal banding therapy)
Transjugular intrahepatic portosystemic shunt
Surgical - bypass, devascularization and transection

35
Q

THE LIVER IS SCARRED

A

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

36
Q

What level of bilirubin is jaundice

A

Over 2 mg/dL

37
Q

Types of jaundice

A

Hemolytic
Hepatocellular
Obstructive

38
Q

Why does edema occur with liver impairment

A

Decreased albumin production
Decreased oncotic pressure
- Monitor for skin breakdown

39
Q

Why does bleeding occur with liver impairment

A

Decreased synthesis of coagulation factors
- Increased risk for bleeding
- Avoid injury

40
Q

Complications of bleeding d/t liver impairment

A

Ruptured variceal bleed
Hemorrhagic stroke

41
Q

What causes excess fluid volume from liver impairement

A

Decreased albumin production leads to third spacing
RAAS activation from decreased intravascular volume causes increased sodium and water retention

42
Q

Excess fluid volume d/t liver impairment complications

A

Ascites leads to decreased ventilation
Fluid overload into pulmonary and venous system
Weeping and skin breakdown

43
Q

What causes activity intolerance/fatigue in liver impairment

A

Vitamin deficiency
Chronic illness
Decreased appetite

44
Q

Diet for liver impairment

A

High calorie, sodium restriction
Small, frequent meals
Supplement vitamins, minerals, B complex, water soluble forms of fat-soluble vitamins

45
Q

Liver cancer manifestations

A

Dull persistent pain, RUQ, back, or epigastrium
Weight loss, anemia, anorexia, weakness
Jaundice, bile ducts occluded, ascites, or obstructed portal veins

46
Q

Surgical tx for liver cancer

A

Surgical removal for hepatocellular carcinoma (HCC)

47
Q

Types of surgery for liver cancer

A

Lobectomy
Cryosurgery - ablation of liver tissues
Liver transplant

48
Q

Liver biopsy

A

Needle biopsy to sample tumor tissue
Some sedation, remain NPO

49
Q

Liver biopsy post op considerations

A

Vitamin K - control bleeding
Right side for 1-2 hours, elevate HOB
Bedrest for 24h
Report new onset of severe pain

50
Q
A

Med-Surg II (4 decks)

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