Exam 3 Liver

Question 1

CIRRHOSIS

Answer 1

Chronic, progressive disease characterized by widespread breakdown and destruction of liver parenchymal cells. Structure and function of liver is disrupted. Excessive alcohol ingestion is single most common cause of cirrhosis.

Four types:

• Alcoholic Cirrhosis (Portal cirrhosis)
• Postnecrotic Cirrhosis
• Biliary Cirrhosis
• Cardiac Cirrhosis

Question 2

CIRRHOSIS

DIAGNOSIS

Answer 2

• Labwork: Increased LFT’s, ↓ albumin, ↑ serumglobulin levels, ↑ bilirubin levels. PT/INR is prolonged (increased bleeding risk).
• Arterial blood gases may reveal hypoxia.
• what to look for in a patient with liver failure: (loss of clotting factors so risk of bleeding), (loss of albumin so third space fluid shift).

Question 3

CIRRHOSIS

SIGNS & SYMPTOMS

Answer 3

What does the patient with cirrhosis looks like-striae, engorged abdominal veins, large fluid shift in abdomen with thin extremities. this may cause SOB

• Paracentesis (the perforation of a cavity of the body or of a cyst or similar outgrowth, especially with a hollow needle to remove fluid or gas) may be needed.
• Remember you don’t want to pull off too much fluid in the paracentesis at one time or you have rebound hypotension.

Question 4

HEPATIC ENCEPHALOPATHY

Answer 4

An altered level of conscious or loss of brain function when a damaged liver doesn’t remove toxins from the blood.

Treatment: Lactulose is given 3-4 times a day which will cause lots of stools, but will bind the ammonia and clear the patient’s mental status.

Question 5

ESOPHAGEAL VARICES

Answer 5

• A complex of enlarged and swollen veins at the end of the esophagus, as a result of portal hypertension.

Question 6

ESOPHAGEAL VARICES

FOODS TO AVOID

Answer 6

alcohol ingestion, swallowing of poorly chewed food, ingestion of coarse food, acid regurgitation from the stomach

Question 7

ESOPHAGEAL VARICES

TREATMENT FOR BLEEDING

Answer 7

• Fresh frozen plasma, packed RBC’s or Vitamin K
• Remember the balloon we place against the varices to tamponad the bleeding.
• Monitor the Hgb and Hct in a patient with a bleed
• check the PT/INR before we do any invasive procedure as they will bleed if the INR is greater than 1.7
• We test for LFTs when we are worried about liver function.
• Vasopressin (VP) and Nitroglycerin (NTG)- lowers Hepatic venous pressure: reduce coronary vasoconstriction
• Beta blockers- ↓ risk of bleeding: Propranolol and Nadolol
• Histamine 2 blockers (Tagamet, Pepcid)
• Balloon tamponade. Sclerotherapy, Ligation of varices
• TIPS therapy- Transjugular intrahepatic portsystemic shunt