GI 3 - LIVER & SPLEEN

Question 1

What is the most common complication of liver cirrhosis?

Answer 1

Anemia

Question 2

What are 4 reasons cirrhosis and anemia are linked?

Answer 2

1. Liver disease impairs Hgb recycling (Decrease Hgb synthesis)
2. EtOH can cause B12/Folic acid deficiency (Pernicious anemia)
3. Some treatments for hepatitis cause aplastic anemia
4. Acute/chronic blood loss are common complications of liver disease

Question 3

What are 2 reasons splenic disease and anemia are linked?

Answer 3

1. When spleen enlarged, sequesters more RBCs and reduces amount in circulation
2. Splenic rupture causes hemorrhage

Question 4

What are 4 steps to nursing management of anemia?

Answer 4

1. Identify the cause and symptoms
2. Manage symptoms
3. Treat the underying cause
4. Provide teaching

Question 5

What is commonly the first sign of acute liver failure?

Answer 5

Encephalopathy

Question 6

In the majority of cases, what is the etiology of hepatocellular carcinoma?

Answer 6

Cirrhosis

Question 7

What is the term for a procedure used to treat liver cancer that involves needle insertion into the tumour and using an electrical current to burn tumour cells?

Answer 7

Radiofrequency ablation (RFA)

Question 8

What is the term for an interventional radiology procedure used to treat liver cancer that involves catheter insertion into arteries supplying the tumour, and an embolic agent with chemotherapeutic agents being injected?

Answer 8

Chemoembolization/Tranarterial chemoembolization (TACE)

Question 9

What is the different between splenomegaly and hypersplenism?

Answer 9

Splenomegaly: just enlargement of the spleen
Hypersplenism: splenomegaly with peripheral cytopenia

Question 10

What are 3 etiologies for splenomegaly?

Answer 10

1. Infections, inflammations
2. Infiltrative diseases, tumours, cysts
3. Congestion

Question 11

Why may splenomegaly affect breathing?

Answer 11

Spleen location relative to diaphragm

Question 12

What are 3 potential causes for splenic rupture?

Answer 12

1. Trauma
2. Surgical complication
3. Disease process

Question 13

What are 2 complications specific to hepatectomy?

Answer 13

1. Increased risk for bleeding (decreased clotting factors)
2. Increased risk for fluid shifting (decreased plasma proteins)
3. Bile leak

Question 14

What are 4 contraindices for liver transplant?

Answer 14

1. Severe extrahepatic disease
2. Advanced hepatocellular carcinoma
3. Ongoing drug/alcohol use
4. Unwilling to comply with post transplant regimen

Question 15

What treatment is required after transplant to prevent organ rejection?

Answer 15

Lifelong course of antirejection meds, most commonly tacrolimus

Question 16

What is the term for a shunt between the systemic and portal venous systems to redirect portal blood flow under radiological guidance?

Answer 16

TIPS (transjugular intrahepatic portosystemic shunt)

Question 17

What is the route the catheter takes in a TIPS procedure?

Answer 17

Jugular > hepatic vein > punctured > portal vein

Question 18

What is placed into the TIPS passageway to allow blood to flow through?

Answer 18

Stent insertion

Question 19

What are 2 complications of the TIPS procedure?

Answer 19

1. Hepatic encephalopathy
2. Stent stenosis