Hepatic Flashcards
Cholelithiasis: definition
presence of gallstones in the CBD
Cholelithiasis: Types
- cholestorl: made of undissolved cholesterol and other parts
- pigment: dark brown/black caused by too much bilirubin in bile
Cholelithiasis: Mild clinical manifestations
- sometimes asymptomatic
- feeling of fullness
- abd. distention
- no guarding/ rebound/ fever
- vague RUQ pain; not localized
- pain after fatty meal
Cholelithiasis: Acute biliary colic clinical manifestations
- N/V with heavy meal
- localized pain in RUQ
- guarding/rebounding/ fever
- severe right side abd pain and, radiates to back and right shoulder
- tachycardia/ diaphoresis
- no/hypoactive BS if severe
Cholelithiasis: mild
not completely obstructed, but full contraction is not permitted
Cholelithiasis:: acute biliary colic
complete obstruction of biliary flow
Cholangitis: definition
infection of the biliary duct
Cholangitis: acute
responds to antibiotic treatment
Cholangitis: toxic
may not respond too antibiotics and may require emergency drainage
Cholangitis: open cholecystectomy: definition
removal of the gallbladder
-emptying fo bile into the duodenum directly from liver
Cholangitis: open cholecystectomy: indications
- severe inflammation, infection, necrosis of gallbladder
- blood disorders
- scar tissue from previous surgery
Cholangitis: open cholecystectomy: procedure
- 1-2 hours
- 2-4 days recovery in hospital
Cholangitis: open cholecystectomy: complications
- surgical site pain
- gas, bloating, constipation
- referred shoulder pain
- bile leakage: occur 1-2 after procedure: anorexia, abd pain, N/V, fever
Sphincter of Oddi
- controls flow of pancreatic juices and bile
- morphine causes it to have spasms, should be used in acute pancreatitis of CBD
- meperidine drug of choice
Acute pancreatitis: definition
-inflammation of the pancreas
Acute pancreatitis: clinical manifestations
- severe abd. pain
- back pain
- tenderness
- N/V
- onset of symptoms 24-48 after heavy meal or ETOH
- grey turner’s sign: bleeding in peritoneal cavity
- cullen’s sign: edema around umbilicus
Acute pancreatitis: treatment
- supportive care
- prevent complications
- monitor for sepsis and organ failure
- surgery too risky
- might use gastric decompression
Acute pancreatitis: nursing care
- medications: IV opioids: meperidine
- nonpharmacologic care
- emotional status
- drugs first
Chronic Pancreatitis: definition
- inflammatory disease that is progressive destruction of pancreas
- healthy tissue is replaced by scarred tissue causing pressure in the pancreas to increase
- often seen in ETOH abuse
Chronic Pancreatitis: Clinical manifestations
- recurrent severe abd. and back pain
- vomiting
- weight loss
- steatorrhea
Chronic Pancreatitis: treatment
- pain management with opioids
- avoid ETOH
- surgery if indicated is risky
Liver Age related changes
- reduced drug metabolism along with other age related factors, cause normal drug dosage to be come toxic and require lower dosing
- increased presence of gallstones and decreased gallbladder contract lead to decreased tolerance for fatty food
Hepatic Dysfunction: definition
-damage to hepatocytes decrease ability to respond to injury with healthy tissue
Hepatic Dysfunction: types
- acute
- chronic
- compensated
- decompensated
Hepatic Dysfunction: causes
- cirrhosis: scarring of tissue
- hepatitis: inflammation related to viral hepatiits
- exposure to toxin: environmental, meds, ETOH
- metabolic disorder
- indirectly from CBD obstruction: PHTN
Hepatic Dysfunction: compensated/early clinical manifestations
- mild insufficient clotting: spider angiomas, palmar erythema, unexplained epistaxis (nose bleed)
- visible ascites
- enlarged liver/ abd. pain, edema
- dyspepsia: decreased ability to digest fat
- vitamin deficit/ malnutrition
- portal HTN: splenomegaly
Hepatic Dysfunction: late/decompensated clinical manifestations
- Jaundice
- esophageal varices
- ascites
- splenomegaly
- changes in responsiveness/ hepatic encephalopathy
- spider angiomas
- anemia: coagulation disorders
- palmar erythema
Hepatic Cirrhosis: definition
- chronic and progressive scarification of the lung
- this shrinks lung size and decreases lug functioning
Hepatic Cirrhosis: types
- alcoholic: scarring around portal areas
- post-necrotic: scarring after viral hepatitis
- biliary: scarring after CBD obstruction or cholelangitis
liver function test
- AST/ALT: increase with abnormal liver function
- GGT: increase with ETOH liver disease
- Serum bilirubin/urobilnogen or fecal/urine urobilnogen: associated with jaundice
- Alk phos. measure biliary obstruction
- PT: increase with time to clot
- ammonia
- serum albumin and protein
Major complication of liver disease
- jaundice
- Portal HTN
- hepatic encephalopathy
- ascites
- esophageal varices
Hepatic Encephalopathy: definition
life threatening consequence of advanced liver disease
-liver’s decreased ability to detoxify by products of metabolism like ammonia cause ammonia build up. Ammonia gets pushed out into blood circulation
Hepatic Encephalopathy: early/compensated clinical manifestations
- mild mental status changes: slight confusion, sleeping patterns, restless
- spider angiomas
- motor disturbances: asterixis, deep tendon reflex, difficulty writing,
- hepaticas: sweet breath
Hepatic Encephalopathy: end/ decompensated clinical manifestations
- severe failure to make protein, clotting factors, and increase portal hypotension
- insuffienct clotting factors: purpura, bruising, epistaxis, anemia
- malnutrition: muscle wasting, sparse body hair, wight loss
- Portal HTN: splenomegaly, esophageal varies
- ascites
- grey stool
- mental deterioration
- dyspepsia: decreased ability to digest fatty food
Hepatic Encephalopathy: progressive worsening
Mental status: sleepier, somnolent, coma
-motor: flaccid extremities, no deep tendon reflex
Hepatic Encephalopathy: treatment
- lactulose (chronulac): decrease pH of bowel and ammonia production to increase BM.
- Neomycin: inhibit protein synthesis in bowl and decrease ammonia production
- avoid: narcotics, sedatives, barbiturates
- protein restriction and nutritional support
- prevent complications of immobility
- symptom management
- promote rest: decreased demon and give liver more blood
- No ETOH or raw shellfish: Hep A risk
- early detection of bleeding: prevent hemorrhage
- skin care: itching
- early detection of decreasing mental jsatuts: reduce risk of injury
Hepatic Encephalopathy: diagnosis
- Labs: decrease albumin and increase in: globulin, all. phos., AST/ALT, GGT, bilirubin, PT
- UGI x ray
- CT scan
- Liver US
- EGD
- Liver biopsy: confirmation
Liver biopsy considerations
- remove piece of liver
- pre: take PPT
- during: hold breath at end of expiration
- post: lay on right side with pillow under to tamponade bleeding and bile leakage and frequent VS for bleeding risk
Jaundice: definition
yellowing of sclera, skin, mucous membranes when bilirubin exceed 2.5 mg/dL
Jaundice: Types
- Hemolytic: increased destruction of RBC
- Hepatocellular: hepatocytes can not get rid of bilirubin fast enough
- Obstructive: bilirubin does not enter small intestine
Jaundice: Hepatocellular clinical manifestations
- N/V
- loss of appetite
- headaches
- chills
- fever: if infection
- fatigue
- increased bilirubin, AST/ALT, urine urobilinogen
Jaundice: Obstructive clinical manifestations
- dark, orange, foamy urine
- clay colored stools
- dyspepsia
- pruritis
- increase bilirubin and all. phos.
Portal HTN: definition
-liver damaged cause high blood pressure in the portal system. this causes albumin to leak out of the system leading to ascites. It also leads to enlarged veins around the body
Portal HTN: clinical manifestation
- esophageal varices
- caput medusae
- ascites marked
- hemorrhoid
- hypersplenism: moderate anemia, neutropenia, thrombocytopenia
- mechanical obstruction
Ascites: definition
increased portal HTN causes vasodilation of the abdominal circulation that leads to decreases in ECF and appears of ascites. Lier function decline leads to decreased metabolism of aldosterone which stimulates the RAAS system to increase sodium and water retention to intravascular systemic, which is then pushed back out of the ECF
Ascites: clinical manifestation
increased abdominal firth: measure daily
- weight gain
- dyspnea
- striae and distended viens
- fluid electrolyte imbalance
Ascites: treatment
goal: reduce fluid retention
- low sodium diet
- diuretics: aldactone
- daily weights: should not lose 1-2kg/day
- bedrest: upright too much pressure on renal system
- paracentesis
- IV salt porr albumin
- TIPS
paracentesis
removed 5-6L
- pre: empty bladder
- during: VS and tolerance, upright
- post: infection, hypovolemia (changes in MS), Hematuria, leaking at puncture sire
Esophagael varices: definition
increase pressure of portal system leads to blood back up in the esophagus veins
Esophagael varices: factors related to
- exertion
- coughing/sneezing
- straining to defecate
- reflux and vomiting
- salicylate
Esophagael varices: symptoms
- hematemesis
- melena
- hemorrhoids
Esophagael varices: complications
- hemorrhage: if ruptured
- made worse by liver inability to clot
Esophagael varices: treatment
- endoscopic sclerotherapy: inject scarring agent to vein to constrict or eliminate vien
- esophageal banding: stop use of vein
Hepatitis: definition
- toxin or drug induced has better recovery (Tylenol)
- systemic viral infection that causes necrosis and inflammation of liver
Hepatitis: types
-A, B, C, D, E, G
Hepatitis: Stages: prodromal/preicteric
- nonspecific flu like symptoms
- malaise
- fatigue
- headache
- myaglis
- anorexia
- N/V/D
Hepatitis : Stages: icteric
- jaundice
- dark urine
- clay stools
- steatorrhea
- pruritus
- large tender liver
- increased liver enzymes
Hepatitis: stages: posticteric
- convasclent stage
- decrease of fatigue
- decrease jaundice
- increase appetite
Hepatitis: acute
-History of Iv drug use, Hepatitis, HIV
-poor appetite
-N/V
fever
-sever RUQ pain
-GI baled
-confusion
-bruising
-dizziness
-dark urine, clay colored stools
-steatorrhea
-flu like
Hepatitis A: defintion
- non chronic
- fecal-oral route
- poor sanitation/ contaminated water
Hepatitis A: clinical manifestation
flu like
- malaise
- fever
- jaundice
- urine
- indigestion
- enlarged liver and spleen
Hepatitis A: prevention
- hand-washing
- Hep A vaccine or globulin 2 weeks after exposure
Hepatitis A: diagnosis
stool specimen
Hepatitis A: treatment
- bedrest during acute stage
- nutritional support
Hepatitis B: definition
- chronic
- parenteral/sexual
Hepatitis B: clinical manifestations
flu like
- malaise
- fever
- jaundice
- urine
- indigestion
- enlarged liver and spleen
Hepatitis B: prevention
- Hep B vaccine
- Globulin is allegory to vaccine: cannot take right after Hep B vaccine, will cancer out effects
Hepatitis B: treatment
- Meds
- bedrest
- nutrition
Hepatic C: definition
- usually chronic
- parenteral /sexual
- blood transfusions
Hepatic C: treatment
- remission is goal
- combination therapy: interferon and ribavirin
