Hepatic/Biliary PT 2 Flashcards
Jaundice
- liver is unable to adequately metabolize and secrete bilirubin
- bilirubin > 3
- result of liver damage/disorders
- yellowing of the skin and sclera of eyes
Portal Hypertension
increase in pressure in the portal vein system that travels throughout liver
-leads to enlarged, swollen veins in stomach, esophagus, intestines, and umbilical area
Major Complications of Portal Hypertension
Ascites
Gastroesophageal varices
Ascites
abnormal build-up of fluid in the peritoneal cavity
-the fluid that accumulates in peritoneal cavity is rich in albumin
S/S of Ascites
- increased abdominal girth
- increased weight
- pedal edema
- dyspnea
- obvious abdominal hernia
- striae
- fluid that shifts w/ movement
- feeling of fullness
- anorexia/weakness
Treatment for Ascites
- Na+ restriction to limit fluid retention
- diuretics
- paracentesis
- TIPS
Paracentesis
removal of ascites through a small puncture in the abdomen
Complications of Paracentesis
- leakage of ascetic fluid
- bleeding
- bowel perforation
- bladder perforation
- pain at site
- dizziness/hypotension
- infection
Nursing Care for Ascites
- low sodium diet
- daily weights
- monitor for side effects of diuretics
- monitor for complications of paracentesis
- monitor for complication from TIPS procedure
Esophageal Varices
Life threatening complication of liver disease
-veins in the esophagus become dilated and over distended secondary to increased pressure and blood flow through the portal vein
What exacerbates bleeding w/ Esophageal Varices?
- veins are low in elasticity/weak
- alcohol use
- strenuous exercise
- heavy lifting
- straining
- vomiting
- coughing
S/S of Esophageal Varices
- hematemesis/melena
- altered mental status
- string history of alcohol
- shock
- malnutrition
Treatment for Esophageal Varices
- protect airway-intubation/suction
- control bleeding
- prevent hypovolemic shock
Pharmacological Treatment for Esophageal Varices
- IV antibiotics (cipro, ceftriaxone)
- vasoconstriction (vasopressin IV)
- synthetic hormones (octreotide)
Endoscopy Variceal Banding
elastic band is placed around bleeding esophageal vein cutting off blood flow through the vein; banded tissue develops into small ulceration that quickly heals after several days-weeks
- difficult w/ active bleeding
- safe/does not increase pressure in portal
Balloon Tamponade of Esophageal Varices
-balloon is inflated w/in the esophagus and stomach to apply pressure on bleeding vessel, compress the vessel, and stop the bleeding
Hepatic Encephalopathy
occurs when ammonia and other toxins can no longer be filtered by the liver; leads to accumulation in toxic proportions and alteration in mental status/neuro function
How many stage of Hepatic Enceph are there?
4
Stage 1 HE
normal LOC w/ alternating periods of lethargy and euphoria; sleep patterns altered
-“hand flap”
Stage 2 HE
increased drowsiness/confusion, mood swings, agitation
-breath smells sweet/musty
Stage 3 HE
sedated, difficult to arouse, extreme confusion, incoherent speech
-increased DTR’s, extremities become rigid
Stage 4 HE
coma/may not respond to pain/death may occur
-absence of tremor, DTR’s, flaccid extremities
Treatment for Hepatic Encephalopathy
- lactulose to excrete ammonia through stool
- monitor for hypokalemia
- neomycin reduces bacteria in intestines
- IV supplementation
Lactulose
- Oral, NG, enema
- adjust dose to obtain 2-3 stools each day/decrease w/ watery stool
- dilute w/ fruit juice
- monitor for hypokalemia
Nursing Management for Hepatic Encephalopathy
- frequent neuro checks
- strict I&O’s
- VS q 4
- turn q 2
- monitor ammonia levels and electrolytes
- low protein diet
- small frequent meals w/ complex carb snack
- communicate w/ fam
- offer realistic expectations
Vitamin A Deficiency
night blindness
Vitamin C Deficiency
swollen, bleeding gums
Vitamin D Deficiency
osteoporosis, fractures
Vitamin K Deficiency
bruising, bleeding
