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Therapeutic Nursing > Hepatic conditions > Flashcards

Hepatic conditions Flashcards

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1
Q

What is the hepatic portal system?

A

a series of veins that carry blood from the capillaries of the stomach, intestine, spleen, and pancreas to capillaries in the liver

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2
Q

What are the functions of the hepatic system?

A

to detoxify blood
to metabolise glucose
to synthesise proteins
to act as a reservoir for blood

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3
Q

What is the hepatic artery?

A

transports oxygenated blood from aorta to liver

receives 75% of the blood flow from the stomach, spleen, and pancreas

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4
Q

In 2018, what percentage of deaths were caused by liver disease and liver cancer in England?

A

2.5% (over half of these deaths occur in people of working age)

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5
Q

What are the most common causes of liver disease?

A

alcohol misuse
non-alcoholic fatty liver disease related to obesity and metabolic syndrome
viral hepatitis - A, B and C
autoimmune liver disease - hemochromatosis and Wilson’s disease
liver cancer

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6
Q

Cirrhosis and other liver diseases are among the top five leading causes of death for which age groups in England (ONS, 2018)?

A

20-34 years

50-64 years

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7
Q

Cirrhosis and other liver diseases are the leading cause of death for which age group in England (ONS, 2018)?

A

35-49 years (account for >10% of deaths in this age group)

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8
Q

What is the prevalence of liver disease in females (ONS, 2018)?

A

top 3 leading causes of death
account for 22,000 working years lost
malignant neoplasm of the breast and intentional self-harm were the top 2 causes

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9
Q

What is the prevalence of liver disease in males (ONS, 2018)?

A

top 4 leading causes of death
account for 38,000 working years lost
intentional self-harm, accidental poisoning, and ischaemic heart disease were the top 3 causes

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10
Q

How have the rates of liver disease in England changed since 2001?

A

increased

highest peak at 18.5 per 100,000 population in 2015-17 (same as 2016-18 rate)

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11
Q

What percentage of deaths caused by liver disease are related to lifestyle and unhealthy environments?

A

90%
mostly alcohol-related
responsible for 4x increase in liver mortality over the last few decades

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12
Q

What is liver cirrhosis?

A

a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions
there is a misconception that cirrhosis is end-stage and irreversible
liver function will often improve dramatically if the underlying cause is removed

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13
Q

List some of the main symptoms of liver cirrhosis.

A 
weight loss
nausea and vomiting
unreasonable bruises on the skin
nasal/gum bleeding
pain in the right hypochondrium
constipation/diarrhoea
loss of appetite
dark urine
yellowing of the skin and sclera
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14
Q

What will happen if the underlying cause of cirrhosis persists?

A

cirrhosis will inevitably progress to liver failure

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15
Q

List some of the common signs and symptoms of liver failure.

A

jaundice
ascites
hepatic encephalopathy
malnutrition and sepsis

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16
Q

Why is liver disease sometimes referred to as the ‘silent killer’?

A

develops silently with no signs or symptoms
the tests currently performed in general practice do not detect underlying liver scarring or cirrhosis
most patients with cirrhosis are unaware they have liver disease until they present with often fatal complications

17
Q

Around half of all patients with cirrhosis develop which condition?

A 
portal hypertension (increased pressure in the abdominal veins)
varicose veins in the gullet can bleed severely and are a common cause of death
18
Q

What treatments may be given to reduce the risk of a first bleed?

A

primary prophylaxis of varices using endoscopic band ligation
therapy with beta-blockers

19
Q

Name the six stages of liver damage.

A 
normal liver
steatosis
steatohepatitis
fibrosis
cirrhosis
hepatocellular carcinoma
20
Q

Name the two clinical stages related to liver disease.

A

compensated and decompensated
there is the potential to pass between these stages, depending on the severity of the condition and patient concordance with advice/education

21
Q

What is compensated liver disease?

A

refers to the body’s ability to cope with a dysfunction in the liver to maintain normal levels
due to the high proportion of healthy cells compared to unhealthy cells
this allows the liver to continue with its normal processes, and the patient is asymptomatic
a median survival rate of 12 yrs, unless a transplant is undertaken

22
Q

What is decompensated liver disease?

A

refers to the liver’s inability to continue to function normally
leads to the manifestation of signs and symptoms
a median survival rate of 2 yrs, unless a transplant is undertaken

23
Q

What findings detected by a physical examination indicate decompensated liver disease?

A

palpable left lobe of the liver, hepatomegaly, splenomegaly

the presence of stigmata of chronic liver disease (spider naevi, palmar erythema, white nails, muscle wasting)

24
Q

List some of the features of severe liver impairment and signs of decompensated liver disease.

A

jaundice (examine the sclera under natural light)
abnormal bruising
peripheral oedema
variceal bleeding
encephalopathy (a sign of this is asterixis - sudden involuntary flexion-extension movements of the wrist and metacarpophalangeal joints when the arms are extended, the wrists dorsiflexed, and the eyes closed for at least 30 secs)

25
Q

If a person is known to have, or suspected to have, chronic liver disease, which blood tests will help to determine the severity and impact of the condition?

A 
platelet count
aspartate aminotransferase (AST)
alanine transaminase (ALT) ratio
bilirubin
albumin
prothrombin time/international normalised ratio (INR)
hepatitis
26
Q

Why is platelet count measured in chronic liver disease?

A

platelet count can be low in liver disease

27
Q

Why is the aspartate aminotransferase (AST) test used in chronic liver disease?

A

AST levels elevated due to liver damage

28
Q

Why is the alanine transaminase (AST) ratio measured in chronic liver disease?

A

AST ratio elevated due to liver damage

29
Q

Why is the bilirubin test used in chronic liver disease?

A

bilirubin levels elevated due to liver damage

30
Q

Why is the albumin test used in chronic liver disease?

A

albumin levels decreased and will lead to other complications

31
Q

Why is the prothrombin time/international normalised ratio (INR) measured in chronic liver disease?

A

elevated due to liver damage

32
Q

When should hepatitis blood tests be used in chronic liver disease?

A

if the history supports exposure to this area

33
Q

What is transient elastography (TE)?

A

a non-invasive, painless test
it measures the liver stiffness using an ultrasound probe and measuring the velocity of a sound wave passing through the liver
this gives an indication of liver ‘stiffness’ and the degree of fibrotic change
results are available immediately and it is able to assess a larger area of the liver than biopsy

34
Q

Transient elastography (TE) (if available) can be used to diagnose cirrhosis in which patient groups?

A

people with hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week, and have done so for several months
people diagnosed with alcohol-related liver disease

35
Q

When is a liver biopsy offered to patients?

A

if TE unavailable

to confirm a diagnosis

36
Q

Why is the accuracy of results from liver biopsies less than 100%?

A

due to the risk of sampling error

37
Q

What percentage of liver biopsies produce a false negative result?

A

around 15%

38
Q

When is an onward referral to a hepatologist or gastroenterologist for further assessment appropriate?

A

if TE unavailable

limited expertise in the diagnosis or management of liver disease

39
Q

When may a liver transplant be recommended?

A

in end-stage liver disease (chronic liver failure)

Therapeutic Nursing (16 decks)

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