Hepatic Disorders

Question 1

Liver Function

Answer 1

Metabolic
Bile Synthesis (excretion)
Storage Function
Mononuclear phagocyte system
Filters blood
Produces albumin
Synthesis of angiotesinogen

Question 2

Metabolic function

Answer 2

carbohydrate, protein, fat

Question 3

Storage functions

Answer 3

glucose, vitamins, albumin

Question 4

Mononuclear phagocyte system (Kupffer cells)

Answer 4

breakdown of old RBCs, WBCs, bacteria

Question 5

Cirrhosis

Answer 5

Final stage of chronic liver disease

When liver cells regenerate, it becomes disorganized

Question 6

Liver cells disorganized regeneration causes…

Answer 6

abnormal BV and bile duct formation
Blocks Blood flow (overgrowth of CT)
Scarring tissue decreasing liver function

Question 7

Factors leading to cirrhosis

Answer 7

Chronic alcohol disorder (alcohol has hepatotoxic effect)
Nonalcohol fatty liver disease (NAFLD)
Extreme dieting, malabsorption, obesity
Hepatitis B and C
Environmental factors
Genetic Predisposition

Question 8

Cirrhosis - manifestations

Answer 8

Peripheral neuropathy
Jaundice, spider angioma, palmar erythema
Anemia, coagulation disorders
Anorexia. N/V, dull pain
Hypokalemia, hyponatremia
Fluid retention, peripheral edema, ascites

Question 9

Spider angioma

Answer 9

occurs in nose, cheeks, upper trunk, neck, shoulders

Question 10

Palmar Erythema

Answer 10

red area that blanches with pressure

palms of hands

Question 11

Spider angioma and Palmar Erythema are appear b/c….

Answer 11

low levels of circulating estrogen b/c liver is unable to metabolize steroid hormones

Question 12

Hematological problems

Answer 12

Thrombocytopenia (decreased thrombocytes/platelets)
Leukopenia (low WBC count)
Anemia
Coagulopathies (bleeding of the gums, nose bleed, easy bleeding)

Question 13

Endocrine disorders - men

Answer 13

gynecomastia (enlarged breast tissue)
Loss of armpit and pubic hair
Testicular atrophy
Impotence

Question 14

Endocrine disorders - young women

Answer 14

Amenorrhea (no period)

Question 15

Endocrine disorders - older women

Answer 15

Vaginal bleeding

Question 16

Peripheral neuropathy

Answer 16

caused by alcoholic cirrhosis

Question 17

Complication of Cirrhosis

Answer 17

Esophageal Varices
Peripheral edema and ascites
Hepatic Encephalopathy

Question 18

Esophageal Varices

Answer 18

Look for bleeding, bleeding in gums, anemic, hemoglobin, vomiting

endoscopy, gastroscopy

Question 19

Ascites

Answer 19

Build up of fluid in the peritoneum or abdominal region

Question 20

Ascites - manifestations

Answer 20

Abdominal distention
weight gain
abdominal striae
decreased UO
signs of dehydration
Hypokalemia

Question 21

Hepatic Encephalopathy

Answer 21

Increased Blood ammonia

Question 22

Hepatic Encephalopathy - manifestations

Answer 22

Altered LOC (confusion)
Neuromuscular disturbances

Question 23

Hepatic encephalopathy tx

Answer 23

decrease protein in diet

Give lactulose and neomycin

Question 24

Collaborative care for hepatic disorders

Answer 24

Rest
Avoid alcohol, ASA, acetaminophen and NSAIDs
Prevention and management of ascites, variceal bleeding and encephalopathy

Question 25

Esophageal Varices - Care

Answer 25

All patients with cirrhosis have screening UGI endoscopy
Avoidance of alcohol, ASA, NSAIDs
If non-bleeding varices present - non-selective BB

Question 26

Ascites - care

Answer 26

Sodium restriction, diuretics, fluid removal

Paracentesis (removes fluid from abdominal cavity, temporary)

Question 27

Hepatic encephalopathy - care

Answer 27

Reduction of ammonia formation (goal)

Lactulose
Antibiotics
Treatment of precipitating cause
Liver transplant

Question 28

Wernicke’s Encephalopathy - Care

Answer 28

Thiamine administration

Question 29

Nursing implications

Answer 29

Health promotion

Interventions (energy conservation, symptom control, I&O, assessment of complications, IV access w pts with varces)

Question 30

Drug considerations

Answer 30

FIRST PASS EFFECT

Question 31

Wernicke’s Encephalopathy