Hepatic Disorders Flashcards
functions fo the liver
breaks down, balances, and creates the nutrients and also metabolizes drugs into forms that are easier to use for the rest of the body or that are nontoxic
detox the body
helps to clot blood
metabolize drugs
synthesis (make) albumin
Glucose Metabolism
Ammonia Conversion
Protein Metabolism
Fat Metabolism
Vitamin and Iron Storage
Bile Formation
Bilirubin Excretion
Drug Metabolism
causes of liver dysfunction
Viral and non-viral hepatitis
Biliary Cirrhosis
Autoimmune disorders of liver
Medication use (drug hepatotoxicity)
Toxins
transmission of hep A
fecal and oral through food and water
diagnostic of hep A
anti-HAV
IgM = active infection
IgG = recovered
treatment for hep A
supportive therapy
rest
vaccine
transmission of hep B
birth and blood
childbirth, sex, IV drugs
diagnostics for hep B
HBsAG = active infection
anti-HBs = immune /recovery
treatment for hep B
acute supportive therapy and rest
chronic antivirals
vaccine
transmission of hep C
body fluids
most common in IV drug users
diagnostics for hep C
anti-HCV
no post exposure immunoglobulin
treatment for hep C
antivirals
interferon
transmission for hep D
hep D occurs with hep B
diagnostics for hep D
HDAg
anti-HDV
treatment for hep D
antivirals
interferon
transmission of hep E
fecal and oral
food and water uncooled meat
3rd world countries
diagnostics of hep E
anti-HEV
treatment for hep E
supportive therapy
rest
acute vs chronic for types of nonviral hepatitis
hep A = acute
hep B = acute and chronic
hep C = acute and chronic
hep D = acute and chronic
hep E = acute
causes of nonviral hepatitis
alcohol
medication
how does alcohol cause liver damage
alcohol is metabolized in the liver and excess can cause damage
types of medications that can cause liver damage
acetaminophen
antibiotics
anticonvulsants
NSAIDs
antituberculosis agents
end stage liver disease
cirrhosis
gender differences for cirrhosis of the liver
2x more common in men
but women are more succeptable
compensated vs decompensated cirrhosis
compensated = no symptoms
decompensated = extended to point of loss of function and symptoms
clinical manifestations of decompensated cirrhosis
Ascites
Jaundice
Weakness
Muscle wasting
Weight loss
Continuous mild fever
Clubbing of fingers
Purpura (due to decreased platelet count)
Spontaneous bruising
Epistaxis
Hypotension
Sparse body hair
White nails
Gonadal atrophy
hematologic disorders as clinical manifestations
Thrombocytopenia (low platelets)
Leukopenia
Anemia
Coagulation disorders
Endocrine disorders
Related to hormone metabolism
PTT use and normal value
how long it takes a blood clot to form
normal = 30-40 sec
heparin = 1.5-2.0
Accumulation of ammonia and toxins
hepatic encephalopathy
signs and symptoms of hepatic encephalopathy
neuro changes
asterixis
fetor hepaticus
portal veins become narrow due to scar tissue
portal hypertension
dilated, tortuous veins that usually are found in the submucosa of the lower esophagus but may develop higher in the esophagus or extend into the stomach
esophageal varices
treatment for GI bleed
Blood transfusion, O2, volume expanders, electrolyte replacement
diagnostics for liver disease
Liver enzyme tests
Total protein, albumin levels
Serum bilirubin, globulin levels
Cholesterol levels
Prothrombin time
Ultrasound elastography (Fibroscan)
Liver biopsy
keep fluid from leaking out of your blood vessels into other tissues. It is also carries hormones, vitamins, and enzymes throughout your body
albumin
assessment factors for liver disease
History
Social History
Assessment
Neuro
GI
Weight
Skin
nursing diagnosis for liver disease
Activity intolerance
Imbalanced Nutrition
Impaired skin integrity
Risk for injury
Risk for bleeding
what is the goal for the patient with liver disease
Increase participation
Improve nutritional status
Improve skin integrity
Decrease risk for potential injury
Improve mental status
Absence of complications
planning for ascites
Sodium restriction
Albumin
Diuretics
Paracentesis
TIPS - Transjugular intrahepatic portosystemic shunt
how to prevent bleeding/ hemorrhage for esophageal and gastric varices
Screen for presence with endoscopy
Avoid alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
Betablockers, Somatostatin, Octreotide
Esophageal banding
planning for liver disease
If bleeding occurs, stabilize patient, manage airway, provide IV therapy and blood products
Endoscopic therapy
Band ligation
Balloon tamponade
Mechanical compression of varices
Supportive measures for acute bleed
-Fresh frozen plasma
-Packed RBCs
-Vitamin K
Proton pump inhibitors
Antibiotics
long term management of varices
Nonselective β-adrenergic blockers
Repeated band ligation
Portosystemic shunts
how to reduce ammonia formation
Lactulose (Cephulac), which traps ammonia in gut
Rifaximin (Xifaxan) antibiotic
Prevent constipation
treatment of precipitating cause of varices
Lower dietary protein intake
Control GI bleeding
Remove blood from GI tract
interventions for liver disease
Rest
Cluster care
Hepatic encephalopathy
Perform neurologic assessment every 2 hours
Control factors known to precipitate encephalopathy
Monitor I and O
Monitor respiratory status
Skin integrity
ROM
importance with nutritional status for liver disease
High protein diet if indicated
Supplemental vitamins Administration of B-complex vitamins
Small frequent meals
Enteral or parental route
Sodium restriction
Avoidance of alcohol
Minimize constipation
Encourage fluids
skin care for liver patients
Q2 hour turns
reduce risk for injury for liver disease
Fall prevention
Minimization or avoidance of aspirin, acetaminophen, and NSAIDs
monitoring for complications for liver disease
Bleeding and Hemorrhage
Encephalopathy
assessment for liver disease
Level of responsiveness
Sensory and motor abnormalities
Fluid/electrolyte imbalances
Acid-base balance
Effects of treatment measures
evaluation for liver disease
Maintenance of food/fluid intake to meet needs
Maintenance of skin integrity
Normalization of fluid balance
Treatment for substance abuse
normal range of ALP
32-92
normal range for ALT and AST
0-35
normal range of amylase
0-130
normal range of creatine kinase
30-170
