Hepatic Disorders Flashcards
Functions of the liver
glucose metabolism
ammonia conversion
protein metabolism
fat metabolism
vitamin and iron storage
bile formation
bilirubin excretion
drug metabolism
The majority of the blood supply to the liver, which is poor in nutrients, comes from the portal vein. T or F
False - majority of supply that is rich in nutrients from the GI tract comes from the portal vein
What LFTs are associated with liver disorders and are known to increase with hepatitis, cirrhosis, and liver cancer?
serum aminotransferases, ALT, AST
What LFT is associated with cholestasis and alcoholic liver disease?
GGT
What does the nurse assess in the patient with liver dysfunction?
H&P - exposure to toxins, travel, alcohol and drug use; skin - yellow and dry, LOC, palpation - liver inflammation
What manifestations are seen with liver dysfunction?
Jaundice
Poral hypertension
Ascites, varices
Hepatic encephalopathy or coma
Nutritional deficiencies
Yellow - ish coloring of sclera or skin caused by increased serum bilirubin
jaundice
Jaundice occurs when bilirubin exceeds
> 2 mg/dL
Types of jaundice
hemolytic, hepatocellular, obstructive
Signs and symptoms of jaundice
**dark orange-brown urine
**clay colored stools
anorexia/N/V
weight loss
fatigue, weakness, malaise
headache, chills, fever, infection
dyspepsia
pruritus
Complication occurring from obstructed blood flow through the liver resulting in increased pressure through the portal venous system
portal hypertension
Portal hypertension can result in?
Ascites
Esophageal tears
What protein draws fluid in resulting in ascites?
albumin
s/ of ascites include
pain
infection
SOB
pressure on vital organs
What can be performed as a comfort measure for ascites?
regular paracentesis
How does the nurse assess ascites?
Record abdominal girth
Daily weight
Assess for fluid in cavity by percussion
Monitor for F&E imbalances
How is ascites managed?
Low sodium diet
Diuretics - spirolactone
Bed rest
Paracentesis- VS, fevers, redness@ site
What emergent condition is caused by the accumulation of ammonia and other toxins in the blood?
Hepatic Encephalopathy
What two major alterations affect the development of hepatic encephalopathy?
Hepatic insufficiency
Portosystemic shunting
The inability of the liver to detoxify toxic by-products of metabolism
hepatic insufficiency
Disorder where collateral vessels develop in the liver allowing toxic portal blood to enter systemic circulation
portosystemic shunting
What are the earliest signs of hepatic encephalopathy?
severe mental changes like hallucinations and motor distrubances
How does the nurse assess the patient for hepatic encephalopathy?
EEG - brain damage
Changes in LOC - hallucinations
Seizure precautions
Monitor F&E, ammonia levels**
What is the most important thing to monitor in hepatic encephalopathy?
ammonia levels
How is hepatic encephalopathy managed?
Stop offending cause - drinking, drugs
Lactulose to reduce serum ammonia
IV glucose to minimize protein catabolism
Protein restricted diet - hard to metabolize in liver failure
Reduce ammonia by gastric suction, abx, enemas
Discontinue sedatives, analgesics, and tranquilizer - nothing metabolized by liver
Monitor/treat complications - fever, change in VS, SOB, GI beed, change in BP, I&O
The first bleeding episode of an esophageal varices has what percentage of mortality?
10-30% depending on severity
Manifestations of esophageal varices
hematemesis, melena, general deterioration, shock
How often should patients with esophageal varices and cirrhosis undergo endoscopy?
Every 2-3 years
How are esophageal varices managed?
Treat for shock - admin O2
IV fluids, blood and blood products, volume expanders to pull fluid where it needs to go
Vasopressin
Nitroglycerin
Propranolol to decrease portal pressure
Balloon tamponade
Maintain safe environment, prevent injury, bleeding and infection
Administer prescribed treatments
Monitor for complications
Encourage deep breathing and position changes
A systemic viral infection that causes necrosis and inflammation of liver cells
viral hepatitis
A disorder that is toxic to the liver and is drug induced
nonviral hepatitis
What types of hepatitis are transmitted via fecal-oral route?
A and E
What types of hepatitis are blood borne pathogens?
B and C
What type hepatitis only affects those who already have hep B?
Hep D
Hepatitis A is transient lasting 4-8 weeks. T or F
True
S/s of Hepatitis A
flu-like symptoms
low grade fever
jaundice w dark urine
indigestion
epigastric distress
enlarged liver and spleen
How is hep A managed?
Good hygiene - hand washing, safe water, proper sewage disposal
Vaccinate
Immunoglobulin for contacts to provide passive immunity
Bed rest
Nutritional support - anorexia
How is hep B transmitted?
blood, saliva, semen, vaginal secretions, STD, mother to baby during birth
Hep B has a long incubation period of 1-6 months. T or F
True
S/s of hep B
insidious and variable
anorexia
dyspepsia
abdominal pain
generalized aches
malaise
weakness
fatigue
**jaundice may or may not be present
How is hep B managed?
Meds - interferon, antivirals: entecavir and tenofovir
Bed rest
Nutritional support - anorexia
Vaccine
How is hep C transmitted?
Blood and sexual contact, needles
What is the most common blood borne infection?
hep C
Hep C is curable. T or F
False
How is hep C managed?
Antiviral medications
Avoid alcohol
Avoid meds that effect liver
Prevention is key
Safe needle use
How is hep D transmitted?
Blood and sexual contact, needles, hemodialysis, transfusions
What is the only drug available to treat hep D?
interferon alfa
How is hep E transmitted?
fecal - oral route; contaminated water
How is hep D managed?
good hygiene, handwashing
Types of hepatic cirrhosis
Alcoholic
Postnecrotic
Biliary
Type of cirrhosis involving scar tissue that surrounds the portal areas of the liver
alcoholic cirrhosis
Type of cirrhosis that involves bands of scar tissue
postnecrotic cirrhosis
Type of cirrhosis that involves scarring around the bile ducts of the liver
biliary
Manifestations of cirrhosis
liver enlargement
portal obstruction
ascites
infection and peritonitis
varices
GI varices
edema
vitamin deficiency
anemia
mental deterioration
How is cirrhosis managed?
Promote rest
Improve nutritional status - restrict protein, supplement vitamins
Provide skin care
Reduce risk for injury - risk for bleeding
Potential complications of cirrhosis
Bleeding and hemorrhage
Hepatic encephalopathy
Fluid volume excess
Primary liver tumors are associated with what?
Hep B and C
Hepatocellular carcinoma
Manifestations of liver cancer
dull persistent RUQ pain
weight loss
anemia
anorexia
weakness
jaundice
ascites
obstructed portal veins
How is liver cancer managed?
Radiation therapy
Chemotherapy
Percutaneous biliary drainage
Surgery - lobectomy, cyrosurgery, transplant
Preoperative nursing care for liver transplant
support
educatoin
encouragement
Postoperative nursing care for liver transplant
monitor for infection, vascular complications, respiratory and liver dysfunction
Caregiver stress
