Hepatic Disorders Flashcards
causes of cirrosis
Hep. B and C, ETOH, autoimmune, bile duct problems, fat collection (hyperlipidemia)
role of liver
metabolizes, detoxifies, stores, produces
chronic scarring of the liver. nodular, bumpy, irreversible
hepatic cirrosis
causes of hepatic cirrosis
inflammation, fibrosis, bile duct occlusion
risk factors for cirrosis
ETOH, chronic viral hep., fatty liver disease/hepatic steatosis, toxic chemical or drug exposure, male, age 40-60
hand flapping
asterixis (due to ammonia)
study manifestations of cirrhosis on page 5
examples: fatigue, bruising, fetor hepaticus (smell),
the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.
caput medusae, due to portal HTN
rash looking on palms
palmer erethymea
given to decrease gastric distress and minimize possiblity of GI bleed
Pepcid, protonics (antacids, HIstamine 2 )
given to promote healing of damaged livers cells and improve general nutrition
adequate diet, vitamines, and nutritional supplements
given to minimize F and E imbalance
potassium sparing diuretics (spironolactone or triamterene) to decrease ascites and monitor hypotension
promotes excretion of ammonia via stool
lactulose
medication that reduces levels of ammonia
neomycin, metronidazole (Flygyl), rifaximin (Xifaxan)
cautious use due to decreased liver function
opioids, sedatives, barbiturates
lower albumin leads to
fluid excess
impaired skin integrity due to
bile salts
Diet
high calorie, lower sodium, LOW PROTEIN
provide what kind of vitamins if patient has steatorrhea
water soluable
when it comes to vitamins for cirrosis, which is most important
B complex
monitor carefully in cirrosis
coagulation studies
restrict these due to edema
sodium, fluids, proteins, document I/O
elevate legs to prevent peripheral edema and increase venous return
assess for dyspnea, increased RR, hypoxia, pleural effusion (fluids pushed into pleural space) everything pushing up
avoid which medication
acetaminophen, aspirin contraindicated with GI bleed
blood pools back due to blockage of bumpy liver. often caused by portal HTN
esphageal varices
what often causes esophageal varices
portal HTN
risk factors for bleeding of esophageal varices
heavy lifting, straining, sneezing, coughing, vomiting, swallowing poorly chewed foods, erosion of vessel walls due to gastric acid, ETOH, or meds
Clinical manifestions of? bleeding may be the only symptom. Melena. Hematemesis, mental or physical deterioration, hemorrhagic shock
esophageal varices
clinical manifestions: splenomegaly, ascites, black stool, spontaneous bruising, hypotension
hepatic cirrhosis
if patient is diagnosed with cirrosis, how often do they need an endoscopy?
q 2 years
umbrella term for identifying cause and source of bleeding for esophageal varices
endoscopy
pharm for bleeding that is preferred for immediate control
octreotide (Sandostatin)
pharm for bleeding that is contraindicated in CAD
vasopressin (Pitressin) w/ nitro
most common for PREVENTING 1st bleed and PREVENTING re bleed
BB - propranolol, nadolol
may be used in combination with BB to stop bleed
nitrates - isosorbide (isordil)
short term use in stopping esophageal bleed. MUST BE INTUBATED IN ORDER TO USE
balloon tamponade
balloon tamponade is for which use only
emergency. used to stablize. risk for rupture, airway obstruction, asphyxiation, aspiration, etc. check q 4-6 hours
stops bleeding but does not prevent subsequent bleeding. Need GI protection (Antacids, H2, PPI)
endoscopic sclerotherapy
preferred method and treatment of choice over sclerotherapy. Reduces re bleeding of Esoph. Varices, mortality, and procedure related complications
esophageal Banding - Esophageal Variceal Ligation (EVL)
used when EVL or sclerotherapy and meds are ineffective in controlling esophageal variceal bleeding. Rapidly reduces portal pressure
transjugular intrahepatic portosystemic shunt (TIPS)
effective in decreasing portal HTN and variceal bleeding. Last resort.
portal systemic shunts
complications of portal shunts
thrombosis, encephalopathy, accelerated liver failure
major factor in hepatic encephalopathy
ammonia
neuropsychiatric manifestation of hepatic failure associated with portal HTN and shunting of blood into system circulation
Hepatic Encephalopathy
which stage of Hep. Enceph? sleep problems, periods of lethargy, euphoria, trouble concentrating, normal EEG
Stage 1 - Mild
which stage of Hep. Enceph? increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation, asterixis, fetor hepaticus, abnormal EEG with marked slowing
Stage 2 - Moderate
stage of Hep. Enceph. stuporous, difficult to arouse, incoherent speech, asterixis, rigid extremities, hyperreflexia, markedly abnormal EEG
3 - Severe
which stage of Hep. Enceph. Comatose, no esterixis, absent deep tendon reflexes, flaccid extremities, markedly abnormal EEG
4 - Final
what should you do for hepatic encephalopathy to reduce serum ammonia
administer lactulose. Goal of 2-3 soft stools/day,
cautions for lactulose
hypokalemia, watery diarrhea, dehydration
administer this for hepatic Eceph. to minimize protein breakdown
IV glucose. Also correct vitamin deficiencies: A, B, C, K, folic acid, and electrolyte imbalance
administer which antibiotics as needed
neomycin (nephrotoxic), metronidazole (Flagyl), rifaximin
discontinue which meds that precipitate encephalopathy
sedatives, tranquilizers, barbiturates, opiates
administer this benzo antagonist for Hep. Enceph
flumazenil
atixis (flapping) caused by
ammonia in brain
syndrome of sudden and severely impaired liver function or severe hepatocyte necrosis in teh absence of preexisting liver disease
fulminant hepatic failure
where is ammonia produced
gut
Bacteria in your gut and in your cells create ammonia when your body breaks down
protein
common cause of fulminant hepatic failure
viral hep
