Hepatic System Flashcards
Liver information basics
-located in the RUQ of the abdominal cavity
-receives approximately 25% of the cardiac output via the hepatic portal vein and the hepatic artery
Portal vein
Carries deoxygenated nutrient-rich blood from the small intestines
Hepatic artery
delivers oxygen-rich blood from the general circulation
Liver function
-blood storage
-blood filtration
-production of bile
-synthesis of clotting factors
-removal of clotting factors to prevent clotting
-metabolism of carbohydrates, fats, and protein
-detoxifies the blood and is a storage area for vitamins A,D,E, K, and iron
-clears bilirubin
Nursing Diagnoses for Hepatic diseases
-Fluid volume excess
-altered tissue perfusion
-altered thought process associated w/ elevated serum ammonia levels secondary to liver disfunction
-altered nutrition
-ineffective breathing pattern
-pain
-Risk for fluid volume deficit
-risk for infection
-risk for bleeding (b/c of alterations in blood clotting factor)
Hepatitis
Diffuse inflammation of the liver, can be
-noninfectious: caused by ETOH, other toxins, autoimmune diseases, congenital, R-sided HF, non-ETOH fatty liver
-infectious: Hep viruses and others
-can occur acutely
-can become chronic
-can lead to hepatoencephalopathy
Hepatitis Assessment - History
IV drug abuse, NSAIDs, alcoholism, use of prescription, herbs, and OTC, occupation and travel exposure, sex (HIV/AIDS)
Hepatitis Assessment - Signs & Symptoms
fatigue, full of malaise (no energy, low grade fever, N/V/D); jaundice (after progression), hepatomegaly, RUQ tenderness (from portal hypertension), muscle wasting, ascites (d/t malnutrition & portal hypertension), hypoalbumemia b/c liver cannot synthesize, loss of appetite
Hepatitis Assessment (book)
-vital signs (look for elevations in temp and pulse associated with infection)
-serum liver enzymes elevated
- elevated serum bilirubin
-jaundice of skin and sclera
-loss of appetite (low nutritional intake)
-daily weight (anorexia secondary to abdominal distenion & an increase in weight secondary to ascites)
-I/O: increase in O d/t ascites
-signs of organ rejection in patients after liver transpalnt
Hepatitis Laboratory data
- elevated AST (20-40)
- elevated ALT (13-40)
- elevated Bilirubin (0.3-1)
- elevated serum ammonia (15-60)
- decreased albumin (3.4-5.1)
AST & ALT
-Early markers
-released when hepatocytes die
Nursing care of Hepatitis
-supportive (not much we can do if not infectious)
-avoid alcohol and rest
-support shortness of breath/dyspnea
-high calorie, low protein diet
-lots of emetics to keep food down
-saline needed not lactated ringer b/c liver cannot metabolize
-lactulose: given for ammonia overload
-cholestyramine to treat the pruritis which comes from jaundice and bile salts
-pericentesis
Complications of liver disease
-cirrhosis
-hepatic encephalopathy
-hepato-renal syndrome
-spontaneous bacterial peritonitis
-hepatocellular carcinoma
cirrhosis assessment
-burst varices d/t increased BP leading to internal bleeding
-hemarroids
-causes extreme fatigue & decreased activity level b/c ascites interferes with lungs
pleural effusions, big bellies
-unstable glucose levels
-clotting dysfunction, low level DIC (end stage) d/t albumin level being low
-ascites, lower extremity edema, khypotension
-increased AST, increased ALT, increased AP
-increased bili (jaundice)
-decreased Na
Complications of Cirrhosis
-portal hypertension
-ascites
-bleeding esophageal varices
-coagulation defects
-jaundice
-hepatic encephalopathy
-hepatorenal syndrome
