Hepatic System: Cirrhosis Flashcards
What is Cirrhosis?
• Extensive degeneration, destruction and fibrosis (scarring) of the liver
What is the patho for cirrhosis?
- Inflammation of the liver results in destruction and replacement of hepatocytes with scar tissue
- This impairs blood flow in the liver and ↓ in liver function
What are the 3 main types/causes:
- Postnecrotic
- Viral hepatitis
- Toxins/drugs
- Biliary
- Chronic biliary obstruction
- Laennec’s
- Chronic alcoholism
What are the early s/s of Cirrhosis?
- Pain
- Fever
- N/V
- Fatigue
- Hepatomegaly
What labs indicate cirrhosis?
- ↑ ALT,AST, Bilirubin, Ammonia
- ↓ Serum protein, Albumin, RBC, Hgb/Hct, Platelets
What are the dx tests for cirrhosis?
- Liver biopsy
- Ultrasound
- CT/MRI
What are the tx options for cirrhosis?
- Medications
- Vitamin/mineral supplements
- Diuretics
- Lactulose
- Procedures
- Liver transplant
What is the nursing care for cirrhosis?
- Monitor I/Os
- Restrict fluids and sodium as ordered
- Monitor for complications
- Encephalopathy
- Portal hypertension
- Esophageal varices
- Hemorrhage
What is our pt teaching for cirrhosis?
- Low sodium diet
- Small freq meals
- No alcohol (encourage recovery program)
True or False
The liver is the strongest organ in the body and by the time the patient dies of liver failure from cirrhosis, the liver is already 90% dead.
• True
What is the difference between where hepatitis pts and cirrhosis pts get their tx?
- Hep pts get their care as an outpatient at a doctor’s office
- Cirrhosis pts get their tx in the hospital
What is Korsakoff’s syndrome?
- A disorder that primarily affects the memory system in the brain.
- It usually results from a deficiency of thiamine (vitamin B1), which may be caused by chronic alcohol abuse and malnutrition
What does vitamin B1 (thiamine) do?
• Helps the body convert carbohydrates into glucose, which is critical for brain function
What are the s/s of Korsakoff’s syndrome?
- Anterograde amnesia
- Retrograde amnesia
- Confabulation
- Meager content in conversation
- Lack of insight
- Apathy
- Ataxia
- Tremor
What is anterograde amnesia?
• Decreased ability to retain new information
What is retrograde amnesia?
• Inability to remember what happened in the years, or decades , prior to injury
What is confabulation?
• Made-up stories fill in any gaps in memory
What is ataxia?
• A condition that presents with difficulties with: balance and walking. speaking. swallowing.
What are the neurologic s/s of cirrhosis?
- Hepatic encephalopathy
- Peripheral neuropathy
- Asterixis
What is hepatic encephalopathy?
- Uncleared toxins due to liver malfunction can travel to the brain and affect brain function.
- People with hepatic encephalopathy may seem confused.
- Treatments can rid the body of toxins and reverse this temporary condition
What is peripheral neuropathy?
- Damaged nerves located outside of the brain and spinal cord (peripheral nerves) that causes weakness, numbness and pain in the hands and feed.
- Can also affect digestion, urination and circulation
What are the GI s/s of cirrhosis?
- Anorexia
- Dyspepsia
- N/V
- Change in bowel habits
- Dull pain
- Fetor hepaticus
- Esophageal, gastritis and hemorrhoidal varices
- Hematemesis
What are the reproductive s/s of cirrhosis?
- Amenorrhea
- Testicular atrophy
- Gynecomastia (enlargement of the breast tissue in men or boys)
- Impotence
What are the integumentary s/s of cirrhosis?
- Jaundice
- Spider angioma
- Palmar erythema (red palms)
- Purpura
- Petechiae
- Caput medusae
What is caput medusae?
• Cluster of swollen veins in your abdomen
What are the hepatologic s/s of cirrhosis?
- Anemia
- Thrombocytopenia (low platelet count)
- Leukopenia
- Coagulation disorders
- Splenomegaly
What are the cardiovascular s/s of cirrhosis?
- Fluid retention
- Peripheral edema
- Ascites
What metabolic conditions occur with cirrhosis?
- Hypokalemia
- Hyponatremia
- Hypoalbuminemia
What are the normal potassium levels?
• 3.5-5.0
What are the s/s of hypokalemia?
- Dysrhythmias
- Weakness/cramps
- Constipation
- Hypotension
- Weak pulse
What are the normal sodium levels?
• 135-145
What are the s/s of hyponatremia?
- Tachycardia
- Hypotension
- Confusion
- Fatigue
- N/V, HA
Explain the patho of portal hypertension and how it leads to ascites/splenomegaly.
- Liver inflammation/scarring results in hepatic resistance to blood flow and causes it to back up into the portal vein
- Pressure builds causing portal hypertension
- As portal vein pressure (around 25mmHg) exceeds interstitial pressure (5-10mmHg) the vesicles start to leak into the abdomen resulting in ascites
- The portal vein pressure also backs up into the spleen resulting in splenomegaly
How does ascites cause hyponatremia and how does this affect the kidneys?
- The water of ascites draws the sodium out of circulation into the abdomen
- The resulting hyponatremia causes the kidneys to retain sodium and more water
- This fluid retention results in a feedback loop that feeds ascites and causes the peripheral edema
What are some ways to treat ascites?
- Medication
- Paracentesis
- TIPS (transjugular intrahepatic portosystemic shunt)
What is the safest way to resolve ascites?
- Sodium restriction (to slow feedback loop)
- Diuretics (for fluid removal)
- Albumin (keeps and draws sodium back into circulation)
What diuretic should be used in resolving ascites and why?
- Tolvaptan (samsca)
- It is an electrolyte sparing diuretic
Why is paracentesis a risky procedure for ascites?
• Due to the internal pressure, it could result in constant leakage and cause the pt to become hemodynamically unstable
What is the relationship between portal hypertension and varices?
- When the portal pressure gets too high, it can back up and make the veins around the stomach and esophagus to swell.
- These swollen veins are called varices.
- If they swell too much, they break open and bleed.
- This is called variceal bleeding
What is the TIPS procedure?
- Pt put under general anesthesia
- A catheter will be inserted into the jugular vein
- An X-ray with contrast dye, is used to guide the catheter until it gets to the liver.
- Then the doctor will create a channel from the hepatic vein, which is the vein that takes blood out of the liver, to the portal vein.
- This channel allows blood to bypass your liver.
- The TIPS stent, which is a wire mesh tube, will be placed to keep the channel open.
- The doctor can measure the blood flow in the veins to make sure the pressure drops.
- If it’s still too high, they might use a balloon on the catheter to open the stent wider.
- The procedure usually takes 2 to 4 hours.
- Hospitalization is required, but most pts can go home after a day or 2.
- It can take weeks or months for the TIPS to work.
What devices could be employed to stop bleeding from esophageal or gastric varices as a result of portal hypertension?
- Minnesota Tube
- Sengstaken-Blakemore Tube
When using tubes to stop variceal bleeding, what is important to monitor?
• Pulse and O2
How do the Minnesota and sengstaken-blakemore tubes work?
- Both tubes contain esophageal and gastric balloons that are inflated once in place.
- This pressure gives time for clotting to occur and stops the bleeding
Why are vitamin K and fresh frozen plasma (FFP) important w/ cirrhosis?
• They both promote clotting
Why would packed RBCs be given to a cirrhosis pt?
• To treat for anemia
What do Propranolol and Nadolol lower?
• Portal hypertension
Spironolactone or Triamterene are administered for what purpose relating to liver cirrhosis?
• Treat ascites or edema
In a pt w/ liver cirrhosis, lactulose or Rifaximin are used to treat what, and can lead to…
- Encephalitis
- Diarrhea
Cholestyramine is used to lower…
• Cholesterol
Ursodiol and antihistamines are used to treat what s/s of cirrhosis
• Pruritus
Why would PPIs be used for someone w/ cirrhosis?
• To relieve hypertensive gastropathy (gastric pressure) caused by ascites
What is the recommended diet for a cirrhosis pt?
- High calorie (3000/day)
- High carb for energy
- Low/moderate fat for bile production/nutrition
- Low/restricted protein as more protein produces more ammonia and increases risk of encephylopathy
Describe stage 1 of the development of cirrhosis.
• mild fibrosis without walls of scarring
Describe stage 2 of the development of cirrhosis.
• mild to moderate fibrosis with walls of scarring
Describe stage 3 of the development of cirrhosis.
• bridging fibrosis or scarring that has spread to different parts of the liver but no cirrhosis.
Describe stage 4 of the development of cirrhosis.
• severe scarring, or cirrhosis.
