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z_NUR411_Medsurge: UNIT 2 > Hepatic System: Cirrhosis > Flashcards

Hepatic System: Cirrhosis Flashcards

1
Q

What is Cirrhosis?

A

• Extensive degeneration, destruction and fibrosis (scarring) of the liver

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2
Q

What is the patho for cirrhosis?

A
  • 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
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3
Q

What are the 3 main types/causes:

A
  • Postnecrotic
    • Viral hepatitis
    • Toxins/drugs
  • Biliary
    • Chronic biliary obstruction
  • Laennec’s
    • Chronic alcoholism
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4
Q

What are the early s/s of Cirrhosis?

A
  • Pain
  • Fever
  • N/V
  • Fatigue
  • Hepatomegaly
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5
Q

What labs indicate cirrhosis?

A
  • ↑ ALT,AST, Bilirubin, Ammonia
  • ↓ Serum protein, Albumin, RBC, Hgb/Hct, Platelets
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6
Q

What are the dx tests for cirrhosis?

A
  • Liver biopsy
  • Ultrasound
  • CT/MRI
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7
Q

What are the tx options for cirrhosis?

A
  • Medications
  • Vitamin/mineral supplements
  • Diuretics
  • Lactulose
  • Procedures
  • Liver transplant
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8
Q

What is the nursing care for cirrhosis?

A
  • Monitor I/Os
  • Restrict fluids and sodium as ordered
  • Monitor for complications
  • Encephalopathy
  • Portal hypertension
  • Esophageal varices
  • Hemorrhage
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9
Q

What is our pt teaching for cirrhosis?

A
  • Low sodium diet
  • Small freq meals
  • No alcohol (encourage recovery program)
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10
Q

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.

A

• True

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11
Q

What is the difference between where hepatitis pts and cirrhosis pts get their tx?

A
  • Hep pts get their care as an outpatient at a doctor’s office
  • Cirrhosis pts get their tx in the hospital
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12
Q

What is Korsakoff’s syndrome?

A
  • 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
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13
Q

What does vitamin B1 (thiamine) do?

A

• Helps the body convert carbohydrates into glucose, which is critical for brain function

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14
Q

What are the s/s of Korsakoff’s syndrome?

A
  • Anterograde amnesia
  • Retrograde amnesia
  • Confabulation
  • Meager content in conversation
  • Lack of insight
  • Apathy
  • Ataxia
  • Tremor
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15
Q

What is anterograde amnesia?

A

• Decreased ability to retain new information

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16
Q

What is retrograde amnesia?

A

• Inability to remember what happened in the years, or decades , prior to injury

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17
Q

What is confabulation?

A

• Made-up stories fill in any gaps in memory

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18
Q

What is ataxia?

A

• A condition that presents with difficulties with: balance and walking. speaking. swallowing.

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19
Q

What are the neurologic s/s of cirrhosis?

A
  • Hepatic encephalopathy
  • Peripheral neuropathy
  • Asterixis
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20
Q

What is hepatic encephalopathy?

A
  • 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
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21
Q

What is peripheral neuropathy?

A
  • 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
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22
Q

What are the GI s/s of cirrhosis?

A
  • Anorexia
  • Dyspepsia
  • N/V
  • Change in bowel habits
  • Dull pain
  • Fetor hepaticus
  • Esophageal, gastritis and hemorrhoidal varices
  • Hematemesis
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23
Q

What are the reproductive s/s of cirrhosis?

A
  • Amenorrhea
  • Testicular atrophy
  • Gynecomastia (enlargement of the breast tissue in men or boys)
  • Impotence
24
Q

What are the integumentary s/s of cirrhosis?

A
  • Jaundice
  • Spider angioma
  • Palmar erythema (red palms)
  • Purpura
  • Petechiae
  • Caput medusae
25
Q

What is caput medusae?

A

• Cluster of swollen veins in your abdomen

26
Q

What are the hepatologic s/s of cirrhosis?

A
  • Anemia
  • Thrombocytopenia (low platelet count)
  • Leukopenia
  • Coagulation disorders
  • Splenomegaly
27
Q

What are the cardiovascular s/s of cirrhosis?

A
  • Fluid retention
  • Peripheral edema
  • Ascites
28
Q

What metabolic conditions occur with cirrhosis?

A
  • Hypokalemia
  • Hyponatremia
  • Hypoalbuminemia
29
Q

What are the normal potassium levels?

A

• 3.5-5.0

30
Q

What are the s/s of hypokalemia?

A
  • Dysrhythmias
  • Weakness/cramps
  • Constipation
  • Hypotension
  • Weak pulse
31
Q

What are the normal sodium levels?

A

• 135-145

32
Q

What are the s/s of hyponatremia?

A
  • Tachycardia
  • Hypotension
  • Confusion
  • Fatigue
  • N/V, HA
33
Q

Explain the patho of portal hypertension and how it leads to ascites/splenomegaly.

A
  • 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
34
Q

How does ascites cause hyponatremia and how does this affect the kidneys?

A
  • 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
35
Q

What are some ways to treat ascites?

A
  • Medication
  • Paracentesis
  • TIPS (transjugular intrahepatic portosystemic shunt)
36
Q

What is the safest way to resolve ascites?

A
  • Sodium restriction (to slow feedback loop)
  • Diuretics (for fluid removal)
  • Albumin (keeps and draws sodium back into circulation)
37
Q

What diuretic should be used in resolving ascites and why?

A
  • Tolvaptan (samsca)
  • It is an electrolyte sparing diuretic
38
Q

Why is paracentesis a risky procedure for ascites?

A

• Due to the internal pressure, it could result in constant leakage and cause the pt to become hemodynamically unstable

39
Q

What is the relationship between portal hypertension and varices?

A
  • 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
40
Q

What is the TIPS procedure?

A
  • 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.
41
Q

What devices could be employed to stop bleeding from esophageal or gastric varices as a result of portal hypertension?

A
  • Minnesota Tube
  • Sengstaken-Blakemore Tube
42
Q

When using tubes to stop variceal bleeding, what is important to monitor?

A

• Pulse and O2

43
Q

How do the Minnesota and sengstaken-blakemore tubes work?

A
  • 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
44
Q

Why are vitamin K and fresh frozen plasma (FFP) important w/ cirrhosis?

A

• They both promote clotting

45
Q

Why would packed RBCs be given to a cirrhosis pt?

A

• To treat for anemia

46
Q

What do Propranolol and Nadolol lower?

A

• Portal hypertension

47
Q

Spironolactone or Triamterene are administered for what purpose relating to liver cirrhosis?

A

• Treat ascites or edema

48
Q

In a pt w/ liver cirrhosis, lactulose or Rifaximin are used to treat what, and can lead to…

A
  • Encephalitis
  • Diarrhea
49
Q

Cholestyramine is used to lower…

A

• Cholesterol

50
Q

Ursodiol and antihistamines are used to treat what s/s of cirrhosis

A

• Pruritus

51
Q

Why would PPIs be used for someone w/ cirrhosis?

A

• To relieve hypertensive gastropathy (gastric pressure) caused by ascites

52
Q

What is the recommended diet for a cirrhosis pt?

A
  • 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
53
Q

Describe stage 1 of the development of cirrhosis.

A

• mild fibrosis without walls of scarring

54
Q

Describe stage 2 of the development of cirrhosis.

A

• mild to moderate fibrosis with walls of scarring

55
Q

Describe stage 3 of the development of cirrhosis.

A

• bridging fibrosis or scarring that has spread to different parts of the liver but no cirrhosis.

56
Q

Describe stage 4 of the development of cirrhosis.

A

• severe scarring, or cirrhosis.

z_NUR411_Medsurge: UNIT 2 (25 decks)

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