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Care of Adult/Older Exam #3 (5701) > Hepatitis and Cirrhosis > Flashcards

Hepatitis and Cirrhosis Flashcards

1
Q

Main Functions of the liver?

A
  • Metabolic functions
  • Bile synthesis
  • Storage
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2
Q

Metabolic function of the liver?

A
  • metabalizes carbohydrates, proteins and fats
  • detoxification
  • steroid metabolism
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3
Q

Liver stores?

A

glucose, fat soluble and water soluble vitamins, fatty acids, minerals, amino acids

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4
Q

Liver weighs?

A

3-4 lbs

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5
Q

Liver blood supply?

A
  • Hepatic artery
  • Portal vein
  • Hepatic veins-blood to inferior vena cava
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6
Q

Viral causes of hepatitis?

A
  • A, B, C, D, and E virus
  • Cytomegalovirus
  • Epstein-Barr virus
  • Herpes virus
  • Rubella virus
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7
Q

Non-viral causes of hepatitis?

A
  • Drugs
  • Chemicals
  • Autoimmune
  • Metabolic
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8
Q

Hep A:

1) source
2) route of transmission
3) Chronic?

A

1) feces
2) fecal-oral (food/water)
3) no

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9
Q

Types of Hepatitis transmitted through blood/body fluids?

A

Hep B, C, D

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10
Q

Types of Hepatitis transmitted through feces?

A

Hep A & E

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11
Q

Chronic forms of Hep?

A

B, C & D

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12
Q

RNA Hepatitis Viruses?

A

A, C, D

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13
Q

DNA Hepatitis Viruses?

A

B

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14
Q

At-risk populations for Hep B?

A
  • Gay men
  • Household contact of chronically infected person
  • Patients undergoing hemodialysis
  • Health care and public safety workers
  • Transplant recipients
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15
Q

S/S of acute Hep C?

A

they are asymptomatic

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16
Q

Prior to what year, was Hep C transmitted through blood transfusions?

A

1992

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17
Q

Hep D requires what to replicate?

A

Hep B

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18
Q

Hep D description?

A

defective single stranded RNA virus, needs HBV to replication, transmitted through body fluids

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19
Q

Which form of Hep occurs primary in developing countries and why?

A

Hep E, contaminated drinking water

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20
Q

Acute phase of Hepatitis

Lasts?

A

from 1 to 4 months

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21
Q

Signs/symptoms of the Acute phase of HEP?

A

Malaise, anorexia, fatigue, nausea, vomiting, abdominal pain

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22
Q

Objective symptoms

of the Acute phase of HEP?

A

Hepatomegaly
Lymphadenopathy
Splenomegaly

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23
Q

Types of Jaundice?

A
  • Hemolytic jaundice
  • Hepatocellular jaundice
  • Obstructive jaundice
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24
Q

Hepatitis with no jaundice?

A

Anicteric hepatitis

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25
Q

Hepatitis Manifestations: Chronic Phase?

A
  • Begins as jaundice is disappearing
  • Major complaints
    • Malaise
    • Easy fatigability
    • Hepatomegaly persists
    • Splenomegaly subsides
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26
Q

Chronic phase of Hepatitis

Lasts?

A

weeks to months

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27
Q

Chronic phase of Hepatitis A.K.A?

A

post-icteric, convalescent

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28
Q

Liver biopsy pre-procedure diagnostics?

A
  • coagulation status

- Blood-T&CM

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29
Q

Liver biopsy procedure diagnostics?

A
  • Position supine/left lateral

- hold breath after expiration for needle insertion

30
Q

Liver biopsy post-procedure diagnostics?

A
  • Lie on right side to splint area, pillow under costal margin, bedrest 12 hours
  • Monitor for hemorrhage, peritonitis
31
Q

Therapy: Acute Hepatitis

A
  • Adequate nutrition
  • Hydration
  • Rest
  • No specific drug therapies
  • Support therapy
    • Antiemetics
32
Q

Chronic Hepatitis B treatment focuses on?

A
  • ↓ Viral load
  • ↓ Liver enzyme levels
  • ↓ Rate of disease progression
  • ↓ Rate of drug-resistant HBV
33
Q

Side effects of peginterferon alfa-2a?

A

Flu like symptoms, depression, hair thinning, diarrhea, insomnia

34
Q

Lamivudine (Epivir)

A
  • Tx for Hep B
  • PO daily
  • Caution in those with renal impairment
35
Q

Adefovir (Hepsera)

A
  • Tx for Hep B
  • PO daily
  • For Lamivudine resistant HBV
  • is Nephrotoxic
36
Q

Nucleoside and nucleotide analog drugs to treat Hep B?

A
  • Lamivudine
  • Adefovir
  • Entecavir
37
Q

drugs to treat Hep C?

A

peginterferon alfa-2a with ribavirin

38
Q

Ribavirin use?

A

used with peginterferon to treat Hep C

39
Q

Ribavirin side effects?

A
  • used to tx Hep-C
  • Anemia
  • anorexia
  • cough
  • rash
  • pruritus
  • dyspnea
  • insomnia
  • teratotoxicity
40
Q

Complications for Hep C?

A
  • Chronic liver disease
  • Cirrhosis
  • Hepatocellular carcinoma
41
Q

Chronic progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes

A

Cirrhosis, repeated destruction cause scar tissue to form

42
Q

Major complications of cirrhosis?

A
  • portal HTN
  • esophageal and/or gastric varices
  • peripheral edema and ascites
  • hepatic encephalopathy (mental status changes, including coma)
  • hepatorenal syndrome
43
Q

Compensated vs decompensated cirrhosis?

A
  • compensated = no complications

- decompensated = 1 or more complications

44
Q

Causes/types of Cirrhosis?

A
  • Alcoholic cirrhosis
  • Hepatitis cirrhosis
    • Complication of viral, toxic, or idiopathic hepatitis
  • Nonalcoholic Fatty Liver Disease (NAFLD)
    • History of diabetes or metabolic syndrome
  • Biliary cirrhosis
    • Associated with chronic biliary obstruction
  • Cardiac cirrhosis
    • From long-standing severe right-sided heart failure
45
Q

Diagnostics for Cirrhosis?

A
  • Liver function tests
  • Serum electrolytes
  • CBC, PT
  • Serum albumin
  • Liver ultrasound
  • CT
  • Endoscopy
  • Liver biopsy
46
Q

Early Manifestations of Cirrhosis?

A
  • Anorexia
  • Dyspepsia
  • Flatulence
  • N/V
  • Bowel changes
  • Fever
  • Abdominal pain
47
Q

Late Manifestations of Cirrhosis

A
  • Jaundice- can’t excretet bilirubin
  • Skin Lesions-dilated blood vessels
  • Hematological problems
    • thrombocytopenia,
    • leukopenia
    • anemia
    • coagulation disorders
  • Endocrine problems
    • gynecomastia
  • Peripheral neuropathy
    • dietary deficiency of
      thiamine, folic acid and
      cobalamin
48
Q

Portal hypertension is characterized by?

A
  • Increased portal venous pressure (caput medusa and hemrrhoids)
  • Splenomegaly
  • Large collateral veins
  • Ascites
  • Gastric and esophageal varices
49
Q

Accumulation of serous fluid in the peritoneal cavity

A

ascites

50
Q

ascites

A
  • Accumulation of serous fluid in the peritoneal cavity
  • Abdominal distention with weight gain
  • Common manifestation of cirrhosis
51
Q

peripheral edema in cirrhosis is cause by?

A

decreased colloidal oncotic or colloidal osmotic pressure

52
Q

What causes hepatic encephalopathy in cirrhosis?

A
  • increased ammonia levels due to inability of liver to convert ammonia to urea
  • ammonia crosses the BBB and causes neurotoxicity
53
Q

S/S of hepatic encephalopathy?

A
  • Changes in neurologic and mental responsiveness
  • Impaired consciousness and/or inappropriate behavior
  • Sleep disturbances to lethargy to coma
  • Asterixis (flapping tremors)
  • Fetor hepaticus (musty sweet odor on breath)
54
Q

musty sweet odor on breath cause by hepatic encephalopathy and portal HTN?

A

Fetor hepaticus

55
Q

flapping tremors caused by hepatic encephalopathy?

A

Asterixis

56
Q

Renal failure with advancing azotemia, oliguria, and intractable ascites

A

Hepatorenal Syndrome

57
Q

Hepatorenal Syndrome

A
  • Renal failure with advancing azotemia, oliguria, and intractable ascites
  • No structural abnormalities
58
Q

high levels of nitrogen containing compounds in the blood?

A

azotemia

59
Q

Treatment: Ascites

A
  • ow NA
  • Diuretics
  • Paracentesis
  • Peritoneovenous shunt
60
Q

Continuous reinfusion of ascitic fluid from the abdomen to the vena cava

A

Peritoneovenous shunt

61
Q

Peritoneovenous shunt

A

Continuous reinfusion of ascitic fluid from the abdomen to the vena cava

62
Q

Meds to treat an acute varices bleed?

A
  • Vitamin K
  • Octreotide
  • Vasopressin (with NTG)
63
Q

Non-med Treatment: Varices

A
  • Endoscopic ligation
  • Endoscopic sclerotherapy
  • Balloon tamponade
64
Q

Medications-long-term management of varices?

A

Propanolol (Inderal)

65
Q
  • Tract (shunt) between systemic and portal venous system
  • Decreases portal venous pressure and decompresses varices
  • non surgical tx
A

Transjugular intrahepatic portosystemic shunt (TIPS)

66
Q

Transjugular intrahepatic portosystemic shunt (TIPS)

A
  • Tract (shunt) between systemic and portal venous system
  • Decreases portal venous pressure and decompresses varices
  • non surgical tx
67
Q

Surgical Tx of Varices

1) decreases bleeding
2) leaves portal venous flow intact

A

1) Portacaval shunt

2) Distal splenorenal shunt

68
Q

medication that traps Ammonia (NH3 ) in gut?

A

Lactulose (Cephulac)

69
Q

Lactulose (Cephulac)

A
  • medication that traps NH3 in gut

- Decreased medication compliance due to severe diarrhea

70
Q

Alternative medication for Lactulose to treat Hepatic Encephalopathy?

A

Neomycin and Rifaxamin

71
Q

Acute Nursing Interventions for cirrhosis?

A

Rest, Nutrition, Fluid, Electrolytes, Accurate I/O, Daily weights, Abdominal girth, Paracentesis

72
Q

Nutritional Therapy - Cirrhosis without complications?

A
  • High in calories (3000 cal/day)
  • ↑ Carbohydrate
  • Moderate to low fat
  • Protein restriction rarely justified

Care of Adult/Older Exam #3 (5701) (8 decks)

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