Hepatitis and Cirrhosis Flashcards
Main Functions of the liver?
- Metabolic functions
- Bile synthesis
- Storage
Metabolic function of the liver?
- metabalizes carbohydrates, proteins and fats
- detoxification
- steroid metabolism
Liver stores?
glucose, fat soluble and water soluble vitamins, fatty acids, minerals, amino acids
Liver weighs?
3-4 lbs
Liver blood supply?
- Hepatic artery
- Portal vein
- Hepatic veins-blood to inferior vena cava
Viral causes of hepatitis?
- A, B, C, D, and E virus
- Cytomegalovirus
- Epstein-Barr virus
- Herpes virus
- Rubella virus
Non-viral causes of hepatitis?
- Drugs
- Chemicals
- Autoimmune
- Metabolic
Hep A:
1) source
2) route of transmission
3) Chronic?
1) feces
2) fecal-oral (food/water)
3) no
Types of Hepatitis transmitted through blood/body fluids?
Hep B, C, D
Types of Hepatitis transmitted through feces?
Hep A & E
Chronic forms of Hep?
B, C & D
RNA Hepatitis Viruses?
A, C, D
DNA Hepatitis Viruses?
B
At-risk populations for Hep B?
- Gay men
- Household contact of chronically infected person
- Patients undergoing hemodialysis
- Health care and public safety workers
- Transplant recipients
S/S of acute Hep C?
they are asymptomatic
Prior to what year, was Hep C transmitted through blood transfusions?
1992
Hep D requires what to replicate?
Hep B
Hep D description?
defective single stranded RNA virus, needs HBV to replication, transmitted through body fluids
Which form of Hep occurs primary in developing countries and why?
Hep E, contaminated drinking water
Acute phase of Hepatitis
Lasts?
from 1 to 4 months
Signs/symptoms of the Acute phase of HEP?
Malaise, anorexia, fatigue, nausea, vomiting, abdominal pain
Objective symptoms
of the Acute phase of HEP?
Hepatomegaly
Lymphadenopathy
Splenomegaly
Types of Jaundice?
- Hemolytic jaundice
- Hepatocellular jaundice
- Obstructive jaundice
Hepatitis with no jaundice?
Anicteric hepatitis
Hepatitis Manifestations: Chronic Phase?
- Begins as jaundice is disappearing
- Major complaints
- Malaise
- Easy fatigability
- Hepatomegaly persists
- Splenomegaly subsides
Chronic phase of Hepatitis
Lasts?
weeks to months
Chronic phase of Hepatitis A.K.A?
post-icteric, convalescent
Liver biopsy pre-procedure diagnostics?
- coagulation status
- Blood-T&CM
Liver biopsy procedure diagnostics?
- Position supine/left lateral
- hold breath after expiration for needle insertion
Liver biopsy post-procedure diagnostics?
- Lie on right side to splint area, pillow under costal margin, bedrest 12 hours
- Monitor for hemorrhage, peritonitis
Therapy: Acute Hepatitis
- Adequate nutrition
- Hydration
- Rest
- No specific drug therapies
- Support therapy
- Antiemetics
Chronic Hepatitis B treatment focuses on?
- ↓ Viral load
- ↓ Liver enzyme levels
- ↓ Rate of disease progression
- ↓ Rate of drug-resistant HBV
Side effects of peginterferon alfa-2a?
Flu like symptoms, depression, hair thinning, diarrhea, insomnia
Lamivudine (Epivir)
- Tx for Hep B
- PO daily
- Caution in those with renal impairment
Adefovir (Hepsera)
- Tx for Hep B
- PO daily
- For Lamivudine resistant HBV
- is Nephrotoxic
Nucleoside and nucleotide analog drugs to treat Hep B?
- Lamivudine
- Adefovir
- Entecavir
drugs to treat Hep C?
peginterferon alfa-2a with ribavirin
Ribavirin use?
used with peginterferon to treat Hep C
Ribavirin side effects?
- used to tx Hep-C
- Anemia
- anorexia
- cough
- rash
- pruritus
- dyspnea
- insomnia
- teratotoxicity
Complications for Hep C?
- Chronic liver disease
- Cirrhosis
- Hepatocellular carcinoma
Chronic progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes
Cirrhosis, repeated destruction cause scar tissue to form
Major complications of cirrhosis?
- portal HTN
- esophageal and/or gastric varices
- peripheral edema and ascites
- hepatic encephalopathy (mental status changes, including coma)
- hepatorenal syndrome
Compensated vs decompensated cirrhosis?
- compensated = no complications
- decompensated = 1 or more complications
Causes/types of Cirrhosis?
- 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
Diagnostics for Cirrhosis?
- Liver function tests
- Serum electrolytes
- CBC, PT
- Serum albumin
- Liver ultrasound
- CT
- Endoscopy
- Liver biopsy
Early Manifestations of Cirrhosis?
- Anorexia
- Dyspepsia
- Flatulence
- N/V
- Bowel changes
- Fever
- Abdominal pain
Late Manifestations of Cirrhosis
- 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
- dietary deficiency of
Portal hypertension is characterized by?
- Increased portal venous pressure (caput medusa and hemrrhoids)
- Splenomegaly
- Large collateral veins
- Ascites
- Gastric and esophageal varices
Accumulation of serous fluid in the peritoneal cavity
ascites
ascites
- Accumulation of serous fluid in the peritoneal cavity
- Abdominal distention with weight gain
- Common manifestation of cirrhosis
peripheral edema in cirrhosis is cause by?
decreased colloidal oncotic or colloidal osmotic pressure
What causes hepatic encephalopathy in cirrhosis?
- increased ammonia levels due to inability of liver to convert ammonia to urea
- ammonia crosses the BBB and causes neurotoxicity
S/S of hepatic encephalopathy?
- 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)
musty sweet odor on breath cause by hepatic encephalopathy and portal HTN?
Fetor hepaticus
flapping tremors caused by hepatic encephalopathy?
Asterixis
Renal failure with advancing azotemia, oliguria, and intractable ascites
Hepatorenal Syndrome
Hepatorenal Syndrome
- Renal failure with advancing azotemia, oliguria, and intractable ascites
- No structural abnormalities
high levels of nitrogen containing compounds in the blood?
azotemia
Treatment: Ascites
- ow NA
- Diuretics
- Paracentesis
- Peritoneovenous shunt
Continuous reinfusion of ascitic fluid from the abdomen to the vena cava
Peritoneovenous shunt
Peritoneovenous shunt
Continuous reinfusion of ascitic fluid from the abdomen to the vena cava
Meds to treat an acute varices bleed?
- Vitamin K
- Octreotide
- Vasopressin (with NTG)
Non-med Treatment: Varices
- Endoscopic ligation
- Endoscopic sclerotherapy
- Balloon tamponade
Medications-long-term management of varices?
Propanolol (Inderal)
- Tract (shunt) between systemic and portal venous system
- Decreases portal venous pressure and decompresses varices
- non surgical tx
Transjugular intrahepatic portosystemic shunt (TIPS)
Transjugular intrahepatic portosystemic shunt (TIPS)
- Tract (shunt) between systemic and portal venous system
- Decreases portal venous pressure and decompresses varices
- non surgical tx
Surgical Tx of Varices
1) decreases bleeding
2) leaves portal venous flow intact
1) Portacaval shunt
2) Distal splenorenal shunt
medication that traps Ammonia (NH3 ) in gut?
Lactulose (Cephulac)
Lactulose (Cephulac)
- medication that traps NH3 in gut
- Decreased medication compliance due to severe diarrhea
Alternative medication for Lactulose to treat Hepatic Encephalopathy?
Neomycin and Rifaxamin
Acute Nursing Interventions for cirrhosis?
Rest, Nutrition, Fluid, Electrolytes, Accurate I/O, Daily weights, Abdominal girth, Paracentesis
Nutritional Therapy - Cirrhosis without complications?
- High in calories (3000 cal/day)
- ↑ Carbohydrate
- Moderate to low fat
- Protein restriction rarely justified
