Hepatitis/Cirrhosis Flashcards
What is viral hepatitis and cirrhosis of the liver?
- inflammation of the liver due to viral infection
- Hep. A,B,C,D,E,G are all viral
- Hep. A, B, C common in canada
What are the lobules?
functional unit of the liver
What does the liver do?
- filters circulating blood
- removes toxins
- aids in digestion
- regulates sugar
- makes and stores proteins/vitamins/fats
Prevention of hepatitis?
- Vaccinations
- No sharing of personal hygiene products
- Safe sex
Non-modifiable risk factors for viral hepatitis?
Culture and ethnicity
-first nation groups have 5.5 times higher rate of hep. C infection
Gender
-hep. c infection rate 2x higher in young men
Modifiable risk factors for viral hepatitis?
- Prison inmates at higher risk of Hepatitis C infection
- Injection drug users have higher rates of hepatitis C infection
Pathophysiology of viral liver disease?
- inflammation of liver tissue
- During acute infection, liver damage is mediated by natural killer cells that cause lysis of infected hepatocytes resulting in cell death
- Liver cells normally regenerate through cellular replication and resume normal function
- Cellular replication may not be possible if liver cell loss is massive
Manifestations of acute hepatitis? + who is at risk?
-pain in upper right quadrant of abdomen
-nausea & vomiting
-loss of appetite
-jaundice
-fatigue
-itching
(usually no symptoms in acute phase. Lasts from 1-4 months)
At Risk:
- ppl who share needles
- healthcare workers exposed to infected blood
Manifestations of chronic hepatitis?
- Malaise
- Easy fatigability
- Myalgia (muscle pain)
- Arthralgia (joint pain)
- Hepatomegaly
Diagnostic Studies for viral hepatitis?
- Viral serology (can screen for current/past infection)
- Serum liver enzymes (ALP & AST will be elevated when liver damage is present)
- Liver function tests (LFT’s)
- bilirubin function test; will not be excreted if liver is damaged
- liver albumin will also be decreased
- prothrombin time and INR test. when elevated, it marks an injured liver
Hep A transmission through?
fecal-oral route. Mainly by ingesting food/liquid with the virus
Prevention precautions for hep. A
- vaccine
- hand washing
Hep B transmission through? + Most common in?
- Transmission by blood and body fluids, nail clippers, sharing of personal hygiene products, body piercings, tattoos
- Immigrants
Highly infectious and can live outside the human body for up to 7 days
doesn’t always go away and can lead to chronic infection
Treatment of chronic hep. B? + Goals of drug therapy?
- interferons
- oral antiviral agents
Goals:
-Decrease viral load decrease liver enzyme levels (interferon)
-Decrease the rate of disease progression (antiviral agent)
Not a cure
Transmission of Hep. C?
-blood and body fluids
likely to cause liver damage
common in individuals between 15-34
Treatment of chronic Hep. C?
- Can be cured with drug treatment
- Combination of interferon and Ribavirin
- Protease Inhibitors may be added to treatment
- Patients with fibrosis and cirrhosis can be treated with the drugs as long as the cirrhosis is compensated
Prevention for Hep. B + C?
- not sharing personal hygiene products
- safe sex
Interventions during acute viral infection?
- Increase intake of food
- Increase rest/Improve activity tolerance
- Improve/Facilitate management of prescribed therapeutic regime
What are non-viral liver diseases?
- non-alcoholic liver disease
- alcoholic liver disease
lifestyle modifications for non-viral liver disease?
- weight loss
- regular exercise
What is cirrhosis of the liver?
- End stage of chronic liver disease.
- Most of functional liver tissue has been replaced by fibrous/scar tissue.
Three categories of cirrhosis?
- Hepatocellular (infection/CA of liver)
- Metabolic liver disease (NAFLD)
- Cholestatic disease (impairment of bile flow)
Etiology of cirrhosis?
Any chronic liver disease can cause cirrhosis
- chronic viral hepatitis (B/C)
- non-alcoholic fatty liver disease (NAFLD)
- alcoholic liver disease
pathophysiology of cirrhosis?
liver cell injury -> scar tissue formation -> cirrhosis
Clinical manifestations of compensated cirrhosis?
- Often no specific physical symptoms
- Abdominal pain
- Fatigue
- Slight weight loss
- Enlargement of the liver and spleen
- Intermittent fever
- Redden palmer
- Unexplained epistaxsis
- Edema
Clinical manifestations of decompensated cirrhosis?
dark urine
- light stool
- GI symptoms (N&V)
- anorexia
- jaundice
Complications of cirrhosis?
- Portal HTN (liver shrinks and is less vascular and blood pools in portal vein)
- Esophageal & gastric varices (abnormal large veins in lower part of esophagus which can rupture and cause the pt to bleed to death)
- Peripheral edema (decreased colloidal osmotic pressure)
- Ascites (accumulation of fluid in abdominal cavity)
Digestive disturbances of cirrhosis?
- lower/upper GI bleed
- Diverticulosis
- Crohn’s disease
- Gallbladder disease
- Pancreatitis/Pancreatic CA
- Abdo pain
- Malnutrition
Complications of cirrhosis?
- Hepatic Encephalopathy
- Hepatorenal Syndrome
Hepatic Encephalopathy?
- Neuropsychiatric manifestation of liver disease
- Lethargy to deep coma
- Results from ammonia entering the systemic circulation without detoxification by the liver.
Hepatorenal syndrome?
- Serious complication of cirrhosis
- Characterized by functional kidney failure
- No structural abnormality of the kidney
- Can be reversed with liver transplantation
Later manifestations of cirrhosis?
- spider nevi (neck,shoulder,cheek)
- palmar erythema (due to increase of circulating estrogen)
- Epitstaxis
- Purpura and Petechiae
Diagnostic studies for cirrhosis?
Blood Tests
- liver function studies
- liver enzyme measurements
Liver ultrasound/ CT Scan/ MRI/ radioisotope liver scan
Liver Biopsy
Goals of collaborative care for cirrhosis?
- Rest
- Management of ascites
- Prevention of bleeding from varices
- Reduction of ammonia formation
Increase rest by?
-generate schedule with periods of rest and activity
-administer pain meds
-group nursing interventions together to decrease stimuli
assistance with ADL’S
Improve nutrition intake by?
- small frequent meals, high calories
- no protein restriction
- fat restriction
- manage N&V
- low sodium
- oral hygiene
- pleasant environment for meal
Maintain skin integrity by?
- avoid use of soap/alcohol based lotion to not dry out skin
- keep fingernails short
- avoid use of harsh detergents
- restrict Na to lessen edema
- T&P, promote movement
- air pressure bed
Decrease risk of injury by?
- side rails up, safe environment, call bell in reach
- clutter free room
- restraints, PRN
- morse fall scale
- soft diet
cold fluid can stop small amounts of bleeding
observe color of stool
antitussive for pt’s with cough
Facilitate chest expansion/pulmonary ventilation by?
- elevate HOB
- deep breathing
- change position
Decrease fluid volume excess by?
- restrict Na
- monitor I&O
- weigh Qd
- track abdominal girth
- administer diuretics
- paracentesis
Nursing care for cirrhosis goals?
- Facilitate role performance
- Improve body image
- Decrease pain and discomfort
- Decrease risk of infection
- Maintain/improve orientation
Preventing Liver Disease?
- limit alcohol consumption
- check home for toxic products to liver (aerosol)
- caution when travelling
- caution when using medications which can cause hepatoxicity
- safe sex
- maintain nutrition & exercise (maintain good wt)
- pamper body (limit piercings/tattoos)
Incubation period for hep. A,B,C
- A: 28 days
- B: 120 days
- C: 45 days
