Liver Flashcards
Liver Function Tests (LFTs)
-Alanine transaminase (ALT): enzyme, an increase indicates liver damage.
Aspartate transaminase (AST): enzyme, an increase indicates liver or muscle damage/disease.
Alkaline phosphatase (ALP): an enzyme in liver, bile ducts, and bone; an increase indicates liver damage or blocked bile duct, or bone disease
Liver Labs
Albumin: protein, made in the liver; decreased levels with liver damage or disease.
Prothrombin time (PT): protein made by the liver; prolonged in liver damage/dz ; monitor INR- increased bleeding.
Bilirubin (Tbili): a substance produced during the normal breakdown of red blood cells. Increased in liver damage/dz and certain anemias.
Ammonia: (NH3), a byproduct of amino acid catabolism. Increased with hepatic encephalopathy.
Diagnostic Evaluation
Liver biopsy
US
CT
MRI
Endoscopy
Laparoscopy
Jaundice
High levels of bilirubin in the blood (hyperbilirubinemia)
Jaundice: serum bilirubin levels > 2-2.5 mg/dL
Different causes
Can cause pruritus, urine bilirubin, and elevated liver function tests
pruritis intervention
keep finger nails short
Portal Hypertension
Scar tissue blocks the flow of blood through the liver and slows its processing functions portal HTN
Consequences:
Ascites
Esophageal varices
Ascites
Low Na diet
Diuretics (spironolactone)
Albumin
May require paracentesis
Nursing management
Esophageal & gastric varices
Bleeding esophageal varices life-threatening
Band ligation (next slide)
Administration of FFP, PRBC, PPI (proton pump inhibitors), Vitamin K, lactulose, antibiotics, meds to stop bleeding (sandostatin)
Sclerotherapy
Balloon tamponade
Shunting procedures (TIPS)
Other manifestations of hepatic dysfunction
Edema and bleeding
Vitamin deficiency
Metabolic abnormalities
Pruritus and other skin changes
Hepatitis
An acute or chronic inflammation of the liver resulting in lysis of infected hepatocytes
Causes:
Viral (A, B, C, D, E, G and mononucleosis, cytomegalovirus, and rubella)
Autoimmune
Nonviral: toxic and drug-induced hepatitis
Clinical Manifestations of hepatitis
Acute (1-4 months)
Maybe asymptomatic but period of maximal infectivity
Malaise, fatigue, anorexia, weight loss, nausea/vomiting, RUQ abdominal pain, taste and smell alterations
headache, low-grade fever, arthralgias, skin rashes
Icteric (jaundice) or anicteric
May have dark urine and/or light or clay-colored stools
Pruritus
Hepatomegaly, lymphadenopathy, and sometime splenomegaly
Convalescent phase (2-4 months)
Malaise and fatigue
Hepatomegaly
Hepatitis A
Educate patients regarding safe practices for preparing and dispensing food.
Encourage conscientious individual hygiene.
Encourage proper community and home sanitation.
Facilitate mandatory reporting of viral hepatitis to local health departments.
Promote community health education programs.
Promote vaccination to interrupt community-wide outbreaks.
Recommend pre-exposure vaccination for all children 12–23 months of age. Continue existing immunization programs for children 1–18 years of age.
Recommend vaccination for travelers to developing countries, illegal drug users (injection and noninjection drug users), men who have sex with men, people with chronic liver disease, people who work with HAV-infected animals or work with HAV in research facilities and recipients (e.g., hemophiliacs) of pooled plasma products for clotting factor disorders.
Support effective health supervision of schools, dormitories, extended care facilities, barracks, and camps.
Hepatitis B
Advise avoidance of high-risk behaviors.
Avoid multidose vials in patient care settings.
Monitor cleaning, disinfection, and sterilization of reusable devices in patient care settings.
Recommend vaccination for international travelers to regions with high or intermediate levels of endemic hepatitis B virus infection and for persons with chronic liver disease or with human immune deficiency virus infection.
Recommend vaccination for persons at risk for infection by sexual exposure, by percutaneous or mucosal exposure to blood.
Recommend vaccination of all infants in the United States regardless of the mother’s hepatitis B.
Use barrier precautions in situations of contact with blood or body fluids.
Use needleless IV and injection systems in health care.
Use standard precautions in clinical care.
Hepatitis C
Advise avoidance of high-risk behaviors such as IV drug use.
Avoid multidose vials in patient care settings.
Monitor cleaning, disinfection, and sterilization of reusable devices in patient care settings.
Use barrier precautions in situations of contact with blood or body fluids.
Use needleless IV and injection systems in health care.
Use standard precautions in clinical care.
CDC Hepatitis C recommendation
CDC recommendation: all adults born during 1945-1965 receive one-time testing for Hepatitis C Virus (HCV)
Diagnostic Testing for Hepatitis
Test for specific antigen or antibody to determine form of hepatitis (for example, Anti-HAV IgM is specific for acute infection of HAV)
Viral genotype testing done in patients undergoing drug therapy for HBV and HCV
Liver function tests
Collaborative care for Acute Hepatitis
Rest
Adequate nutrition
Avoid alcohol
Notification of possible contacts
Pharmacologic Therapy for Chronic Hepatitis
Goal: suppress viral replication and prevent complications
Monitor for anemia, leukopenia, and depression with drugs (side effects of drugs particularly for Hep C)
Complications of Hepatitis
Most patients with acute viral hepatitis recover completely
Complications that can occur:
Acute liver failure
Chronic hepatitis (some HBV and majority of HCV)
Cirrhosis of the liver
Hepatocellular carcinoma
Autoimmune, Genetic, Metabolic Diseases of the Liver
Autoimmune hepatitis
Wilson’s (cumulation of copper)
Hemochromatosis
NAFLD (nonalcoholic fatty liver disease) and NASH (nonalcoholic steatohepatitis)
Nonviral Hepatitis, Toxic Hepatitis
Chemicals
Early treatment and removal of causative agent
No effective antidotes
Signs/symptoms: early (resembles viral hepatitis) to toxic (fulminant hepatic failure)
Nonviral Hepatitis Drug Induced
Anabolic Steroids
Cirrhosis
Cells attempt to regenerate but are disorganized
Diffuse fibrosis forms constrictive bands
Formation of nodules and scarring
Cirrhosis Risk Factors
alcohol
malnutrition
viral hepatitis
biliary obstruction
obesity
right-sided heart failure
Cirrhosis s/sx
Early: fatigue
Later: Jaundice
Spider angiomas and palmar erythema
Thrombocytopenia, leukopenia, anemia
Coagulation disorders (bleeding tendencies)
Endocrine problems
Peripheral neuropathy
Cirrhosis Diagnostic Studies
Liver function studies*
Liver ultrasound
Liver biopsy
Cirrhosis complications
Portal hypertension
varices (esophageal, gastric, hemorrhoids, superficial abd. veins)
ascites and edema
splenomegaly
hepatic encephalopathy
hepatorenal syndrome
Collaborative Care for Cirrhosis
Goal: slow the progress of cirrhosis, prevent and treat any complications
Management of ascites
Prevent bleeding and hemorrhage from esophageal and gastric varices
Reduction of ammonia formation with hepatic encephalopathy
Diet high in calories, high CHO, moderate to low levels of fat; pt with ascites-low-sodium diet; protein restriction rare
Initiate appropriate referrals
Nursing Care for patients with Cirrhosis
Dyspnea- semi-fowler’s, coughing and deep breathe. Cluster care.
Fatigue
Anorexia, n/v
Jaundice, pruritus
Edema, ascites (monitor, BP, Daily weights, lung sounds, I&Os)
Monitor electrolytes (diuretics)
Bleeding tendencies (soft toothbrush)
Hepatic encephalopathy (safety!- bed alarms)
Acute liver failure/ fulminant hepatic failure
Causes: drugs (acetaminophen), HBV
S/sx: change in mentation, jaundice, coagulation abnormalities, encephalopathy
Complications: renal failure, cerebral edema, sepsis
Treatment
Liver cancer/hepatocellular cancer
Cirrhosis caused by chronic hepatitis C most common cause
Metastatic carcinoma is more common than primary carcinoma
Manifestations often insidious ( slow-creeps in)
Tx: hepatic resection of the tumor, different types of ablation, chemotherapy, or transplantation
Liver transplantation
Rigorous pre-surgery screening
Performed using both deceased and live donor livers
Split liver transplant (peds*)
Postop complications
Immunosuppressive therapy
