Liver Flashcards
serum aminotransferases
- indicators of injury to the liver cells
- useful in detecting hepatitis
alanine aminotransferase (ALT)
- levels increase primarily in liver disorders
- used to monitor course of hepatitis, cirrhosis, the effects of treatments that may be toxic to the liver
asparte aminotransferase (AST)
- not specific to liver diseases
- levels of AST may be increased in cirrhosis, hepatitis, and liver cancer
Gamma-glutamyl transferase (GGT)
- levels are associated with cholestasis
- alcoholic liver disease
Diagnostic Studies
- liver biopsy
- US
- CT
- MRI
- LFTs
S/S Physical Manifestations of Hepatic Dysfunction
- jaundice
- portal HTN
- ascites and varices
- hepatic encephalopathy or coma
- nutritional deficiencies
Jaundice
- yellow or green sclera and skin caused by increased serum bilirubin levels
- bilirubin level exceeds 2mg/dL
S/S of Hepatocellular Jaundice
- mild or severely ill
- lack of appetite, n/v, weight loss
- malaise, fatigue, weakness
- HA, chills, fever, infection
S/S of Obstructive Jaundice
- dark orange-brown urine, clay-colored stools
- dyspepsia and intolerance of fats, impaired digestion
- pruritus (itchy)
Portal HTN results in…
- ascites
- varices
Ascites Assessment
- record abdominal girth and weight daily
- assess for fluid in abdominal cavity (percussion or fluid wave)
- monitor for potential fluid and electrolyte imbalances
Ascites Treatment
- low sodium diet
- diuretics
- bed rest
- paracentesis
- administration of salt-poor albumin
- TIPS
The nurse is caring for a patient immediately after paracentesis. It is most important for the nurse to ask what question?
Are you feeling dizzy?
Bleeding Varices Treatment
- treat for shock
- O2 administration
- IV fluids, electrolytes, volume expanders, blood and blood products
- VASOPRESSIN, SOMATOSTATIN, OCTREOTIDE to decrease bleeding
- nitroglycerin in combination with vasopressin to reduce coronary vasoconstriction
- PROPANOLOL and NADOLOL to decrease portal pressure (used in combo with other tx)
- balloon tamponade
- endoscopic sclerotherapy
- TIPS
- surgical bypass procedures
- devascularization and transection
- AVOID alcohol, NSIADS, and aspirin
The purpose of an H2 receptor blocker for a patient with bleeding esophageal varices is…
to prevent irritation of enlarged veins
A patient is being treated for bleeding esophageal varices with balloon tamponade. What nursing action will be included in the plan of care?
monitor patient for SOB
Early S/S of Hepatic Encephalopathy
- mental changes (confusion)
- motor disturbances (asterixis)
Assessment of Hepatic Encephalopathy
- EEG
- changes in LOC
- potential seizures
- fetor hepaticus
- monitor fluid, electrolyte, and ammonia levels
Stage 1 of Hepatic Encephalopathy and Nursing Dx
- normal LOC with periods of lethargy and euphoria
- reversal of day-night sleep patterns
- impaired writing and ability to draw line figures
- normal EEG
- Nursing Dx: activity intolerance, impaired ability to manage regime, impaired sleep pattern
Stage 2 of Hepatic Encephalopathy and Nursing Dx
- increased drowsiness
- disorientation
- inappropriate behavior, mood swings
- agitation
- asterixis
- fetor hepaticus
- abnormal EEG w/ generalized slowing
- Nursing Dx: impaired socialization, impaired role performance, risk for injury, acute confusion
Stage 3 of Hepatic Encephalopathy and Nursing Dx
- stuporous
- difficult to rouse
- sleeps most of time
- marked confusion
- incoherent speech
- asterixis
- increased deep tendon reflexes
- rigidity of extremities
- EEG markedly abnormal
- Nursing Dx: impaired nutritional intake, impaired mobility, impaired verbal communication
Stage 4 of Hepatic Encephalopathy and Nursing Dx
- comatose
- may not respond to painful stimuli
- absence of asterixis
- absence of deep tendon reflexes
- flaccidity of extremities
- EEG markedly abnormal
- Nursing Dx: risk for aspiration, exchange impaired tissue integrity
Medical Management of Hepatic Encephalopathy
- eliminate precipitating cause
- LACTULOSE, RIFAXIMIN OR NEOMYCIN to reduce serum ammonia levels
- IV glucose to minimize protein catabolism
- protein intake 1.2-1.5g/kg/day
- reduction of ammonia from GI tract by gastric suction, enemas, oral ABX
- d/c sedatives, analgesics, and tranquilizers
- monitor or treat complications of infection
Which action should the RN take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?
ask the patient to extend both arms forward (assess for asterixis)
Hepatitis A Pathophysiology
- fecal-oral
- spread by poor hand hygiene
- incubation: 2-6 weeks
- illness may last 4-8 weeks
Hep A S/S
- mild flu-like s/s
- low-grade fever
- anorexia
- later: jaundice and dark urine
- indigestion and epigastric distress
- enlargement of liver and spleen
Hep A Management
- Bed rest during acute stage
- nutritional support
Hep A Prevention
- good hand washing, safe water, and proper sewage disposal
- vaccination (HAVRIX AND VAQTA)
- immune globulin for contacts to provide passive immunity
- health promotion
Hepatitis B Pathophysiology
- transmitted through blood, saliva, semen, and vaginal secretions
- sexually transmitted
- transmitted to infant at the time of birth
- long incubation period: 1-6 months
Hep B Risk Factors
- close contact with carrier of Hep B
- frequent exposure to blood, blood products, or other body fluids
- health care workers
- hemodialysis
- IV/injection drug use
- gay men and bisexual activity
- mother-to-child transmission
- multiple sex partners
- receipt of blood or blood products
- recent hx of STI
- tattooing
- travel to residence in area w/ uncertain sanitary conditions
Hep B S/S
- insidious and variable
- similar to HAV
- loss of appetite
- dyspepsia
- abdominal pain
- generalized aching
- malaise
- weakness
- jaundice may or may not be evident
Hep B Complications
- liver failure
- chronic liver disease
- cirrhosis
- primary liver cancer
Hep B Surface Antigen (HBsAg)
- Active disease
- screening test for Hep B
- presence of antigen means either an acute infection or chronic Hep B infection
Hep B Surface Antibody (Anti-HBs)
- resolving illness
- past infection
- immunized with vaccine for HBV
Hep B Core Antibody (Anti-HBc)
- appears at the onset of s/s in acute Hep B and persists for life
- the presence of anti-HBc indicates previous or ongoing infection with HBV in an undefined time frame
Hep B e-antigen (HBeAg)
- indicates active viral replication
- may be highly infectious
Antibody to Hep B e-antigen (Anti-HBe)
- lower levels of virus, less infectivity
Hep B Prevention
- HBV screening
- safe sex practices
- HBV Vaccine
- hand washing
- standard precautions
Management of Hep B
- Acute HBV –> bed rest and nutritional support
- Chronic HBV –> medications include ALPHA INTERFERON AND ANTIVIRAL AGENS: ENTECAVIR (ETV) AND TENOFOVIR (TDF)
- Vaccine (ENGERIX-B, RECOMBIVAX HB): for persons at high risk, routine vaccination of infants
- new HEPLISAV-B for people over 18
- passive immunization for those exposed but not vaccinated (HBIG)
- standard precautions and infection control measures
- screening of blood and blood products
Hepatitis C Pathophysiology
- transmitted by blood and sexual contact (including needle sticks and sharing of needles)
- most common blood borne infection
- Incubation period: 15-160 days
- chronic carrier state frequently occurs
Hep C S/S
usually mild
Hep C Risk Factors
- children born to women infected with HCV
- health care and public safety workers after needlestick injuries or mucosal exposure to blood
- multiple contacts with a person infected with HCV
- multiple sex partners, hx of STI, unprotected sex
- past/current illicit IV/injection drug use
- recipient of blood products or organ transplant before 1992 or clotting factor concentrates before 1987
Hep C Dx Sequence
HCV Antibody + –> HCV RNA + –> Current HCV Infection
Hep C Prevention
- universal screening for all persons born between 1945 and 1965
- universal screening for all persons given blood products before 1992
- screening at least once in a lifetime for ALL ADULTS aged 19 years and older
- screening for ALL PREGNANT WOMEN DURING EACH PREGNANCY
- screening of blood, organ, and tissue donors
- using infection control precautions
- modifying high risk behaviors
- avoid sharing needles, razors, and toothbrushes
Hep C Management
- Antiviral medications:
- DIRECT-ACTING ANTI-VIRAL (DAA) PREFERRED TX: can cure HCV
- COMBINATION THERAPY: ombitasvir + paritaprevir + ritonvir + dasabuvir (Viekira Pak) + ribavirin - alcohol potentiates disease
- medications that effect liver should be avoided
Cirrhosis of the Liver S/S
THE LIVER IS SCARRED
- Tremors of hands
- Hepatic fetor
- Eye and skin yellowing
- Loss of appetite
- Increased bilirubin
- Varices
- Edema in legs
- Reduced platelets
- Itchy Skin
- Spider angiomas
- Splenomegaly
- Confusion or Coma
- Ascites
- Redness on the palms
- Renal failure
- Enlarged breasts in men
- Deficient vitamins
What finding indicates to the nurse that lactulose is effected for an older adult who has advanced cirrhosis?
patient is alert and oriented
Nursing Interventions for Cirrhosis of the Liver
- promoting rest
- improving nutritional status
- providing skin care
- reducing risk of injury
- monitoring and managing potential complications
Liver Cancer S/S
- dull persistent pain, RUQ, back, or epigastrum
- weight loss, anemia, anorexia, weakness
- jaundice, bile ducts occluded, ascites, or obstructed portal veins
Nonsurgical Management of Liver Cancer
- underlying cirrhosis –> increases risks of surgery
- radiation therapy
- chemotherapy
- percutaneous biliary drainage
Surgical Management of Liver Cancer
- Tx of choice if confined to one lobe and liver function is adequate
- lobectomy
- cryosurgery
- liver transplant
Post-Op Care of Patient Undergoing Liver Transplant
- monitory for infection, vascular complications, respiratory and liver dysfunction
- constant close monitoring
Which action should the RN in the Ed take FIRST for a new patient who is vomiting blood?
check BP and HR
