Liver cirrhosis

Question 1

Liver cirrhosis: what

Answer 1

scarring of the liver

Question 2

Liver cirrhosis: etiology (developed (3) vs developing world (2) + other(4))

Answer 2

*developed world: HepC, alcoholic liver disease, nonalcoholic steatohepatitis

*developing world: hep B and C

*Other: chronic liver disease, autoimmune hepatitis, drug-induced liver cirrhosis, and chronic right-sided HF

Question 3

liver cirrhosis: patho (relation to hepatitis (6))

Answer 3

*cirrhosis occurs when liver becomes damaged over a long period of time.

*infection life Hep b and c injures the liver -> scar tissue and nodules to form -> inflammatory response occurs -> alters the normal anatomy of the liver -> scarring turns fibrotic and alters the liver function -> decreased ability to metabolize drugs, change in blood flow, and change in protein binding

Question 4

liver cirrhosis: diagnostic studies and pertinent labs (10)

Answer 4

*AST and ALT: norm or elevated
*ALP: elevated
*GGT: high
*bilirubin: elevated later, important predictor of mortality
*albumin: decreased
*PTT decreased
*Immune globulins: increased
*Na: low
*RBC: low
*platelets: low

Question 5

What are three things that build up in the blood when the liver becomes damaged

Answer 5

fluid, ammonia, and bilirubin

Question 6

liver cirrhosis: long-term comp (3) + s/s

Answer 6

*ascites: edema, distended abd, bacterial peritonitis (life-threatening)

*hyperammonemia: irritability, HA, n/v, ataxia, seizures, coma, encephalopathy, cerebral edema, brain herniation (life-threatenting)

*hyperbilirubinemia: jaundice, fever, chills, pale stool

Question 7

long-term comp tx (3)

Answer 7

*ascites: low Na diet, diuretics, paracentesis

*hyperammonemia: lactulose, dialysis

*hyperbilirubinemia: treat cause

Question 8

indication for a paracentesis w/ liver cirrhosis

Answer 8

ascites

Question 9

hospice criteria for liver cirrhosis (5)

Answer 9

*must have at least 3 of the following…
1. malnutrition
2. jaundice
3. ascites
4. encephalopathy
5. variceal bleeding

Question 10

liver cirrhosis: pt education (5)

Answer 10

*no lifestyle change will lead to a cure, but can delay disease progression
*avoid alcohol
*avoid seafood
*eat low Na diet
*get hepatitis vaccines

Question 11

hospice care for liver cirrhosis

Answer 11

*pain management
*s/s management: fatigue, nausea, loss of appetite, difficulty breathing
*emotional/psychological support
*assistance w/ADLs
*end-of-life planning

Question 12

concerns regarding s/s management and drug abuse hx

Answer 12

*supportive measures include proper diet, rest, and avoiding potentially hepatotoxic OTC drugs such as tylenol in high doses and abstaining from alcohol
*can be difficult for pts who’s cirrhosis is caused by alcohol abuse.
*provide care w/o be condescending or judgemental and tx pts w/ respect and concern for their well-being
*provide info about community support programs such as AA

Question 13

function of the liver

Answer 13

*metabolism of nutrients, drugs, toxins
*Protein synthesis: liver produces important proteins (albumin) which helps maintain fluid balance and clotting factors
*Bile production: necessary for digestion and absorption of fats in the intestines
*Detoxification
*Storage: stores glycogen which is an energy reserve for the body and stores vitamins and minerals

Question 14

effects of lactulose

Answer 14

A drug that traps ammonia in the gut, reduces ammonia formation in the intestines. Helps manage hepatic encephalopathy by reducing ammonia formation. The drugs laxative effect expels ammonia from the colon.