Liver Cirrhosis Flashcards
Venous blood from the GI tract organs empties into what
portal vein
What perfuses the liver
Portal vein
Where is the liver located
right upper quadrant
What is the liver enclosed in
peritoneum
Functional units of the liver are the
lobules
Kupffer cells
carry out phagocytic activity / Removal of bacteria and toxins from the blood
Liver has two types of cells
hepatocytes and phagocytics
What does the portal circulatory system (enterophatic) do
Brings blood to the liver from the stomach, intestines, spleen and pancreas
Portal vein carries what
absorbed products of digestion directly to the liver
Why is the liver essential for life
functions in the manufacture, storage, transformation, and excretion of a number of substances involved in metabolism
The liver removes what from the portal blood
glucose and amino acids
The liver aids in the synthesize of what
glucose, amino acids and fats
What does the liver store
blood up to one 1L
What does the liver secrete to emulsify fat
bile
Past medical history data you should obtain regarding the GI system
- history of abdominal pain
- distention
- jaundice
- anemia
- heartburn
- dyspepsia (upset stomach)
- changes in appetite
- hemataemesis (blood vomit)
- food intolerance
- melena (black sticky bloody stool)
- trouble swallowing
- hemorrhoids
- rectal bleeding
- reflux, gastritis, hepatitis, colitis, gallstones, peptic ulcer disease, cancer, diverticuli, or hernias
- any unexplained weight loss or gain in the past 6-12 months
Medication History to obtain for the GI system
- medications past and present
- Name of all drugs, frequency of use, duration of use
- OTC medications, herbals, vitamins and nutritional supplements
- Chemical exposure
- Drug use
- NSAID use
- Antibiotics
- Antacids and laxatives
Surgical history to obtain for GI system
- Any GI related hospitalizations
- Any history of abdominal or rectal surgery (year, reason, postoperative course and if any blood was received)
Health Pattern questions to ask for the GI system
- Normal body weight
- Adequate nutrition
- Elimination habits
- Foreign travel
- RIsky behaviors
- Alcohol usage
- Smoking history
- Family history
Upper GI or barium swallow
Fluoroscopic x-ray study using a contrast medium. Used to diagnoses structural abnormalities of esophagus, stomach, and duodenum. Used to identify disorders such as esophageal strictures, polyps, tumors, hiatal hernias, foreign bodies, and peptic ulcers
Nursing responsibilities for Upper GI or barium swallow
Explain procedure to the patient including the need to drink contrast medium and assume various positions on an x-ray table. Keep the patient NPO for 8-12 hours before the procedure. Tell the patient to avoid smoking after midnight before study. After x-ray take measures to prevent contrast medium impaction (fluids and laxatives) . Tell patient that stool may be white for up to 72 hours after test
Esophagogastroduodenscopy (EGD)
Directly visualizes mucosal lining of esophagus, stomach, and duodenum with flexible endoscope. Test may use video imagine to visualize stomach motility. Inflammations, ulcerations, tumors, varices or mallory weiss tears may be detected. Biopsies may be taken and varices can be treated with band ligation or sclerotherapy
Nursing Responsibilities for EGD
Before procedure: Keep patient NPO for 8hours. Make sure signed consent is in chart. Give preoperative medication if ordered. Explain to patient that local anesthesia may be sprayed on throat before insertion of scope and that patient will be sedated during the procedure.
After procedure: Keep patient NPO until gag reflex returns. Use warm saline gargles for relief of sore throat. Check temperature q15-30min for 1-2hours (sudden temperature spike is a sign of perforation.)
Liver Biopsy
Precutaneous procedure uses needle inserted between 6th or 7th and 8th or 9th intercostal spaces on the right side to obtain specimen of hepatic tissue. Often done using ultrasound or CT guidance
Nursing responsibilities for liver biopsy
Before procedure: Check patients coagulation studies. Ensure the patients blood has been typed and crossmatched. Take vital signs as baseline data. Explain that informed consent has been signed and in chart.
After procedure: Check vital signs to detect internal bleeding q15minx2, q30x4, q1hrx4. Keep patient laying on right side for a minimum of 2 hours to splint puncture site. Keep patient in bed flat position for 12-14hours. Assess patient for complications such as bile peritonitis, shock, pneumothorax
Serum bilirubin
measurement of liver’s ability to conjugated and excrete bilirubin, allowing differentiation between unconjugated and conjugated bilirubin in plasma
Total bilirubin
measurement of conjugated and unconjugated total bilirubin
Conjugated (direct) Billirubin
Measurement of conjugated bilirubin
- elevated in obstructive jaundice
Unconjugated (indirect) bilirubin
measurement of unconjugated bilirubin
- Elevated in hepatocellular and hemolytic conditions
Urinary bilirubin
measurement of urinary excretion of conjugated billirubin
Serum protein
measurement of serum proteins manufactured by the liver
albumin, globulin, total proteins, A/G ratio
Albumin labs
3.5-5.0g (35-50mg)
Globulin labs
2.5-3.5g (25-35mg)
Total protein labs
6.4-8.3g (64-83mg)
Prothrombin Time (PT)
determination of prothrombin activity
Normal PT
11-16 seconds
International normalized ration (INR)
standardized system of reporting PT based on a reference calibration model and calculated by comparing the patients PT with a control value (warfarin/coumadin)
Normal INR
2-3 is considered therapeutic
Vitamin K
essential cofactor for many clotting actors
Normal Vitamin K levels
0.1-2.2
