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Med Surg 2 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What is Cirrhosis

A

Widespread scarring throughout liver caused by inflammation produce nodules, blocks blood flow

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2
Q

Types of Cirhrosis (4)

A

NASH
Postnecrotic ( hep or drug)
Laennac’s -> chronic alcohol
Billary Cirrhosis

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3
Q

Is cirrhosis reversible

A

yes if its caught early and whats causing is removed but many people don’t realize they have cirrhosis later in disease

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4
Q

Uncompensated
Vs. Compensated

A

Decompensated-> liver failure with symptoms

Compensated -> scarring present but liver can still function

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5
Q

What is Portal HTN

A
  • increase in pressure by 5mm hg
  • Blood meets resistance as it tries to flow through liver
  • vein becomes dilated
  • new bvs form and unfilter blood enters circulation
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6
Q

What is ascites

A
  • Collection of fluid in peritoneal cavity
    -plasma protein leaks out of vessels
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7
Q

What can the liver not make properly?

A

Albumin

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8
Q

Esophageal varices

A
  • Cause by portal HTN
  • backflow into esophageal vein
  • varices become distended
  • ITS an emergency if they start bleeding
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9
Q

Esophageal varices causes and what it may lead to

A

Causes: heavy lifting, exercise, dry hard food
- may occur spontaneously as well
- Leads to death

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10
Q

Hepatic Encephaothy or porta systemic ecephalpathy?

A

cognitive disorder resulting from liver failure

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11
Q

What are early sign of hepatic encephalopathy

A

Sleep disturbances, mood disturbances, mental status changes, and speech problems.

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12
Q

What are late signs of HE

A
  • Altered LOC, Altered cognition, neuromuscular problems, Coma
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13
Q

Common meds for HE

A

Lactulose and lactulose enemas if in coma

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14
Q

Causes of HE

A
  • GI bleed, hgih protein diet, infection, hypovolemia, hypokalemia, constipation
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15
Q

Ascites contributes to what?_____ via what process______

A

hepatorenal syndrome, vasoconstriction

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16
Q

hepatorenal is often triggered by what _____

A

GI bleeds, HE

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17
Q

What would you see with Hepatorenal syndrome and is the prognosis good?

A

Urinary output of less than 500mL per day as well as elevated BUN/ creatinine and no prognosis is poor

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18
Q

Risk Factors for Liver disease

A
  • Hep B and C , Alcohol/ Drugs, Sexual Hx, Tattoos, Jaundice, Billary tract disorders, Blood transfusions, obesity, lipids, liver injury

-A;; baby booomers should be screened for Hep C

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19
Q

Early signs of Liver disease

A

Fatigue, wt changes, GI problems, abd pain, RUQ tenderness, brusing/ petechaie, red palms, Gi bleeding, jaundice , and ascites, edema in LE

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20
Q

More symptoms

A
  • spider angiomas, hypotension, asterixis, fruity breath, amenorrhea, Gynecomastia, impotence, mental state/ neuro assessment
21
Q

For ascites what should you be concerned about? (5)

A

Measure, weights (best indicator) everyday, breathing, balance,hernias
assess for bleeding, fall risk

22
Q

Caput medusae

A

umbillical veins not in use

23
Q

WHat labs are expected what is increased esp in early liver disease

A

AST, ALT, LDH, AST/ALT Ratio, and Bilirubin

24
Q

What labs are expected to be decreased

A

Albumin and platelets

25
Q

Diagnostics

A

US is most common
- MRI, CT, XR
- Biopsies are risky
- EGD or ERCP

26
Q

Priorities for Liver Disease (5)

A
  • prevent resp complications
  • maintain adequate circulation
  • prevent bleeding
  • decrease ascites and edema
27
Q

What is the sodium restriction for ascites

A

1-2 g

28
Q

What medications are used to treat ascites ?

A

Diuretics

29
Q

What vitamin supplements are prescribed?

A

Multivitamins, Thiamine, folate

30
Q

What procedure can be done to relieve ascites

A

Paracentesis

31
Q

When do you not give diuretics?

A

If dehydrated and hypotensive

32
Q

What is Paracentesis?

A

When a needle is inserted into the peritoneal cavity to drain fluid guided by US

33
Q

Fluid in peritoneal cavity puts a patient at risk for what

A

Spontaneous Bacterial Peritonitis

34
Q

What is spontaneous bacterial peritonitis?

A
  • no obvious source
  • less obvious than normal peritonitis
  • low grade fever, loss of apetite, pain abd rigidity, mental status change, decreased bowel sounds
35
Q

What is spontaneous bacterial peritonitis?

A
  • no obvious source
  • less obvious than normal peritonitis
  • low grade fever, loss of apetite, pain abd rigidity, mental status change, decreased bowel sounds
36
Q

If spontaneous bacterial peritonitis occurs what should happen?

A

A provider needs to be called in and perform a diagnostic paracentesis and prescribe abx

37
Q

Resp interventions for hepatopulmonary syndrome related to ascites

A
  • HOB elevated
  • O2 therapy
  • get help
38
Q

How do you screen for esophagela varices

A

EGD

39
Q

What meds are used to treat E varices?

A

BB to prevent bleeding by reducing hepatic venous pressure and HR

40
Q

Mananaging bleeding from E. varices

A
  • Balloon tamponade: blakemore tube with a balloon at the end. Can lead to risk of aspiration or perforation
  • needs ventilation
41
Q

Other Procedures performed

A

-TIPS: Transjugular Intrahepatic Portal-Systemic Shunt (last resort)
-Ligation or sclerotherapy

42
Q

Bleeding Support interventions what do you do?

A

IV fluids, blood products, vasopressors, Ocreotide, ABX

43
Q

Almost all GI bleeds are precipitated by ________

A

Infection!! treat w/ abx

44
Q

What do you give for ammonia buildup?

A

lactulose

45
Q

Things to consider with lactulose

A
  • skin breakdown from diarrhea
  • can cause hypovolemia so make sure they weight themselves
  • Hypokalemia make sure that potassium is monitored
46
Q

What is Rifaximin?

A

Intestinal antiseptic
- decreases rate of ammonia production
- urine is funky orange

47
Q

If a patient can’t eat or drink

A
  • Give lactulose in a enema
48
Q

What type of protein diet is recommended for someone with hepatic encephalopathy?

A

Moderate protein diet

49
Q

What consults would be appropriate for these patients

A

Palliative care
-Nutrition, physical therapy, assistance w/ abstinence
- home adaptation

Med Surg 2 (3 decks)

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