Liver Disease Flashcards
What is Cirrhosis
Widespread scarring throughout liver caused by inflammation produce nodules, blocks blood flow
Types of Cirhrosis (4)
NASH
Postnecrotic ( hep or drug)
Laennac’s -> chronic alcohol
Billary Cirrhosis
Is cirrhosis reversible
yes if its caught early and whats causing is removed but many people don’t realize they have cirrhosis later in disease
Uncompensated
Vs. Compensated
Decompensated-> liver failure with symptoms
Compensated -> scarring present but liver can still function
What is Portal HTN
- 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
What is ascites
- Collection of fluid in peritoneal cavity
-plasma protein leaks out of vessels
What can the liver not make properly?
Albumin
Esophageal varices
- Cause by portal HTN
- backflow into esophageal vein
- varices become distended
- ITS an emergency if they start bleeding
Esophageal varices causes and what it may lead to
Causes: heavy lifting, exercise, dry hard food
- may occur spontaneously as well
- Leads to death
Hepatic Encephaothy or porta systemic ecephalpathy?
cognitive disorder resulting from liver failure
What are early sign of hepatic encephalopathy
Sleep disturbances, mood disturbances, mental status changes, and speech problems.
What are late signs of HE
- Altered LOC, Altered cognition, neuromuscular problems, Coma
Common meds for HE
Lactulose and lactulose enemas if in coma
Causes of HE
- GI bleed, hgih protein diet, infection, hypovolemia, hypokalemia, constipation
Ascites contributes to what?_____ via what process______
hepatorenal syndrome, vasoconstriction
hepatorenal is often triggered by what _____
GI bleeds, HE
What would you see with Hepatorenal syndrome and is the prognosis good?
Urinary output of less than 500mL per day as well as elevated BUN/ creatinine and no prognosis is poor
Risk Factors for Liver disease
- 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
Early signs of Liver disease
Fatigue, wt changes, GI problems, abd pain, RUQ tenderness, brusing/ petechaie, red palms, Gi bleeding, jaundice , and ascites, edema in LE
More symptoms
- spider angiomas, hypotension, asterixis, fruity breath, amenorrhea, Gynecomastia, impotence, mental state/ neuro assessment
For ascites what should you be concerned about? (5)
Measure, weights (best indicator) everyday, breathing, balance,hernias
assess for bleeding, fall risk
Caput medusae
umbillical veins not in use
WHat labs are expected what is increased esp in early liver disease
AST, ALT, LDH, AST/ALT Ratio, and Bilirubin
What labs are expected to be decreased
Albumin and platelets
Diagnostics
US is most common
- MRI, CT, XR
- Biopsies are risky
- EGD or ERCP
Priorities for Liver Disease (5)
- prevent resp complications
- maintain adequate circulation
- prevent bleeding
- decrease ascites and edema
What is the sodium restriction for ascites
1-2 g
What medications are used to treat ascites ?
Diuretics
What vitamin supplements are prescribed?
Multivitamins, Thiamine, folate
What procedure can be done to relieve ascites
Paracentesis
When do you not give diuretics?
If dehydrated and hypotensive
What is Paracentesis?
When a needle is inserted into the peritoneal cavity to drain fluid guided by US
Fluid in peritoneal cavity puts a patient at risk for what
Spontaneous Bacterial Peritonitis
What is spontaneous bacterial peritonitis?
- no obvious source
- less obvious than normal peritonitis
- low grade fever, loss of apetite, pain abd rigidity, mental status change, decreased bowel sounds
What is spontaneous bacterial peritonitis?
- no obvious source
- less obvious than normal peritonitis
- low grade fever, loss of apetite, pain abd rigidity, mental status change, decreased bowel sounds
If spontaneous bacterial peritonitis occurs what should happen?
A provider needs to be called in and perform a diagnostic paracentesis and prescribe abx
Resp interventions for hepatopulmonary syndrome related to ascites
- HOB elevated
- O2 therapy
- get help
How do you screen for esophagela varices
EGD
What meds are used to treat E varices?
BB to prevent bleeding by reducing hepatic venous pressure and HR
Mananaging bleeding from E. varices
- Balloon tamponade: blakemore tube with a balloon at the end. Can lead to risk of aspiration or perforation
- needs ventilation
Other Procedures performed
-TIPS: Transjugular Intrahepatic Portal-Systemic Shunt (last resort)
-Ligation or sclerotherapy
Bleeding Support interventions what do you do?
IV fluids, blood products, vasopressors, Ocreotide, ABX
Almost all GI bleeds are precipitated by ________
Infection!! treat w/ abx
What do you give for ammonia buildup?
lactulose
Things to consider with lactulose
- skin breakdown from diarrhea
- can cause hypovolemia so make sure they weight themselves
- Hypokalemia make sure that potassium is monitored
What is Rifaximin?
Intestinal antiseptic
- decreases rate of ammonia production
- urine is funky orange
If a patient can’t eat or drink
- Give lactulose in a enema
What type of protein diet is recommended for someone with hepatic encephalopathy?
Moderate protein diet
What consults would be appropriate for these patients
Palliative care
-Nutrition, physical therapy, assistance w/ abstinence
- home adaptation
