Liver Disease

Question 1

Ascites: Causes & S/Sx

Answer 1

Causes:
- Portal hypertension
- Changes in ability to metabolize aldosterone, increases fluid retention
- Albumin moves into peritoneal cavity

S/Sx:
- Striae
- Distended veins
- Umbilical hernia

Question 2

Ascites: Treatment & Nursing Management

Answer 2

• Paracentesis (administer albumin after to prevent circulatory & renal dysfunction)
• Low-sodium diet
• Diuretics (spironolactone #1, furosemide)
• Salt-poor albumin
• TIPS or Transjugular Intrahepatic Portosystemic Shunts (procedure to connect portal veins to lower BP)
• Record abdominal girth, daily weights, I&O’s

Question 3

Esophageal Varices: Causes & S/Sx

Answer 3

Causes:
- Cirrhosis

S/Sx:
- Hematemesis
- Melena
- Deterioration & shock

Question 4

Esophageal Varices: Treatment (including meds & procedures)

Answer 4

• Treat shock
• Oxygen
• IV F&E, volume expanders
• Blood

Medications:
- Vasopressin & somatostatin (octreotide): decrease bleeding (octreotide > vasopressin)
- Nitroglycerin (with vasopressin): reduce coronary vasoconstriction
- Propranolol & nadolol: decrease portal pressure
- Isosorbide dinitrate

Procedures:
- Balloon tamponade (direct pressure on bleeding)
- Endoscopic sclerotherapy (injection to control bleeding)
- Esophageal banding (strangles veins to prevent bleeding)

Question 5

Esophageal Varices: Nursing Management

Answer 5

• Monitor patient condition (including emotional response, cognitive status)
• Monitor for complications:
  
  • Hepatic encephalopathy resulting from bleeding in GI tract
  • Delirium related to alcohol withdrawal
• Tube care, GI suction, oral care
• Measures to reduce anxiety & agitation
• Education

Question 6

Hepatic Encephalopathy: Causes & S/Sx

Answer 6

Causes: Accumulation of ammonia & other toxic substances in the blood

S/Sx:
- Mental status changes & motor disturbances
- Alterations in mood & sleep (insomnia, restlessness)
- Potential seizures, coma
- Fetor hepaticus (musty, sweet odor from patient’s breath)
- Asterixis (involuntary flapping of hands)

Question 7

Hepatic Encephalopathy: Treatment

Answer 7

Lower ammonia levels:
- Lactulose
- Gastric suction, enemas, oral Abx (in GI tract)
- Neomycin, metronidazole, rifaximin (reduce ammonia-forming bacteria in colon)
- IV glucose to reduce protein levels

Question 8

Hepatic Encephalopathy: Nursing Management

Answer 8

• Assess neurological status frequently
• Mental status monitored by daily record of handwriting
• Monitor serum ammonia levels (15-45)
• Discontinue sedatives, analgesics, tranquilizers
• Protein restriction (1.2-1.5 g/kg/day)

Question 9

Identify the labs assessed for liver dysfunction and damage.

Answer 9

• ALT (8-40): Primary liver injury indicator
• AST (10-40): Less specific
• GGT, GGTP (must be elevated with ALT or AST to indicate liver disease)
• LDH (lactate dehydrogenase)
• Protein, alkaline phosphatase (ALP), ammonia, albumin
• Bilirubin
• PT and INR (elevated; liver not producing enough vitamin K)
• Cholesterol

Question 10

Identify supplements that are often added to an ESLD patient’s IV fluids.

Answer 10

• Glucose: reduce protein levels
• Vitamin A, B, C, K
• Steatorrhoea → give Vit. A, D, E (fat-soluble)
• Folic acid → treat potential bleeding
• Electrolytes to treat imbalance (K)

Question 11

Identify safety risks for ESLD patients.

Answer 11

• Activity tolerance related to fatigue
• Impaired skin integrity (turn frequently to prevent pressure injuries)
• Risk for injury & bleeding (prevent falls, give Vit K)
• Risk for seizures
• Imbalanced nutrition (give vitamins, supplements)
• Acute confusion
• Risk for aspiration (coma; inability to respond to stimuli)

Question 12

What is the most common surgical procedure for liver cancer?

Answer 12

Lobectomy

Removal of a lobe of the liver

Question 13

Hepatitis A: Causes & Most at Risk

Answer 13

Causes:
- Poor hand hygiene
- Fecal-oral route (ingestion of food or liquids)
- Sexual activity
(NOT blood)

Most at Risk:
- Homeless

Question 14

Hepatitis B: Causes & Most at Risk

Answer 14

Causes:
- Blood, saliva, semen, vaginal secretions
- Mothers to infants

Most at Risk:
- Exposure to blood or bodily fluids
- Hemodialysis, IV/injection drug use
- Multiple sexual partners
- STI (recent)

Question 15

Hepatitis C: Causes & Most at Risk

Answer 15

Causes: Blood, contaminated needles (sex uncommon)

Most at Risk:
- Contaminated
- Multiple sex partners
- Patients receiving frequent blood transfusions

Interferon treatment, no vaccine

Question 16

Discuss the desired outcome for administering lactulose.

Answer 16

• Decreases serum ammonia
• Stool 2-3x a day
• Monitor for hypokalemia & dehydration