Liver Disorders and Cirrhosis Flashcards
Liver
- complex organ
- multiple metabolic, regulatory functions
- metabolism of proteins, carbs
- vital to digestion, metabolism of nutrients
Cirrhosis
- end stage chronic liver disease
- progressive
- irreversible
Alcoholic cirrhosis
most common form
Liver Disease
impaired liver cells has multiple effects:
-impaired protein metabolism with decreased production of albumin and clotting factors
Low albumin levels
edema in peripheral tissues and ascites
- glucose alterations (hypo/hyper)
- inadequate Vit K, affects clotting factors, leads to bleeding tendency
- feminization in men and irregular menses in women
Cirrhosis Etiology
- most common cause of liver dz in the US
- end stage chronic liver dz
- progressive, irreversible, leads to liver failure
Cirrhosis may result from..
- chronic Hep B or C
- prolonged biliary obstruction
- long term, severe HF
- other liver dz’s
Cirrhosis Patho
- functional liver tissue replaced by fibrous scar tissue
- hepatocytes and liver lobules are destroyed, metabolic functions are lost
- structurally abnormal nodules encircled by connective tissue form
- restricted blood flow leads to portal HTN
- incidence and mortality vary greatly among populations
Alcohol causes…
metabolic changes in liver
Biliary cirrhosis
bile flow obstructed within liver, biliary system
Post-hepatic cirrhosis
-results from chronic hepatitis or unknown cause
Risk factors..
alcohol use, injection drug use
Early stage Clinical Manifestation
- liver enlarged, may be tender
- weight loss, weakness, anorexia
As disease progresses…
manifestations related to liver cell failure
-portal HTN
Cirrhosis Tx
- supportive
- slowing progression to liver failure
Portal HTN
causes blood to be rerouted to adjoining vessels
Splenomegaly
- blood shunted to splenic vein
- greater destruction of RBCs, WBCs, platelets
Ascites
- plasma-rich fluid in abdominal cavity
- hypoalbuminemia and hyperaldosteronism
Esophageal varices
- enlarged, thin-walled veins form in submucosa of esophagus
- from portal HTN
- may rupture leads to massive hemorrhage
Portal systemic encephalopathy
- hepatic encephalopathy
- asterixis
- changes in personality, mentation
asterixis
tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings
Hepatorenal syndrome
- renal failure with:
- azotemia
- sodium retention
- oliguria
- hypotension
-result of imbalanced blood flow
Spontaneous bacterial peritonitis
inflammatory response to peritonitis
Holistic approach
- psych needs
- psychosocial needs
- spiritual needs
Pharm Tx
- used to treat complications and effects
- will not reverse or slow process
Diuretics
reduce fluid retention, ascites
Lactulose, Neomycin
reduce nitrogen load, lower serum ammonia
Beta Blockers
prevent rebleeding of esophageal varices
Ferrous sulfate, folic acid
treats anemia
Oxazepam (Serax)
treats acute agitation
Nutritional Therapy
- Sodium intake restricted to less than 2g per day
- fluid restrictions
- protein restricted/eliminated
- high calorie, moderate fat intake
- vitamin, mineral supplements
Transplantation indications
- functional decline
- increasing bilirubin
- decreasing albumin
- increasing problems with complications
Contraindications
- malignancy
- active alcohol or drug abuse
- poor surgical risk
Nursing Process
- reduce further liver damage
- teach client to make healthier lifestyle choices
- minimizing symptoms of disease
Physical Assessment
- VS
- Mental status
- condition of skin and MM
- peripheral pulses, edema
- abdominal assessment
Nursing diagnoses
- excess fluid volume
- risk for acute confusion
- ineffective protection
- impaired skin integrity
- imbalanced nutrition: less than body requirements
Planning
goals may include that client will:
- maintain proper hydration levels as indicated by urine specific gravity
- appro diet
- VS normal limits
- report regular bowel elimination
- be oriented to person, place, time
- avoid alcohol
Interventions
- stress relationship between alcohol, drug abuse, and disease
- balance fluid volume:
- maintain mental status
- minimize bleeding
maintain skin integrity
- promote balanced nutrition
- manage complications
Expected Outcomes
- improved labs
- VS improvement
- absence of bruising or bleeding
- adequate urinary and bowel elimination
- decreasing ascites
- restorative sleep and decreased discomfort
