Liver Disorders and Cirrhosis

Question 1

Liver

Answer 1

• complex organ
• multiple metabolic, regulatory functions
• metabolism of proteins, carbs
• vital to digestion, metabolism of nutrients

Question 2

Cirrhosis

Answer 2

• end stage chronic liver disease
• progressive
• irreversible

Question 3

Alcoholic cirrhosis

Answer 3

most common form

Question 4

Liver Disease

Answer 4

impaired liver cells has multiple effects:

-impaired protein metabolism with decreased production of albumin and clotting factors

Question 5

Low albumin levels

Answer 5

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

Question 6

Cirrhosis Etiology

Answer 6

• most common cause of liver dz in the US
• end stage chronic liver dz
• progressive, irreversible, leads to liver failure

Question 7

Cirrhosis may result from..

Answer 7

• chronic Hep B or C
• prolonged biliary obstruction
• long term, severe HF
• other liver dz’s

Question 8

Cirrhosis Patho

Answer 8

• 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

Question 9

Alcohol causes…

Answer 9

metabolic changes in liver

Question 10

Biliary cirrhosis

Answer 10

bile flow obstructed within liver, biliary system

Question 11

Post-hepatic cirrhosis

Answer 11

-results from chronic hepatitis or unknown cause

Question 12

Risk factors..

Answer 12

alcohol use, injection drug use

Question 13

Early stage Clinical Manifestation

Answer 13

• liver enlarged, may be tender

- weight loss, weakness, anorexia

Question 14

As disease progresses…

Answer 14

manifestations related to liver cell failure

-portal HTN

Question 15

Cirrhosis Tx

Answer 15

• supportive

- slowing progression to liver failure

Question 16

Portal HTN

Answer 16

causes blood to be rerouted to adjoining vessels

Question 17

Splenomegaly

Answer 17

• blood shunted to splenic vein

- greater destruction of RBCs, WBCs, platelets

Question 18

Ascites

Answer 18

• plasma-rich fluid in abdominal cavity

- hypoalbuminemia and hyperaldosteronism

Question 19

Esophageal varices

Answer 19

• enlarged, thin-walled veins form in submucosa of esophagus
• from portal HTN
• may rupture leads to massive hemorrhage

Question 20

Portal systemic encephalopathy

Answer 20

• hepatic encephalopathy
• asterixis
• changes in personality, mentation

Question 21

asterixis

Answer 21

tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings

Question 22

Hepatorenal syndrome

Answer 22

• renal failure with:
• azotemia
• sodium retention
• oliguria
• hypotension

-result of imbalanced blood flow

Question 23

Spontaneous bacterial peritonitis

Answer 23

inflammatory response to peritonitis

Question 24

Holistic approach

Answer 24

• psych needs
• psychosocial needs
• spiritual needs

Question 25

Pharm Tx

Answer 25

- used to treat complications and effects | - will not reverse or slow process

Question 26

Diuretics

Answer 26

reduce fluid retention, ascites

Question 27

Lactulose, Neomycin

Answer 27

reduce nitrogen load, lower serum ammonia

Question 28

Beta Blockers

Answer 28

prevent rebleeding of esophageal varices

Question 29

Ferrous sulfate, folic acid

Answer 29

treats anemia

Question 30

Oxazepam (Serax)

Answer 30

treats acute agitation

Question 31

Nutritional Therapy

Answer 31

- Sodium intake restricted to less than 2g per day - fluid restrictions - protein restricted/eliminated - high calorie, moderate fat intake - vitamin, mineral supplements

Question 32

Transplantation indications

Answer 32

- functional decline - increasing bilirubin - decreasing albumin - increasing problems with complications

Question 33

Contraindications

Answer 33

- malignancy - active alcohol or drug abuse - poor surgical risk

Question 34

Nursing Process

Answer 34

- reduce further liver damage - teach client to make healthier lifestyle choices - minimizing symptoms of disease

Question 35

Physical Assessment

Answer 35

- VS - Mental status - condition of skin and MM - peripheral pulses, edema - abdominal assessment

Question 36

Nursing diagnoses

Answer 36

- excess fluid volume - risk for acute confusion - ineffective protection - impaired skin integrity - imbalanced nutrition: less than body requirements

Question 37

Planning

Answer 37

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

Question 38

Interventions

Answer 38

- stress relationship between alcohol, drug abuse, and disease - balance fluid volume: - maintain mental status - minimize bleeding maintain skin integrity - promote balanced nutrition - manage complications

Question 39

Expected Outcomes

Answer 39

- improved labs - VS improvement - absence of bruising or bleeding - adequate urinary and bowel elimination - decreasing ascites - restorative sleep and decreased discomfort