Liver failure Flashcards
The high degree of nodular regeneration is a significant “risk” for:
Hepatocellular carcinoma
Causes
- alcoholic liver disease
- hep. C (B coincident w hep.D)
- cryptogenic causes– fat accumulating in the liver (non-alcoholic fatty liver disease)
Major derangements from cirrhosis
- ascites
- portal hypertension
- hepatic encephalopathy
What happens in portal hypertension
obstruction/ increased resistance to flow or due to pathological increases in portal blood flow could lead to portal hypertension (with portal pressures over 12mm Hg)
Causes of portal hypertension
alcoholic and viral cirrhosis
Impaired liver function and thus hepatic encephalopathy can lead to high levels of _______.
ammonia
Causes of hepatic encephalopathy
- A high protein diet
- Bacterial infection
- Constipation
- GI bleeding
S/S of hepatic encephalopathy
- mood changes & sleep patterns (Eg insomnia)
- confused
- restlessness
- reversible syndrome (eg. seizures & visual loss)
- asterixis (flapping tremor of hands)
Nur management of cirrhosis
- eliminate alcohol
- prevent infections
- enuf carbohydrates & calories
- correcting fluid & electrolyte imbalances
- decreasing ammonia production in the GI tract
- liver transplant
Nur management of ascites
- daily measurement of abdominal girth & body weight
- daily inspection of potential distended veins & umbilical hernia
- percussion: assess if got fluid in abdominal cavity (shifting dullness/fluid wave)
- monitor potential fluid & electrolyte imbalances
- pt edu
Nur management of HE - protein restriction: - reduce ammonia by: - discontinue: - monitor: - assessment: .....
- eliminate cause
- lactulose to reduce serum ammonia levels
- protein restriction: IV glucose to minimise protein catabolism
- reduce ammonia: by gastric suction, enemas, oral antibiotics
- discontinue sedatives analgesics & tranquilisers
- monitor complications & infections
- glasgow coma scale daily
- assessment of sleep patterns, mental status, ADL, flapping tremor, ADLs, speech, number connection test etc
Is cirrhosis irreversible?
Yes
Treatments for ascites
- paracentesis
- diuretics (eg. thiazides)
- administer albumin
- low sodium diet
- TIPS (Transjugular intrahepatic portosystemic shunt)
For the Glasgow Coma Scale, how many pts considered severe brain injury?
3-8 out of 15
Diagnosis to confirm liver cirrhosis
- liver function test
- liver biopsy
- ultrasound of abdomen
