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Nursing and Complex Care > Liver Failure > Flashcards

Liver Failure Flashcards

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1
Q

What is the role of the liver?

A
  1. Metabolism CHO, protein, Fats
  2. Metabolises steroid hormones & most drugs
  3. Synthesis essential blood protein (Albumin & clotting factors)
  4. Convert ammonia to urea
  5. Detoxifies alcohol
  6. Produce bile
  7. Stores minerals & fats
  8. Supplies glycogen
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2
Q

What are the 3 manifestations of Liver Failure?

A
  1. Hepatocellular failure
  2. Jaundice
  3. Portal hypertension
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3
Q

Manifestation of Hepatocellular Failure

A
  1. Impaired protein metabolism= decreased albumin & clotting factors
  2. Disrupted glucose metabolism & storage
  3. Decreased bile production
  4. Impaired metabolism of steroid hormones
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4
Q

What is Jaundice?

A
  1. Is the result of disrupted metabolism & excretion of bilirubin
  2. Yellow stain of the skin
  3. First seen in sclera of the eyes then in skin
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5
Q

What are the 3 types of Jaundice?

A
  1. Haemolytic Jaundice
  2. Hepatic Jaundice
  3. Obstructive Jaundice
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6
Q

What is Haemolytic Jaundice?

A
  1. Is having more bilirubin in the circulation than the liver can process
  2. Result of destruction of the RBC
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7
Q

What is Hepatic Jaundice?

A
  1. Impaired liver cell function

2. Disrupts the conversion & secretion of bilirubin

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8
Q

What is the Obstructive Jaundice?

A
  1. Obstruction of bile flow in biliary system
  2. Gall bladder & bile ducts
  3. Pink/clay like stool is a trademark, due to lack of bile pigment
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9
Q

What is portal hypertension?

A
  1. High BP within the liver
  2. Result from inadequate blood flow through the liver
  3. Venous system drains GIT, spleen & abdomen which develops varicose vein.
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10
Q

What is the result of portal hypertension?

A
  1. Dilation of veins in GIT & abdomen
  2. Splenomegaly
  3. Ascites
  4. Portal system encephalopathy
  5. Hepatorenal syndrome
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11
Q

Within portal hypertension what happens when there is a dilation of veins of GIT and abdominal wall?

A
  1. Congestion suppresses appetite
  2. Formation of varicose veins: Oesophagus, stomach & rectum: Hemorrhoid’s
  3. Collateral veins show on the abdomen wall around the umbilicus
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12
Q

Within portal hypertension what happens when there is ascites?

A
  1. Accumulation of fluid in the peritoneal cavity
  2. Result of increased pressure in the abdomen which forces the fluid out into the peritoneal cavity
  3. Appear pregnant
  4. Low albumin
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13
Q

Within portal hypertension what happens when there is portal system encephalopathy?

A
  1. Altered state of consciousness & MS (seizures & strokes)
  2. Accumulation of waste products in the blood (ammonia)
  3. Ammonia (toxic fatty acid) alters neurotransmitters and plasma to amino acid ratio
  4. Late sign of liver failure: increased ICP & decrease CPP results in cells becoming hypoxic.
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14
Q

Within portal hypertension what happens when there is hepatorenal syndrome?

A
  1. Renal failure due to disrupted blood flow as a result of liver failure.
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15
Q

What is hepatitis?

A
  1. Inflammation of the liver
  2. Predominately exposed to the virus
  3. Caused by: Alcohol, drugs, toxins, pathogens
  4. Chronic hepatitis can lead to liver cancer
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16
Q

What is the simple pathophysiology of hepatitis?

A
  1. Virus replicates in the liver
  2. Inflammation processes damages the hepatic cells, disrupts liver function
  3. Bile flow in the biliary system is impaired: Jaundice
  4. Metabolism of nutrition, drugs, alcohol, toxins and bile excretion is disrupted
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17
Q

What are the 4 phases of viral hepatitis?

A
  1. Incubation phase
  2. Prodromal phase
  3. Icteric Phase
  4. Convalescents phase
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18
Q

What is the incubation phase?

A
  1. Post- exposure with no symptoms
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19
Q

What is the prodromal phase?

A
  1. Pre-jaundice with abrupt insidious onset;

2. Symptoms: fatigue, muscle aches, nausea/vomitting

20
Q

What is the icteric phase?

A
  1. Jaundice
  2. Bilirubin excretion is disrupted
  3. Symptoms: Rashes & dark brown but clear urine
21
Q

Hepatitis A

A
  1. Mild inflammation with limited damage
  2. MOT: Faecal - oral
  3. Incubation: 2-6 weeks
  4. Complications: Rare
22
Q

Hepatitis B

A
  1. MOT: Body, blood, perinatal fluids
  2. Incubation: 6-24 weeks
  3. Complications:
    a) Chronic hepatitis
    b) Cirrhosis
    c) Liver Cancer
23
Q

Hepatitis C

A
  1. MOT: Blood & body fluids
  2. Incubation: 5-12 weeks
  3. Complications:
    a) Chronic hepatitis
    b) Cirrhosis
    c) Liver cancer
24
Q

Hepatitis D

A
  1. MOT: Blood, body & perinatal fluids
  2. Incubation: 3-13 weeks
  3. Complications:
    a) Chronic hepatitis
    b) Cirrhosis
    c) Liver cancer
25
Q

What are the 5 of hepatitis?

A
  1. Viral hepatitis
  2. Chronic hepatitis
  3. Fulminant hepatitis
  4. Toxic hepatitis
  5. Hepatobiliary hepatitis
26
Q

Manifestations of Chronic Hepatitis

A
  1. Chronic infection
  2. Few symptoms
  3. Caused by HBV, HCV & HDV
  4. Is primary caused by:
    a) Cirrhosis
    b) Liver cancer
    c) Liver transplantation
  5. Usually leads to cirrhosis and end-stage liver failure
27
Q

Manifestations of Fulminant hepatitis

A
  1. Rapid progression
  2. Liver failure occurs 2-3 weeks of symptoms
  3. Uncommon
  4. Related to HBV
28
Q

What are the causes of Toxic hepatitis?

A
  1. Alcohol, drugs & toxins

2. Paracetamol

29
Q

Why does alcohol, drugs and toxins cause Toxic hepatitis?

A
  1. Necrosis of the hepatocytes
  2. Inflammation of the parenchyma
  3. Continued exposure leads to cirrhosis
30
Q

Why does paracetamol cause Toxic hepatitis?

A
  1. Directly damages the cells of the liver leading to necrosis
  2. Degree is determined by:
    a) Extent of exposure
    b) Age
31
Q

What is the cause of Hepatobiliary hepatitis?

A
  1. Cholestasis -> gallbladder
  2. Bile blood flow is interrupted leads to inflammation of the liver and parenchyma
  3. Re-establish bile flow by treating the obstruction
32
Q

Management of Hepatitis

A
  1. Prevention:
    a) Vaccinations
    b) Education
    c) Safe practises
  2. Use of interferon alpha
  3. Use of anti-viral agents
  4. Treatment of symptoms
  5. Education
33
Q

What is cirrhosis?

A
  1. End stage liver disease
  2. Progressive and irreversible disorder
  3. Leads to liver failure
  4. Results from:
    a) Alcohol
    b) Chronic hep B & C
    c) Prolong obstruction
    d) Severe right heart failure
34
Q

Simple pathophysiology of Cirrhosis

A
  1. There gradual tissue destruction with scarring
  2. Hepatocytes and liver lobules are destroyed
  3. Metabolic function of the liver is lost
  4. Fibrous tissue constricts the blood flow
  5. Blood no longer flows through the liver
  6. Portal hypertension develops
  7. Alcoholic cirrhosis (metabolic changes)
  8. Biliary cirrhosis
  9. Post- hepatic cirrhosis
35
Q

Manifestations of Cirrhosis include?

A
  1. Few manifestations in early cirrhosis
  2. Tenderness, Enlarged liver
  3. Weakness, Weight loss, Anorexia
  4. GIT disturbances: Diarrhoea & constipation
36
Q

What are the progressive manifestations of cirrhosis?

A
  1. Oesophagus varicose
  2. Splenomegarly
  3. Ascites
  4. Portal hypertension
  5. Portal system encephalopathy
  6. Hepatorenal syndrome
37
Q

What are your nursing management of cirrhosis?

A
  1. Diagnosis
  2. Medications: Diuretics, laxatives, anti-infections (neomycin)
  3. Beta-blockers & Ca channel blockers
  4. Nutrition
  5. Paracentesis
  6. Monitor for bleeding
  7. Endoscope
  8. Balloon tamponade
  9. Transplant
  10. Fluid replacement
  11. Neurological assessment
  12. Skin integrity
  13. Careful monitoring for complications associated with cirrhosis
38
Q

What is pancreatitis?

A
  1. The release of pancreatic enzymes into its own tissue which results in:
    a) Haemorrhage
    b) Necrosis
39
Q

What is pancreatitis associated with?

A
  1. Gallstones: 30-40% of cases

2. Alcohol: 25% of cases

40
Q

Simple pathophysiology of Pancreatitis

A
  1. Inflammation disorder
  2. Self destructive pancreatitis (auto-digestion)
  3. Necrotising pancreatitis: Inflammation haemorrhage & necrosis of tissue
41
Q

What are the risk factors that make you more susceptible to acquiring acute pancreatitis?

A
  1. Gallstones
  2. Alcohol
  3. Trauma
  4. 3rd trimester pregnancy
  5. Tissue ischaemia
  6. Elevated ca
  7. Hyperlipidaemia
42
Q

Simple pathophysiology of acute pancreatitis

A
  1. Release of pancreatic enzymes
  2. Releases proteolytic enzymes
  3. Destroys the blood vessel walls
  4. Results in: oedema, haemorrhage & necrosis of parenchymal cells
  5. Cellular damage releases enzymes cause vasodilation which:
    a) Increases permeability
    b) Fluid shifts into the retro- peritoneal cavity
43
Q

What medications to be given with acute pancreatitis?

A
  1. NSAIDs
  2. Thiazide
  3. Diuretics
  4. Oestrogen
  5. Steriods
44
Q

What are some of the manifestations of acute pancreatitis?

A
  1. Severe epigastric/abdo pain
  2. Nausea & vomiting
  3. Abdominal distention/ rigidity with decreased bowel sounds
  4. Tachycardia, hypotension, elevated tempt
  5. Mild jaundice
  6. Peritoneal bleeding 3-6 days after onset
45
Q

What are some of the complications of chronic pancreatitis?

A
  1. Malabsorption/ Malnutrition
  2. Pseudocyst/ Abscess
  3. Strictures of common bile duct
  4. Narcotic dependancy
  5. Increase pancreatic cancer
46
Q

What is chronic pancreatitis?

A
  1. Irreversible destruction of the function tissue
  2. Leads to insufficiency
  3. Alcohol is the primary risk factor
  4. Children/ adolescents with cystic fibrosis
47
Q

What are the nursing management for chronic pancreatitis?

A
  1. Diagnosis
  2. Symptom support
  3. Medications:
    1. Narcotics
    2. Anti-biotics
    3. Enzyme supplements
    4. H2 anatagonist/ Proton pump inhibitors
    5. Octreotide

Nursing and Complex Care (8 decks)

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