Liver/Gallbladder Disorders Flashcards
Name the routes of transmission for:
-Hep A
-Hep B
-Hep C
-Hep D
-Hep E
A: fecal-oral
B: blood to blood/sexual
C: blood to blood/sexual
D: hep B
E: fecal-oral
Which types of viral hepatitis have a preventative vaccine?
Hep A + B
Hep __ and __ are more common types of hepatitis in crowded living situations because they spread through the fecal-oral route
A, E
Pathophysiology of Hepatitis
Infection (most common), alcohol, drugs (tylenol), autoimmune disease –> direct damage to liver cells (hepatocytes)
Care for hepatitis?
-outpatient symptom management, rest, nutrition
-avoid drugs and alcohol
-if due to drugs, take N-Acetylcysteine
Why/when would a patient take N-Acetylcysteine?
If they had drug-induced hepatitis (ex: tylenol overdose)
Name the 5 non-hepatic viruses that can cause viral hepatitis
CMV, EBV, HSV, coxsackievirus, rubella
S/S general liver dysfunction
-jaundice
-dark urine, light stool
-pruritis
-hepatomegaly
-asterixis (hand flapping)
S/S specific to hepatitis
-flu-like (arthralgia–joint pain, malaise/fatigue, fever)
-N/V, anorexia
-RUQ tenderness
-lymphadenopathy
Hepatitis ___ is self limiting
A
Causes and pathophysiology of cirrhosis
cause: chronic liver disease
-chronic hep C, B
-alcoholism, malnutrition
–> hepatocytes unable to regenerate –> fibrous growth
–> scarred/fibrotic liver –> decreased function
Describe the patho of portal hypertension, a complication of _______
cirrhosis –> blocked blood flow –> increased pressure in liver
(portal hypertension) –>
-ascites
-gastric and esophageal varices
-splenomegaly –> RBC/platelet depletion
Hypoalbuminia in cirrhosis leads to _______. Describe how.
-ascites
-low albumin –> decreased oncotic pressure –> ‘leaky’ capillaries –> edema/ascites
Encephalopathy can be caused by cirrhosis through what mechanism?
Reduced liver function –> toxin (ammonia) build up
List 4 main complications of cirrhosis
-ascites, edema
-gastric/esophageal ulcer and bleeding
-splenomegaly –> decreased clotting factors (anemia, thrombocytopenia, leukopenia) and bleeding
-hepatic encephalopathy
S/S of cirrhosis by system:
-GI
-heme
-skin
-CV
-metabolic
-GI: N/V, anorexia, abdominal pain, esophageal/gastric varices & bleeding
-heme: thrombocytopenia, leukopenia, coagulation issues
-skin: jaundice (general liver dysfunction s/s), spider angiomas, petechiae/purpura, palmar erythema
-CV: fluid retention, peripheral edema, ascites
-metabolic: hypo-issues: low K, low Na, low albumin, dehydration
Cirrhosis Rx - general
-restrict Na (2g/day)
-restrict fluids (1L/day)
-vit k supplementation
-TIPS (shunt that reduces hypertension)
Cirrhosis Rx - ascites
-paracentesis
-meds: albumin, diuretics, antibiotics
Cirrhosis Rx - Varices
-non selective beta blockers (‘-lols’) ASAP to reduce variceal rupture risk
-endoscopy: banding, clipping, balloon tamponade
-PPIs
Cirrhosis Rx - hepatic encephalopathy
-med: lactulose
When variceal bleeding occurs, the first step is to:
stabilize the patient and manage the airway
Asterixis is a sign of:
advanced cirrhosis with hepatic encephalopathy
________ ________ the gold standard for a definitive diagnosis of cirrhosis
liver biopsy
Nursing management for cirrhosis
-Constant assessment (daily weights, I/Os, skin, GI/GU, neuro)
-Restrict Na (2g/day) and fluids (1L/day)
-encourage nutrition–small meals, oral care
-monitor labs, bleeding…
Describe the patho of cholelithiasis, aka _________
Gallstones
-idiopathic (infection? cholesterol issues?) –> super cholesterol-ly bile from liver into gallbladder –> stone formation
Describe the patho of cholecystitis
gallbladder obstruction –> inflammation (often d/t cholelithiasis)
Risk factors for cholelithiasis and cholcystitis
-F sex
-multiparity
-over 40
-HRT and BC
-sedentary lifestyle, obesity
Cholecystitis in the absence of obstruction
(acalculous cholecystitis) occurs most often in:
older adults and in patients who are critically ill.
S/S cholelithiasis and cholecystitis
-SEVERE pain: biliary colic
-indigestion, fever, chills, jaundice, N/V
-elevated WBCs
Dx for cholelithiasis
-ultrasound
-endoscopic retrograde cholangiopancreatography: ECRP for visualization and bile sampling
Once gallstones become symptomatic, ___________ is usually needed.
cholecystectomy (gallbladder removal)
Nursing management - gallbladder disease
-pain management!!
-NPO if ordered for severe pain/surgery
-I/Os
-post-op wound care
-teach low-fat diet
Signs of choledocholithiasis (obstruction of common bile duct by gallstones):
-RUQ pain
-jaundice
-clay-colored stools
-dark, foamy urine
-fever
-increased WBC count.
A 49 y/o mother of three presents with a low grade fever, diaphoresis, nausea, right shoulder and scapular pain. Upon examination, she notes some pain in her abdomen (epigastric, RUQ) as well. What might she be diagnosed with? With what diagnostic tool?
-likely, cholecystitis d/t cholelithiasis
-will likely receive ultrasound
When a gallstone is stuck in the ampulla of vader between the common bile duct and small intestine, this is called:
choledocholithiasis
