Liver Problems Flashcards
What is hepatitis?
What are the causes of hepatitis?
Liver inflammation
Causes:
- Viral (most common), A, B, C, D, E
- Drugs (Alcohol), Chemicals
- Autoimmune diseases
- Metabolic abnormalities
How does acute liver infection cause liver damage?
What can liver inflammation cause in relation to bile?
Infected cells are killed by the immune system
It can interrupt the flow of bile (Cholestasis)
Can liver function return to normal after an ACUTE liver infection is resolved?
Yes, liver cells can regenerate after the resolution of an acute infection
Can liver function return to normal during a CHRONIC infection?
No, prolonged infection results in liver fibrosis/scarring, which can then progress to liver cirrhosis
What are the symptoms that may arise due to the antigen-antibody complexes and complement system activation from liver infection?
Rash
Angioedema
Arthritis
Fever
Malaise
Cryoglobulinaemia
Glomerulonephritis
Vasculitis
Do all patients exhibit symptoms of hepatitis?
No, many are asymptomatic
What are some acute symptoms of hepatitis?
Malaise
Anorexia
Weight loss
Fatigue
Nausea/vomiting
Abdominal discomfort
Distaste for cigarettes
decreased sense of smell
Low-grade fever
Joint stiffness
Skin rashes
What are some assessment findings associated with the acute phase of hepatitis?
Enlarged liver and enlarged spleen and/or lymph nodes
+/- Jaundice, and if so patient may also have:
- Dark urine
- Light or clay-coloured stools
- Itchy skin as a result of bile salt buildup under skin
What happens to symptoms as a hepatitis infection shifts from the acute to the convalescent phase?
Jaundice starts disappearing
Malaise and ease of fatigue persists
Enlarged liver persists, enlarged spleen subsides
What diagnostic tests can detect viral hepatitis?
CT Scan
Liver biopsy (More common in chronic hepatitis than acute)
Viral genotype testing
Liver function tests
Physical assessment findings
What is the management plan for hepatitis?
Well-balanced diet +/- vitamin supplements
Rest depending on the severity
Avoiding alcohol intake and drugs detoxified by the liver (e.g. paracetamol)
Notification of possible contacts
What are some complications of hepatitis?
Cirrhosis
Ascites
Osesphageal and gastric varices
Hepatic encephalopathy
What is cirrhosis?
How does this affect the liver?
A chronic, progressive disease of the liver where cells attempt to regenerate but are disorganised
The disorganised regeneration results in abnormal architecture, overgrowth of fibrous connective tissue and impeded blood flow, resulting in decreased liver function
What is the difference between compensated and decompensated cirrhosis?
Compensated - No other liver complications
Decompensated - One or more complications
What are the signs and symptoms of cirrhosis?
Early symptoms:
- Fatigue
Late symptoms:
- Jaundice
- Peripheral oedema
- Ascites
- Skin, haematologic, endocrine and neurologic disorders
What is ascites?
What are symptoms associated with ascites?
Accumulation of serous fluid in the peritoneal cavity
Symptoms include:
- Abdominal distension
- Weight gain
- Signs of dehydration
- Decreased urine output
- Hypokalaemia
How is ascites managed?
Sodium restriction
Albumin
Diuretics
Parancetesis
- Fluid removal from the abdomen
What are oesophageal and gastric varices?
What are strategies for managing oesophageal and gastric varices?
Dilated veins resulting from increased portal hypertension
Prevent bleeding/haemorrhage
- Avoid alcohol, aspirin, and irritating foods
- Screen for presence with endoscopy
- Nonselective beta-blockers to reduce pressure
If bleeding occurs
- Stabilise patient
- Manage airway
- Provide IV therapies and blood if needed
What is hepatic encephalopathy?
What are strategies for managing hepatic encephalopathy?
A change in the neurological and mental state/responsiveness of the patient resulting from a buildup of ammonia in the blood when the liver can’t convert ammonia into urea
Management:
- Reduce ammonia formation
- Neurological assessments regularly
- Preventing constipation
- Encourage fluids
How is cirrhosis managed?
Rest
Administration of B-complex vitamins
Avoiding alcohol, aspirin, acetaminophen, NSAIDs
Nutritional therapy
- High calorie diet
- High carbohydrates and moderate to low fat
- Protein supplements for protein-calorie malnutrition
- Low sodium diet for patients with ascites and oedema
