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MedSurge 3 > Liver Problems > Flashcards

Liver Problems Flashcards

1
Q

What kind of cells does the liver have?

A

hepatocytes and phagocytic

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2
Q

What are the functions of the liver?

A

storage of vitamin A, E, D, and K
stores glucose as glycogen
Protects using Kupffer cells
Detoxifies
Produces albumin, prothrombin, bile, and fibrinogen
metabolizes proteins to ammonia to urea

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3
Q

what are Kupffer cells?

A

liver macrophages that engulf bacteria and old RBC’s

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4
Q

What are some age related changes of the liver?

A

Decrease in size and weight
Decrease in blood flow
drug metabolism decreases
No significant changes in LFT’s

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5
Q

What are some examples of hepatoxic drugs?

A

tylenol, ketoconazole (antifungal) valproic acid (anticonvulsant meds)

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6
Q

What is cirrhosis?

A

scar tissue bands that change the liver’s anatomy and cause dysfunction

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7
Q

What are the major complications of cirrhosis?

A

portal hypertension
ascites
esophageal varices
biliary obstruction
hepatic encephalopathy

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8
Q

What factors are apart of a liver assessment? (i.e. history)

A

occupation and travel
lifestyle (give examples)
drug use
family hx

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9
Q

What are some neurological symptoms you would find in someone with cirrhosis?

A

Malaise
fatigue
pruritis
change in mentation
tremors
asterixis

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10
Q

What do you expect to see when doing a physical assessment on someone with cirrhosis?

A

jaundice
petechiae, bruising, spider angiomas
muscle atrophy
edema

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11
Q

What is asterixis and why does it happen?

A

involuntary flapping movements of hands
due to damage brain cells from liver’s inability to metabolize ammonia to urea

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12
Q

How do you physically assess the liver?

A

palpate
abdominal fluid wave

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13
Q

How do you palpate the liver?

A

place left hand under right lower ribcage
press down on abdomen during inspiration
feel the inferior border

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14
Q

What are labs that you look at for cirrhosis?

A

ALT
AST
Bilirubin
Ammonia
lipids
clotting factors
albumin

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15
Q

Total albumin is (blank) in pts with chronic liver disease because..

A

decreased due to decreased synthesis by the liver

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16
Q

When phosphorus is high calcium is?

A

low

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17
Q

What is the range of ALT?

A

0-35

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18
Q

How does INR present in liver disease?

A

Prolonged time meaning risk for bleeding!

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19
Q

What are some other diagnostics/labs used to determine liver diease?

A

Lipid panel (fatty liver)
Liver biopsy
CT/MRI

20
Q

Explain Jaunice.

A

yellowish skin and tinged body tissues due to the liver not effectively excreting bilirubin

21
Q

How is bilirubin formed?

A

breakdown of Hgb

22
Q

Pathophysiology of portal hypertension

A

obstruction of blood flow due to scarring
this causes increased venous pressure
Blood flow backs into the veins of the spleen causing splenomegaly and into the veins of the esophagus
this is how you get ascites and varices

23
Q

How is thrombocytopenia in liver disease?

A

from portal hypertension the blood backs up into the spleen and traps platelets, decreasing the overall platelet count in the body

24
Q

Explain ascites.

A

free fluid in peritoneal cavity from portal HTN
involves collecting of plasma protein which reduces circulating plasma protein
causing fluid shift into abdomen (third spacing)

25
Q

Explain esophageal varices

A

back up of blood due to portal HTN and ascites causes veins to become distended
combined with decreased PT time, increases risk for bleeding

26
Q

What is the nursing management of varices?

A

TPN
NGT (blakemore tube)
VS
Oral care
blood transfusions

27
Q

What meds would a pt with varices have?

A

sandostatin (prevents engulfing of RBCs)
vasopressors
beta blockers

28
Q

What are some medical procedures/treatment for varices?

A

tamponade
banding
TIPS

29
Q

What is TIPS?

A

shunt placed between hepatic and portal vein
allows blood to bypass the liver to reduce portal pressure

30
Q

What is the medical management of ascites?

A

measure abdominal girth
dietary
spironolactone
bedrest
paracentesis

31
Q

When is a paracentesis for ascites indicated?

A

diuretics and nutrition aren’t working
respiratory problems

32
Q

What are the nursing interventions for ascites?

A

I&O
measure abdominal girth
daily weight
monitor resp status and labs and mental status

33
Q

What is hepatic encephalopathy?

A

Liver cannot detoxify toxic by products

34
Q

What are the early s/s of hepatic encephalopathy?

A

mental status change
asterixis
sweet fecal odor breath

35
Q

what are the s/s of late progressed hepatic encephalopathy?

A

difficult to wake
complete disorientation
seizures
coma

36
Q

What is the treatment for hepatic encephalopathy?

A

lactulose
vitamins
electrolyte imbalance correction
antibiotics to reduce ammonia-forming bacteria

37
Q

what are the nursing intervention for hepatic encephalopathy?

A

Neuro checks
daily weight
I&O
limit protein to 1.2-1.5 g/day
small frequent meals, 3 small snacks

38
Q

What are other issues that can arise from hepatic encephalopathy?

A

edema
bleeding
abnormal glucose metabolism
hypoglycemia
pruritus

39
Q

What are some causes of Cirrhosis?

A

Hepatitis B, C, or D
Fatty liver diease
Alcoholism
genetics

40
Q

How is hep B transmitted?

A

blood, semen, or saliva

41
Q

is there a vaccine for hep b?

A

yes

42
Q

how is hep c transmitted?

A

body fluids
common amongst IV drug users

43
Q

is there a vaccine for hep c?

A

no

44
Q

s/s of hep B

A

N/V
anorexia
fever
dark urine

45
Q

nursing interventions for a paraentesis

A

vital signs
weight
ask patient to void
position with HOB elevated
measure drainage
document color
apply dressing at site
bedrest

46
Q
A

MedSurge 3 (28 decks)

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