Liver Problems

Question 1

What kind of cells does the liver have?

Answer 1

hepatocytes and phagocytic

Question 2

What are the functions of the liver?

Answer 2

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

Question 3

what are Kupffer cells?

Answer 3

liver macrophages that engulf bacteria and old RBC’s

Question 4

What are some age related changes of the liver?

Answer 4

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

Question 5

What are some examples of hepatoxic drugs?

Answer 5

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

Question 6

What is cirrhosis?

Answer 6

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

Question 7

What are the major complications of cirrhosis?

Answer 7

portal hypertension
ascites
esophageal varices
biliary obstruction
hepatic encephalopathy

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Malaise
fatigue
pruritis
change in mentation
tremors
asterixis

Question 10

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

Answer 10

jaundice
petechiae, bruising, spider angiomas
muscle atrophy
edema

Question 11

What is asterixis and why does it happen?

Answer 11

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

Question 12

How do you physically assess the liver?

Answer 12

palpate
abdominal fluid wave

Question 13

How do you palpate the liver?

Answer 13

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

Question 14

What are labs that you look at for cirrhosis?

Answer 14

ALT
AST
Bilirubin
Ammonia
lipids
clotting factors
albumin

Question 15

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

Answer 15

decreased due to decreased synthesis by the liver

Question 16

When phosphorus is high calcium is?

Answer 16

low

Question 17

What is the range of ALT?

Answer 17

0-35

Question 18

How does INR present in liver disease?

Answer 18

Prolonged time meaning risk for bleeding!

Question 19

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

Answer 19

Lipid panel (fatty liver)
Liver biopsy
CT/MRI

Question 20

Explain Jaunice.

Answer 20

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

Question 21

How is bilirubin formed?

Answer 21

breakdown of Hgb

Question 22

Pathophysiology of portal hypertension

Answer 22

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

Question 23

How is thrombocytopenia in liver disease?

Answer 23

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

Question 24

Explain ascites.

Answer 24

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)

Question 25

Explain esophageal varices

Answer 25

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

Question 26

What is the nursing management of varices?

Answer 26

TPN NGT (blakemore tube) VS Oral care blood transfusions

Question 27

What meds would a pt with varices have?

Answer 27

sandostatin (prevents engulfing of RBCs) vasopressors beta blockers

Question 28

What are some medical procedures/treatment for varices?

Answer 28

tamponade banding TIPS

Question 29

What is TIPS?

Answer 29

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

Question 30

What is the medical management of ascites?

Answer 30

measure abdominal girth dietary spironolactone bedrest paracentesis

Question 31

When is a paracentesis for ascites indicated?

Answer 31

diuretics and nutrition aren't working respiratory problems

Question 32

What are the nursing interventions for ascites?

Answer 32

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

Question 33

What is hepatic encephalopathy?

Answer 33

Liver cannot detoxify toxic by products

Question 34

What are the early s/s of hepatic encephalopathy?

Answer 34

mental status change asterixis sweet fecal odor breath

Question 35

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

Answer 35

difficult to wake complete disorientation seizures coma

Question 36

What is the treatment for hepatic encephalopathy?

Answer 36

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

Question 37

what are the nursing intervention for hepatic encephalopathy?

Answer 37

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

Question 38

What are other issues that can arise from hepatic encephalopathy?

Answer 38

edema bleeding abnormal glucose metabolism hypoglycemia pruritus

Question 39

What are some causes of Cirrhosis?

Answer 39

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

Question 40

How is hep B transmitted?

Answer 40

blood, semen, or saliva

Question 41

is there a vaccine for hep b?

Answer 41

yes

Question 42

how is hep c transmitted?

Answer 42

body fluids common amongst IV drug users

Question 43

is there a vaccine for hep c?

Answer 43

no

Question 44

s/s of hep B

Answer 44

N/V anorexia fever dark urine

Question 45

nursing interventions for a paraentesis

Answer 45

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