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
Explain esophageal varices
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
What is the nursing management of varices?
TPN NGT (blakemore tube) VS Oral care blood transfusions
27
What meds would a pt with varices have?
sandostatin (prevents engulfing of RBCs) vasopressors beta blockers
28
What are some medical procedures/treatment for varices?
tamponade banding TIPS
29
What is TIPS?
shunt placed between hepatic and portal vein allows blood to bypass the liver to reduce portal pressure
30
What is the medical management of ascites?
measure abdominal girth dietary spironolactone bedrest paracentesis
31
When is a paracentesis for ascites indicated?
diuretics and nutrition aren't working respiratory problems
32
What are the nursing interventions for ascites?
I&O measure abdominal girth daily weight monitor resp status and labs and mental status
33
What is hepatic encephalopathy?
Liver cannot detoxify toxic by products
34
What are the early s/s of hepatic encephalopathy?
mental status change asterixis sweet fecal odor breath
35
what are the s/s of late progressed hepatic encephalopathy?
difficult to wake complete disorientation seizures coma
36
What is the treatment for hepatic encephalopathy?
lactulose vitamins electrolyte imbalance correction antibiotics to reduce ammonia-forming bacteria
37
what are the nursing intervention for hepatic encephalopathy?
Neuro checks daily weight I&O limit protein to 1.2-1.5 g/day small frequent meals, 3 small snacks
38
What are other issues that can arise from hepatic encephalopathy?
edema bleeding abnormal glucose metabolism hypoglycemia pruritus
39
What are some causes of Cirrhosis?
Hepatitis B, C, or D Fatty liver diease Alcoholism genetics
40
How is hep B transmitted?
blood, semen, or saliva
41
is there a vaccine for hep b?
yes
42
how is hep c transmitted?
body fluids common amongst IV drug users
43
is there a vaccine for hep c?
no
44
s/s of hep B
N/V anorexia fever dark urine
45
nursing interventions for a paraentesis
vital signs weight ask patient to void position with HOB elevated measure drainage document color apply dressing at site bedrest
46