T13: Hepatitis & Acute Liver Failure Flashcards
hepatitis
inflammation of the liver
causes of hepatitis
viral, ALCOHOL, medications (hepatotoxic), fatty liver disease
liver is the only organ in the body that can
regenerate
how do we help to regenerate the liver
adequate nutrition and rest
Hepatitis A (HAV)
Transmission
-Most commonly fecal-oral route-comtaminated water or food
prevention of hepatitis A (HAV)
through strict handwashing, stool and needle precautions, HEPATITIS A VACCINE (two doses)
Hepatitis B (HBV) Transmission
-Through direct contact with blood or body fluids of infected person
prevention of hepatitis b (HBV)
o strict hand washing, screening blood, needle precautions, avoiding sexual contact with anyone who is Hep B positive, HEPATITIS B VACCINE
Hepatitis C (HCV) transmission
primarily through blood (IV drug use, high risk-sex behavior, dialysis, blood transfusion before 1992, perinatal)
prevention of hepatitis C
strict hand washing, needle precautions, screening of blood, NO VACCINE
which type of hepatitis does NOT have a vaccine
Hepatitis C
hepatits clinical manifestations: preicteric stage
- Flu-like symptoms (malaise, fatigue, anorexia, N/V, diarrhea, myalgias (muscle aches), arthralgias (joint pain)
- Rash: IMPORTANT TO TEACH HOW TO SCRATCH WITH KNUCKLES
- RUQ tenderness (caused by liver inflammation)
hepatits clinical manifestations: icteric stage
-Appearance of jaundice (elevated bilirubin levels)
· Look at sclera and palms/bottom of feet
· Palmar erythema
-DARK/TEA COLORED URINE
-CLAY COLORED STOOLS
-Pruritis
pruritis interventions
· Use cholestyramine or hydroxyzine, lotions, soft, or old linen, temperature control, short nails; rub with knuckles
hepatits clinical manifestations: posticteric stage
- Jaundice, urine, and stool color return to normal
- Energy increases and pain subsides
diagnostics for hepatitis
-Elevated bilirubin, gamma GT, AST, ALT
-Prolonged PT and INR
-Leukopenia, transient neutropenia, lymphocytosis
-Blood test for hepatitis associated antigen A, B, C, D
-Liver biopsy
Total bilirubin
0.3-1.0 mg/dL
interprofessional care for hepatitis
o Adequate nutrition
- IV GLUCOSE OR ENTERAL NUTRITION
-Small frequent meals, use measures to stimulate appetite (mouth care, antiemetics, attractively served meals)
o Rest (degree and strictness varies)
o AVOID alcohol intake and drugs detoxified by liver
o HOB elevated
what drug can be used for hep C infection
interferion
Hepatic encephalopathy
potentially life-threatening spectrum of neurologic, psychiatric, and motor disturbances (results from liver’s inability to remove toxins)
clinical manifestations of hepatic encephalopathy
-lethargic, personality changes
-cannot write well
-asterixis
-Fetor hepaticus (musty, sweet odor of patient’s breath; rotten eggs + garlic)
Asterixis
aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.
What causes hepatic encephalopathy?
accumulation of ammonia that gets into the brain
what do we give for hepatic encephalopathy to get rid of ammonia
LACTULOSE
Lactulose
ammonia binds to the stool and patients gets diarrhea, so we are worried about F&E imbalances
manifestations of chronic hepatitis
· Coagulation problems
o Easy bruising and bleeding
· Skin manifestations
o Spider angiomas, palmar erythema, and gynecomastia. Some patients have splenomegaly, hepatomegaly, or cervical lymph node enlargement
cirrosis
end-stage disease liver “scarring”
clinical manifestations of cirrosis
- Skin: jaundice (decreased ability to remove bilirubin), palmar erythema (red area that blanches with pressure), pruritus, spider angioma
- Neuro: asterixis (flapping tremor), portal-systemic encephalopathy
- Respiratory: dyspnea, hyperventilation, hypoxemia
- Ascites
- Clay-colored stools
- Esophageal varices
- Hematologic: thrombocytopenia, anemia, leukopenia, coagulation disorders
treatment of hematologic conditions of cirrosis (thrombocytopenia, anemia, leukopenia, coagulation disorders)
Platelets, FFP, RBCs
why do patients get peripheral neuropathy with cirrosis
due to dietary deficiencies of thiamine, folic acid, and cobalamin-vitamin B12
cor pulmonale
right ventricular hypertrophy and heart failure DUE TO pulmonary hypertension
portal hypertension
characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices.
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)
· used to alleviate ascites that does not respond to diuretics; a nonsurgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow.
ascites
accumulation of fluid in the peritoneal cavity
treatment for ascites
diuretics (spironolactone, furosemide, triamterene) and paracentesis
o Limit sodium
procedure for ascites
paracentesis
paracentesis
needle into the abdomen to pull fluid off
what should the patient do before a paracentesis
void
what color should the fluid be from a paracentesis
pale yellow
post care paracentesis
§ Patient voids immediately before
§ High Fowler’s position or sitting on side of bed
§ Monitor for hypovolemia and electrolyte imbalances
§ Monitor BP and heart rate
§ Monitor dressing for bleeding/leakage
peripheral edema
occurs as in the lower extremities and presacral area
treatment for peripheral edema
exogenous albumin
esophageal varicies
dilates and tortuous veins in the submucosa of the esophagus that are fragile, thin-walled distended esophageal veins that become irritated and rupture
what should you avoid with esophageal varicies
alcohol, aspirin, NSAIDs
how to screen for esophageal varices
endoscopy
if bleeding occurs with esohageal varicies what should be done
stabilize patient, manage airway, prive IV therapy and blood products
-band ligation
-sclerotherapy
-balloon tamponade
band ligation
placement of a small rubber band (elastic O-ring) around the base of the varix (enlarged vein)
sclerotherapy
involves injection of a sclerosing solution into the swollen veins through an injection needle that is placed through the endoscope
balloon tamponade
mechanical compression of varices
SAFETY ALERT for balloon tamponade
· Label each lumen to avoid confusion.
· Secure the tube to prevent movement of the tube which could result in occlusion of the airway.
· Deflate balloons for 5 minutes every 8 to 12 hours per institutional policy to prevent tissue necrosis.
Portal systemic encephalopathy
end-stage hepatic failure characterized by altered level of consciousness, neuro symptoms, impaired thinking
jaundice
occurs because liver is unable to metabolize bilirubin
hepatorenal syndrome
progressive renal failure associated with hepatic failure
· Characterized by a sudden decreased in UO, elevated BUN and CRE
treatment for hepatorenal syndrome
liver transplant
care for cirrosis
o Rest
o Administration of b-complex vitamins
o Avoid alcohol
o Minimize/avoid aspirin, acetaminophen, and NSAIDs
o Diet for patient without complications
- High in calories (3000 cal/day)
- ↑ Carbohydrate
- Moderate to low fat
- Protein supplements for protein-calorie malnutrition
- Low-sodium diet for patient with ascites and edema
- Seasonings to make food more palatable
liver cancer treatment
CHEMOTHERAPY
o Triple pronged approach
-Immunosuppressive therapy
o Corticosteroids, Cyclosporine/tacrolimus, Azathiprine, Hepatitis-antiviral therapy
