Test 5 Flashcards
Cirrhosis
Extensive, irreversible scarring of the liver, usually caused by chronic reaction to hepatic inflammation and necrosis.
Develops slowly and has a progressive, prolonged, destructive course resulting in end-stage liver disease.
Cirrhosis patho
By widespread fibrotic (scarred) bands of connective tissue that change the livers normal makeup.
Liver
Largest and one of the most vital internal organs, performing more than 400 functions and affecting every system in the body.
When diseased or damaged it cannot accomplish these functions. As a result digestion, nutrition and metabolism can be severely affected.
Most common causes for cirrhosis
Chronic alcoholism Chronic viral hepatitis Nonalcoholic steatohepatitis Bile duct disease and genetic disease Gallbladder disease Drugs and chemical toxins Cardiovascular disease
Complication of cirrhosis
Portal hypertension: a persistent increase in pressure with the portal vein greater than 5mm, results form increased resistance to obstruction of the flow of blood through portal vein
Ascites and gastroesophagel: collection of free fluid within the peritoneal cavity caused. By increased hydrostatic pressure fro portal hypertension
Biliary obstruction
Jaundice
Hepatic encephalopathy
Stages of hepatic encephalopathy
Stage 1
Subtle manifestations Personality changes Behavior changes Impaired thinking Inability to concentrate Fatigue, drowsiness Slurred speech Sleep pattern
Stage 2 of HE
Continuing mental changes
Mental confusion
Disorientation to time,place, or person
Asterixis (hand flapping)
Stage 3 HE
Progressive deterioration Marked mental confusion Stuporous, drowsy but arousable Abnormal ecg Muscle twitching Hyperrelexia Asterixis
Stage 4 HE
Unresponsiveness, leading to death Unarousable Usually no response to pain No asterixis Positive babinski sign Muscle rigidity Factor hepaticus (liver breath-musty, sweet odor) Seizures
Hepatitis C
Second leading cause of cirrhosis and liver failure in the US
Infectious bloodborne illness that usually causes chronic disease
Manifestation of cirrhosis
Fatigue
Change in weight
Gi symptoms anorexia and vomiting
Abdominal pain and liver tenderness
Assess for
Jaundice Dry skin Rash Purpuric lesions petechia or ecchymoses Warm and bright red palms Vascular lesions Ascites Peripheral dependent edema Vitamin deficiency Amenorrhea Gynecomastia
Labs for cirrhosis
AST, ALT and LDH increase
Bilirubin increase
Total serum protein and albumin are decreased
PT/INR is prolonged because the liver decreases the production of prothrombin
RBC, WBC decreased
Ammonia levels are increased
Skin irritation for patients with cirrhosis
Use cool rather than warm water on the skin and to not use in excessive amount of soap
Lotion to smooth skin
Nutrition for cirrhosis
Patients with abdominal as cities on a low sodium diet
Vitamin supplements thiamine, folate and multivitamins
Cirrhosis
Nutrition therapy
Consume a diet that adheres to the guidelines set by your physician,nurse or dietitian
If you have excessive fluid in your abdomen, follow the low sodium diet
Eat small, frequent meals that are nutritionally well balanced
Include in your diet daily supplement liquids and multivitamin
Cirrhosis drug therapy
Take the diuretic or preventive beta blocker Take meds that help prevent gi bleeding Take lactucose Do not take any other meds Do not consume any alcohol
Hepatitis
Is the widespread inflammation of liver cells
Viral is the most common type and can either be acute or chronic
Viral results from an infection caused by one of 5 major viruses
Hep A, B, C, D, E
Hepatitis C
Enveloped, single stranded RNA virus. Transmission is blood to blood.
Spread most common by
Illicit drugs needle sharing
Blood, blood products or organ transplant received before 1992
Needle stick injury
Unsanitary tattoo
Sharing of intranasal cocaine
Not transmitted by casual contact, do not share razors, tooth brush or pierced earring
The average incubation period is 7 weeks
Complications of hepatitis
Failure of the liver to regenerate with progression of the nectroic process results in a severe acute and often fatal form of hepatitis known as fulminant hep.
Hep is considered chronic when liver inflammation last longer than 6 months, can lead to cirrhosis and liver cancer
Measure to prevent hepatitis a
Hand washing especially after sheep fish
Avoid contained food or water in higher countries
Receiving immunoglobulin within 14 days if exposed to the virus
Receiving the HAV before traveling to areas where the disease is common (mexico, caribbean)
Receiving the vaccine if living or working in enclosed areas with others such as college, prison, day care and long term facility
Prevention of viral hep in health care
Use standard precaution to prevent the transmission of disease
Eliminate needles and other sharp instruments by substituting needless system
Take the hep b vaccine
For postexposure prevention of hep a, seek medical attention immediately for ig admin
Report all cases of hep to the local health department
Health practice to prevent viral hepatitis
Maintain adequate sanction and personal hygiene. Wash your hands before eating and after the toilet
Drink water treated by a water purification system
If traveling in underdeveloped or non-industrialized countries, drink only bottled water . Avoid washed foodfrom tap
Use adequate sanitation practices to prevent the spread
Do not share bed linens, towels, utensils, drinking glasses
Do not share needles,piercing, tattoos, razors, nail clippers, toothbrush
Use condom
Cover sores
;if infected never donate blood
Physical assessment o hepatitis
Abdominal pain Changed in skin or sclera Arthralgia (joint pain) or myalgia (muscle pain) Diarrhea/constipation Changes in color of urine Fever Lethargy Malaise N/v Itching
Lab test for hepatitis
ELISA is the initial screening for patients suspected of being infected, antibodies can be detected within 4 weeks
RIBA
Interventions for hepatitis
Rest is essential intervention to reduce the livers metabolic demands and increase its blood supply
Diet should be high in carbs and calories with moderate amounts of fat and protein after nausea and anorexia subside
Small frequent meals, encourage to eat food
Viral hepatitis
Avoid all medications including OTC drugs such as acetaminophen (tylenol unless prescribed
Avoid all alcohol
Rest frequently throughout the day and sleep at night
Eat small frequent meals with high carb, moderate fat and protein
Avoid sexual intercourse until test negative
Follow guidelines for preventing transmission
Fatty liver
Caused by the accumulation of fats in and around the hepatic cells. It may be caused by alcohol use or other factors
Causes include:
Diabetes mellitus
Obesity
Elevated lipid profile
Most common and typical finding is an elevated ALT and or AS or normal ALT and elevated AST
Liver trauma
The liver is one of the most common organs to be injured in patients with abdominal trauma
Often injured by steering wheels in car crashes. Common injuries include simple lacerations, multiple lacerations, avulsions (tears) and crush injuries
Key features of liver trauma
Right upper quadrant pain with abdominal tenderness
Abdominal dissension and ridgity
Guarding of the abdomen
Increased abdomen pain exaggerated by deep breathing and referred to the right shoulder
Indicators of hemorrhage and hypovoemic shock
Hypotension
Tachycardia
Tachypnea
Pallor
Diaphoresis
Cool, clammy skin
Confusion or other change in mental state
Cancer of the liver
Patho
Chronic infection with HBV and HCV frequently lead to cirrhosis which is a risk factor for developing liver cancer.
Most patients are without symptoms, later in the disease they report weight loss, anorexia and weakness.
Ask the patient about abdominal pain, the most common concern. Most often felt in the right upper quadrant before jaundice, bleeding ascites and edema develop
Intervention for liver cancer
Surgical resection and liver transplant offer the only treatment for long term survival from liver cancer
Abdominal drain such as pleurX may be used at home, teach them how to empty and drain and maintain system, remind not remove more than 2000 ml of fluid at a time to prevent hypovlomic shock
Cryotherapy uses liquid nitrogen to freez and destroy tumor
Chemo may be administered orally or IV
Patient with advanced liver cancer usually need end of life care and hospice services
Liver transplantation
For patient with end stage liver disease or acute liver failure who has not responded to conventional medical or surgical intervention is a potential candidate
Patients who are not considered candidates for transplant
Severe cardiovascular disease
Severer respiratory disease
Metastatic tumors
Instability to follow instructions regarding drug therapy and self management
