Topic 8: Cirrhosis & Liver Cancer

Question 1

cirrhosis

Answer 1

Cirrhosis is the ends stage of liver disease, liver tissue is replaced by scar tissue (fibrosis)

Question 2

most common cause of cirrhosis

Answer 2

Most common causes are hepatitis C infection and ALCOHOL-indices liver disease

Question 3

Early Manifestations of cirrhosis

Answer 3

· Patient may be unaware because few symptoms present
· Fatigue
· Enlarged liver

Question 4

Late Manifestations of cirrhosis

Answer 4

· Jaundice (due to inability to excrete bilirubin into the small intestine)
· Spider angiomas
· Palmar erythema
· Thrombocytopenia leukopenia anemia, coagulation disorders
· Peripheral neuropathy

Question 5

spider angioma

Answer 5

dilated blood vessels with bright red center point and spider like branches

Question 6

palmar erythema

Answer 6

red area that blanches with pressure

Question 7

complications with cirrhosis

Answer 7

· Portal HTN and Esophageal and Gastric Varices
· Peripheral edema and Abdominal ascites
· Hepatic encephalopathy
Hepatorenal Syndrome

Question 8

Portal HTN and Esophageal and Gastric Varices

Answer 8

o Changes in liver structure lead to obstruction of blood flow in and out of the liver which increases portal pressure.
o To reduce the pressure, the body develops collateral circulation, often in the lower esophagus which causes he complex torturous enlarged veins in the esophagus or upper part of the stomach (esophageal/gastric varices)

Question 9

what happens if Esophageal and Gastric Varices rupture

Answer 9

it can cause hemorrhage. Patient may present with melena or hematemesis

Question 10

· Hepatic encephalopathy is caused by

Answer 10

o Ammonia levels are high
o High ammonia leads to neurologic toxic manifestations because it can cross the BBB

Question 11

for a patient with hepatic encephalopathy what types of food should they reduce

Answer 11

protein

Question 12

· Hepatic encephalopathy manifestations

Answer 12

changes in mental status, impaired consciousness, inappropriate behavior, trouble concentrating, ASTERIXIS

Question 13

diagnostics for cirrhosis

Answer 13

· Liver function tests (ALT, AST, alkaline phosphate, bilirubin, GGT)
· Serum albumin
· Serum electrolytes
· PT time
· CBC
· Liver biopsy
· Liver ultrasound
· Upper endoscopy
CT scan, MRI

Question 14

conservative therapy for cirrhosis

Answer 14

· Rest
· B-complex vitamins
· Avoiding alcohol
· Minimizing or avoiding aspirin, acetaminophen, NSAIDS

Question 15

interventions for ascites

Answer 15

· Low sodium diet
o Limit to 2g/day
· Diuretics
o Spironolactone, furosemide (Lasix), Tovaptan (Samsca)
· Paracentesis

Question 16

what is used to screen for varices

Answer 16

Upper endoscopy (EGD)

Question 17

Esophageal and Gastric Varices interventions

Answer 17

· Avoid alcohol aspirin and NSAIDs
· Endoscopic band ligation (elastic O-ring around the base of the enlarged vein)
· Sclerotherapy (injecting sclerosing solution into swollen vein)
· Balloon tamponade (controls hemorrhage by mechanical compression of the varices)
· Trans jugular Intrahepatic portosystemic shunt (TIPS)

Question 18

if bleeding occurs with Esophageal and Gastric Varices…

Answer 18

STABILIZE PATIENT AND MAINTAIN AIRWAY

Question 19

Esophageal and Gastric Varices Drug Therapy Nonselective B-Blocker

Answer 19

(propranolol) - used to decrease portal pressure which reduces risk for rupture and hemorrhage

Question 20

Esophageal and Gastric Varices Drug Therapy

Answer 20

Octreotide (Sandostatin)- Vasopressin produce vasoconstriction

Question 21

Paracentesis

Answer 21

· A sterile procedure performed by HCP where a catheter is used to with drawl fluid from the abdominal cavity

Question 22

pre-procedure for paracentesis

Answer 22

o Have client void (empty the bladder)
o Obtain baseline VS, weigh patient and assess abdominal girth
o Assess baseline lab values
o Give any sedation or analgesia if ordered
o Teach patient to remain immobile during the procedure
o Help the patient to a high-fowler position with feet on the floor

Question 23

post-procedure for paracentesis

Answer 23

o Perform assessment and compare VS, weight, abdominal girth and pain
o Note signs of hypovolemia
o Have patient sit on side of the bed pr place in high fowlers position
o Label and send fluid to lab for analysis
o Check dressing for bleeding or leakage of ascitic fluid
o Give IV fluid or albumin as ordered
o Measure any drainage and describe the collected fluid
o Reweigh the patient and monitor I&Os
o Maintain bedrest per agency protocol

Question 24

acute care

Answer 24

· Conserving patients’ strength while maintaining muscle strength and tone
· If patient needs complete bedrest: implement measures to prevent pneumonia, thrombolytic problems and pressure injuries
· Oral hygiene before meals
· Make between meal snacks available so patient can eat them when food is best tolerated
· Itching- cholestyramine or hydroxyzine may help
· Note color of urine and stool
· Record I&Os, weight, abdominal girth
· Semi-fowlers or fowlers allows for maximal respiratory efficiency
Edematous tissue is prone to breakdown, so skin care is important

Question 25

what drugs need to be taught about for a patient with cirrhosis

Answer 25

· Teach to avoid hepatotoxic OTC because the diseased liver cannot metabolize them
avoid alcohol

Question 26

Teach patients with esophageal or gastric varices to…

Answer 26

avoid NSAIDs and aspirin to prevent hemorrhage

Question 27

Teach patient with portal HTN and varices that…

Answer 27

straining at stool, coughing, sneezing, and retching and vomiting may increase the risk for variceal hemorrhage

Question 28

primary liver cancer starts in the liver and often metastasizes where

Answer 28

to the lung

Question 29

clinical manifestations of liver cancer

Answer 29

· Hepatomegaly, splenomegaly
· Fatigue
· Peripheral edema
· Ascites
· Other complications from portal HTN
· Fever/chills
· Jaundice
· Anorexia and weight loss
· Palpable mass
RUQ pain

Question 30

diagnostic studies for liver cancer

Answer 30

· Ultrasound
· CT
MRI

Question 31

prevention for liver cancer

Answer 31

· Treating chronic hepatitis B and C viral infections
· Treating chronic alcohol use

Question 32

treatments for liver cancer

Answer 32

· Surgical liver resection
· Liver transplant
· Nonsurgical: percutaneous ablation, chemoembolization, radioembolization, sorafenib oral therapy
TACE or TARE (transarterial chemoembolization or radioembolization):

Question 33

percutaneous ablation

Answer 33

thin needle in core of tumor injected with various substances

Question 34

TACE or TARE (trans arterial chemoembolization or radioembolization):

Answer 34

catheter placed via femoral artery or radial arterial then advanced into arterial blood supply of the tumors in the liver, releases chemotherapy agent or radioactive material