Topic 8: Cirrhosis & Liver Cancer Flashcards
cirrhosis
Cirrhosis is the ends stage of liver disease, liver tissue is replaced by scar tissue (fibrosis)
most common cause of cirrhosis
Most common causes are hepatitis C infection and ALCOHOL-indices liver disease
Early Manifestations of cirrhosis
· Patient may be unaware because few symptoms present
· Fatigue
· Enlarged liver
Late Manifestations of cirrhosis
· Jaundice (due to inability to excrete bilirubin into the small intestine)
· Spider angiomas
· Palmar erythema
· Thrombocytopenia leukopenia anemia, coagulation disorders
· Peripheral neuropathy
spider angioma
dilated blood vessels with bright red center point and spider like branches
palmar erythema
red area that blanches with pressure
complications with cirrhosis
· Portal HTN and Esophageal and Gastric Varices
· Peripheral edema and Abdominal ascites
· Hepatic encephalopathy
Hepatorenal Syndrome
Portal HTN and Esophageal and Gastric Varices
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)
what happens if Esophageal and Gastric Varices rupture
it can cause hemorrhage. Patient may present with melena or hematemesis
· Hepatic encephalopathy is caused by
o Ammonia levels are high
o High ammonia leads to neurologic toxic manifestations because it can cross the BBB
for a patient with hepatic encephalopathy what types of food should they reduce
protein
· Hepatic encephalopathy manifestations
changes in mental status, impaired consciousness, inappropriate behavior, trouble concentrating, ASTERIXIS
diagnostics for cirrhosis
· 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
conservative therapy for cirrhosis
· Rest
· B-complex vitamins
· Avoiding alcohol
· Minimizing or avoiding aspirin, acetaminophen, NSAIDS
interventions for ascites
· Low sodium diet
o Limit to 2g/day
· Diuretics
o Spironolactone, furosemide (Lasix), Tovaptan (Samsca)
· Paracentesis
what is used to screen for varices
Upper endoscopy (EGD)
Esophageal and Gastric Varices interventions
· 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)
if bleeding occurs with Esophageal and Gastric Varices…
STABILIZE PATIENT AND MAINTAIN AIRWAY
Esophageal and Gastric Varices Drug Therapy Nonselective B-Blocker
(propranolol) - used to decrease portal pressure which reduces risk for rupture and hemorrhage
Esophageal and Gastric Varices Drug Therapy
Octreotide (Sandostatin)- Vasopressin produce vasoconstriction
Paracentesis
· A sterile procedure performed by HCP where a catheter is used to with drawl fluid from the abdominal cavity
pre-procedure for paracentesis
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
post-procedure for paracentesis
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
acute care
· 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
what drugs need to be taught about for a patient with cirrhosis
· Teach to avoid hepatotoxic OTC because the diseased liver cannot metabolize them
avoid alcohol
Teach patients with esophageal or gastric varices to…
avoid NSAIDs and aspirin to prevent hemorrhage
Teach patient with portal HTN and varices that…
straining at stool, coughing, sneezing, and retching and vomiting may increase the risk for variceal hemorrhage
primary liver cancer starts in the liver and often metastasizes where
to the lung
clinical manifestations of liver cancer
· Hepatomegaly, splenomegaly
· Fatigue
· Peripheral edema
· Ascites
· Other complications from portal HTN
· Fever/chills
· Jaundice
· Anorexia and weight loss
· Palpable mass
RUQ pain
diagnostic studies for liver cancer
· Ultrasound
· CT
MRI
prevention for liver cancer
· Treating chronic hepatitis B and C viral infections
· Treating chronic alcohol use
treatments for liver cancer
· Surgical liver resection
· Liver transplant
· Nonsurgical: percutaneous ablation, chemoembolization, radioembolization, sorafenib oral therapy
TACE or TARE (transarterial chemoembolization or radioembolization):
percutaneous ablation
thin needle in core of tumor injected with various substances
TACE or TARE (trans arterial chemoembolization or radioembolization):
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
