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MED SURG > TOPIC 8 - cirrhosis, liver disease, and hepatitis > Flashcards

TOPIC 8 - cirrhosis, liver disease, and hepatitis Flashcards

1
Q

cirrhosis

A

extensive irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis.

typically has a progressive, slow, destructive course resulting in end-stage liver disease.

characterized by widespread fibrotic scarring that changes the liver. Inflammation results in the destruction of hepatocytes and leads to nodular tissue and the liver becomes hard and shrinks in size leading to a decrease in liver function.

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2
Q

risk factors for cirrhosis

A

ETOH, viral hep (or chronic hep B and C), autoimmune hepatitis, fatty liver disease, drugs and chemical toxins, gallbladder disease, metabolic causes, genetic causes, cardiovascular disease

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3
Q

assessment and manifestations related to cirrhosis

A

Fatigue
Jaundice
Peripheral edema
Ascites
Skin lesions
Hematologic disorders
Endocrine disturbances
Peripheral neuropathies

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4
Q

labs related to cirrhosis

A

elevated AST, ALT, LDH, PT, INR, bilirubin

decreased K, protein, albumin

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5
Q

diagnostics for cirrhosis

A

gold standard = biopsy (identify liver cell changes)
– high risk for bleeding

xrays may show hepato or splenomegaly or massive ascites

ultrasound detects ascites, hepato or splenomegaly and the presence of biliary stones or duct obstruction

EGD directly visualizes the upper GI tract to detect bleeding, esophageal varices, stomach ulcers, or duodenal ulcers

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6
Q

nursing interventions for cirrhosis

A

monitor fluids, electrolytes, admin albumin and diuretics, skin care, Na restriction of 2g/day

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7
Q

pre and post op responsibilities for paracentesis

A

pre op :
Ensure permit is signed
Base line vital signs
Patient teaching
Have to empty their bladder
Ensure their IV is patent

post op :
Monitor vital signs
Lie down on side without wound for 2 hours
Monitor for leakage from site
Don’t get up until the nurse tells you to
Check for new orders for fluids

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8
Q

chronic liver complications

A

portal hypertension, ascites, peripheral edema, esophageal varices, coagulopathy, hepatic, encephalopathy, hepatorenal syndrome, biliary obstruction jaundice

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9
Q

complications of cirrhosis

A

Portal Hypertension
Bleeding
Jaundice
Hepatic encephalopathy
Hepatorenal syndrome
Ascites
Esophageal varices

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10
Q

biliary obstruction leads to

A

decreased production of bile and prevents absorption of vitamin K = bleeding and bruising

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11
Q

what can cause esophageal varices

A

portal hypertension

can be life threatening from severe blood loss that leads to hypovolemia

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12
Q

what causes neurologic toxic manifestations in hepatic encephalopathy

A

ammonia crossing the blood brain barrier

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13
Q

other characteristics of hepatic encephalopathy

A

asterixis (tremors in arms and hands)
fetor hepaticus (musty sweet breath from accumulation of digestive by-products that the liver cannot degrade)

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14
Q

incubation period of hepatitis A

A

15-50 days

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15
Q

incubation period of hepatitis B

A

45-180 days

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16
Q

incubation period of hepatitis C

A

14-180 days

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17
Q

transmission route of hepatitis A

A

fecal oral

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18
Q

transmission route of hepatitis B

A

Blood & mucous membranes
Perinatal
High risk sexual contact

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19
Q

transmission route of hepatitis C

A

same as hep B

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20
Q

those at risk for hepatitis A

A

Crowded conditions, poor personal hygiene, poor sanitation, contaminated food/milk/water/shellfish, sexual contact with an infected person, IV drug users, receiving food from someone handling/preparing food

21
Q

those at risk for hepatitis B

A

Contaminated needles, syringes, blood, sexual contact with an infected person, tattoos/ body piercings with contaminated needle, asymptomatic person, blood and blood products

22
Q

those at risk for hepatitis C

A

same as hep B

23
Q

most infectious when (hep A)

A

During the first 2 weeks prior to onset of symptoms and 1-2 weeks after the onset of symptoms

24
Q

most infectious when (hep B)

A

Before & after symptoms appear. Infectious 4-6 months, carriers can be infectious for life

25
Q

most infectious when (hep C)

A

1-2 weeks before symptoms appear, during course of disease, 75-85% of people will develop chronic hepatitis c and be infectious during their life

26
Q

assessment of Hep B and C

A

Anorexia
N/V
Fever
Fatigue Right upper quadrant pain
Dark urine and light stool
Jaundice
Malaise
Easy fatigability

27
Q

complications of chronic hepatitis

A

Skin manifestations
Spider angiomas
Palmar erythema
Gynecomastia
Splenomegaly
Hepatomegaly
Cervical lymph node enlargement
HE
Ascites

28
Q

drug therapy to decrease viral load and slow rate of disease progression in chronic HBV

A

nucleoside and nucleotide
interferon therapy

29
Q

drug therapy directed at eradicating the virus and preventing HCV complications

A

antivirals

30
Q

if a client reports “no appetite” or “losing taste for food” … suggest :

A

increasing fluids and intake of juices

31
Q

initial vs later assessment of liver cancer

A

initial can be hard to detect:
Hepatomegaly
Splenomegaly
Fatigue
Peripheral edema
Ascites
Portal hypertension

later s/s:
fever, chills, jaundice, anorexia, weight loss, palpable mass, RUQ pain

32
Q

most common type of liver cancer

A

hepatocellular carcinoma

33
Q

common sites for metastasis

A

Lung
Gallbladder
Peritoneum
Diaphragm

34
Q

without treatment for liver cancer :

A

death in 6-12 months from hepatic encephalopathy or massive GI bleed

35
Q

assessment of chronic pancreatitis

A

Pancreatic insufficiency
Acute and/or chronic pain – gnawing/heavy, burning/cramping
Malabsorption & weight loss
Constipation,
Mild jaundice & dark urine
Steatorrhea – can be severe with large BMs that are foul-smelling
Abdominal tenderness
Diabetes mellitus

36
Q

chronic pancreatitis results in

A

strictures, calcifications, and progressive destruction of the pancreatic tissue

37
Q

most common causes of chronic pancreatitis

A

ETOH abuse and cholethiasis

other :
Chronic alcohol use
Obstruction: inflammation of the sphincter Oddi
Tumor
Pseudocysts
Trauma
Systemic diseases (SLE)
Autoimmune pancreatitis
Cystic fibrosis

38
Q

diagnostics and labs for chronic pancreatitis

A

elevated Amylase
elevated Lipase
Serum bilirubin
ALP
ESR
ERCP (visualize ducts)
CT
MRI
Abdominal ultrasound
Stool samples for fecal fat

39
Q

diet for chronic pancreatitis

A

low fat, bland, small and frequent meals

pancreatic enzyme replacements !! ( bile salts to facilitate absorption of vit ADEK )

40
Q

manifestations fo chronic pancreatitis

A

Abdominal pain (acute): heavy, gnawing feeling or sometimes as burning and cramp-like
Malabsorption
Constipation
Mild jaundice with dark urine
Steatorrhea
Diabetes Mellitus

41
Q

cholecystitis

A

Inflammation is the major pathophysiologic condition and may be confined to the mucous lining or involve the entire wall of the gallbladder.

During an acute attack of cholecystitis, the gallbladder is edematous and hyperemic, and it may be distended with bile or pus.

42
Q

common causes of cholecystitis

A

gallstones or biliary sludge
inflamed bile duct

43
Q

manifestations of cholecystitis

A

Severe pain (biliary colic): pain is steady, excruciating, tachycardia, diaphoresis, prostration, may last up to an hour, occurs 3-6 hours after eating fat.
If total obstruction occurs: see S/S of obstructed Bile Flow
Indigestion to severe pain, fever, chills, and jaundice, tenderness in RUQ, which may be referred to the right shoulder and scapula

44
Q

4 F’s of cholecystitis

A

fat, fertile, female, fourty

45
Q

s/s of obstructed bile flow

A

Obstructive jaundice
Dark amber to brown urine which foams when shaken
Clay-colored stools
Pruritus
Steatorrhea
Fever, chills

46
Q

diagnostics for gallstones

A

Ultrasound
Percutaneous transhepatic cholangiography
Elevated WBCs
ERCP

47
Q

treatment of gallstones

A

Removal of stone via ERCP
Disintegrate stone: Extracorporeal shock-wave lithotripsy (ESWL): uses a high-energy shock waves to disintegrate stone
Surgical removal of the gallbladder and/or stones
Laparoscopic Cholecystectomy
Cholecystectomy

48
Q

cholecystitis interventions

A

NPO, care of NG tube
Comfort care & pain control
Prepare the client for a procedure or surgery
Client education re: diet, medications, post-op recovery
Monitor for signs/symptoms the condition is getting worse
Monitor for infection
Skin care

49
Q

post op care for cholecystectomy

A

Opioids via PCA pump
T-tube (and care of)
Antiemetics
Wound care
NPO
Nutrition therapy
Percutaneous trans hepatic biliary catheter T-tube

MED SURG (30 decks)

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