Unit 2: Liver Disease Flashcards
Causes of Post-necrotic Cirrhosis (2)
- Viral Hepatitis (especially HepC
- Drug-induced (or toxin-induced)
Laennec’s Cirrhosis =
Alcoholic Cirrhosis (Chronic Alcoholism)
Causes of Biliary Cirrhosis (2)
aka cholestatic cirrhosis
1. Biliary obstruction
2. Autoimmune disease
______ cirrhosis = scarring present, but liver can still function.
Compensated Cirrhosis
cellular regulation is impaired, but liver can still perform essential functions w/o causing major Sxs
______ cirrhosis = liver failure with Sxs
Decompensated Cirrhosis
What Complication Am I?
A persistent increase in portal vein pressure >5 mm Hg; results from increased resistance to or obstruction (blockage) of the flow of blood thru the portal vein and its branches.
Portal HTN
Complications r/t Portal HTN
- Splenomegaly
- Caput medusae (prominent abdominal veins)
- Ascites
- Esophageal varices
- Hemorrhoids
What can splenomegaly result in?
Thrombocytopenia
(often the first clinical sign of liver dysfunction)
EXTRA: Portal HTN results in the formation of collateral circulation. Does the blood running through these new vessels get filtered by the liver?
NOPE
Patho of Ascited r/t Liver Disease:
Ascites will continue to worsen. What’s missing and why does the fluid continue to shift? What homeostatic system gets triggered?
Low/no albumin production by the liver = decreased colloid osmotic pressure in circulatory system;
Increased hydrostatic pressure in portal veins → Plasma proteins collect in peritoneal cavity → H2O moves from LOW to HIGH [conc.] of solvents;
RAAS gets triggered by renal vasoconstriction → BIG BELLY
A pt with Ascites r/t to Liver disease may have both Edema and ____ at the same time!
Edema AND Hypovolemia!
What 4 things should we measure r/t Ascites?
- Daily wts
- Breathing (effort, lung sounds)
- Balance
- Hernias
Interventions for Ascites (Procedure + Nutrition + Drug therapy)
- Paracentesis
- Low Na+ diet (1-2 G/day)
- Vit Sups (multivit, thiamine, folate)
- Diuretics (furosemide + spironolactone)
Name 2 Complications of a Paracentesis
- Rebound ascites if fluid removal is too fast
- Peritonitis
Renal Vasoconstriction r/t Liver disease aka
Hepatorenal Syndrome
Hepatorenal Syndrome is often triggered by (2)
- GI bleed
- Hepatic encephalopathy
Hepatorenal Syndrome = ____ Prognosis
Name some abnormal labs you might see
POOR PROGNOSIS
U/O <500 mL/day
Increased BUN/Crea
What the heck is Hepatopulmonary Syndrome? How do we treat this and what are the 2 Interventions to manage it?
Ascites places pressure on lungs → Dyspnea
Tx: REMOVE THE FLUID (only thing that will help)
Mx:
1. Raise HOB
2. O2 therapy
Why is there such a biiiig risk for bleeding r/t Liver disease?
You ain’t got no clottin’ factors bc the liver ain’t makin’ them (prolonged PT/INR + APTT), and ur spleen is tearin’ up your platelets!
What test can we do to determine if a pt has esophageal varices?
EGD
Drug therapy to PREVENT bleeding r/t esophageal varices
Beta-blockers
We can probably guess esophageal varices will cause hematemesis, but you may also see..
Melena (blood in poop; black, tarry stool)
What patient teaching should we provide r/t esophageal varices?
- No heavy lifting
- Chill exercises only dood
- Avoid dry, hard foods
Where else might we see bleeding that results in chronic, slow blood loss, occult-positive stools, and anemia?
GI bleeding! SMELLYYYY
(due to portal hypertensive gastropathy)
