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Nursing 283 > Week 1 Liver > Flashcards

Week 1 Liver Flashcards

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1
Q

What is cirrhosis?

A

extensive scarring of the liver

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2
Q

Most common causes for cirrhosis in the US

A

hepatitis C, alcoholism, and biliary obstruction

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3
Q

Basic functions of the liver

A

digestion, nutrition metabolism, protein synthesis, detoxify blood, produce bile, converts glucose to glycogen, converts ammonia, regulates platelets, produces heme

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4
Q

What happens when there is a lack of albumin (a protein created by the liver)?

A

Because of the large molecule keeping pressure in the vascular system, patients will start third spacing huge volumes of fluid in their gut and lower extremities

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5
Q

What is the tx for tylenol overdose?

A

Mucomyst

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6
Q

What medications cause the most liver problems?`

A

Tylenol, “glitazone” diabetic drugs and anti-TB drugs

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7
Q

What happens when someone doesn’t make bile?

A

They can’t emulsify fat and develop steatorrhea and fat leave through the stool. Also can not get fat soluble vitamins (AEDK)

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8
Q

Function of vitamin K in liver patients

A

responsible for much of the blood clotting cascade

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9
Q

Why give FFP over FP to a liver PT?

A

FFP has more clotting factors (7&9) that the PT lacks

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10
Q

Will the PT with ESLD by hypo or hyper glycemic?

A

Hypoglycemic because the liver can not convert glucose to glycogen for storage

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11
Q

Ammonia and ESLD

A

the liver is unable to convert ammonia which is a bi-product of protein and excrete it so it builds up in the body

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12
Q

Anemia and ESLD

A

the liver processes heme so you will be anemic in ESLD

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13
Q

What medication is used to remove ammonia?

A

Lactulose

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14
Q

Which antibiotic is commonly used in liver disease?

A

Rifaximin according to Rita

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15
Q

Function of antibiotic use in liver disease

A

Helps prevent episodes of HE and keeps PTs out of the hospital

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16
Q

Kupffer cells

A

found in the liver and involved in the immune system and infection response. They decrease as your liver function decreases and you are less able to fight infections

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17
Q

AST/ALT levels in liver disease

A

Both will be elevated, ALT is more specific to liver cells

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18
Q

Bilirubin levels in liver disease

A

they will be very high because the body can’t excrete it. It will cause urine to be light to dark brown

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19
Q

Level of ammonia in liver disease

A

elevated

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20
Q

Level of albumin in liver disease

A

decreased

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21
Q

Level of Ca2+ in liver disease

A

decreased

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22
Q

Qty of platelets in liver disease

A

drastically decreased

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23
Q

Number of WBCs in liver disease

A

decreased

the immune system is inhibited

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24
Q

PT/INR levels in liver disease

A

prolonged

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25
Q

Function of EGD test

A

looking for esophageal varicies. If there are, you have portal HTN (over 5mmHg of pressure)

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26
Q

MARs procedure

A

Dialysis of the liver to purify their blood

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27
Q

Why give aldactone in liver disease?

A

It decreases aldosterone which regulates H2O and Na in the body

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28
Q

What type of diet should liver patients be on?

A

High calorie, high carb, low/moderate fat, high protein, LOW salt
6 meals/ day

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29
Q

What is hepatitis?

A

Inflammation of the hepatocytes in the liver

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30
Q

How is Hep A transmitted

A

fecal-oral route, contaminated H2O, food, more common in underdeveloped areas

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31
Q

Hep A vaccine?

A

Yes

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32
Q

Hep B vaccine?

A

Yes but people who are overweight should have their titers checked because the vaccine may not remain as effective

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33
Q

Hep B infection series of events

A

May not know infection has occurred, most recover and develop immunity, a small # become carriers and need lifelong tx

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34
Q

Tx for chronic Hep B infection

A

lifelong Ribavirin and pegylated interferon only if you become a chronic carrier, otherwise, you won’t need these meds

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35
Q

Hep C Sx

A

Most people a asymptomatic which delays tx and can lead to ESLD

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36
Q

Hep C transmission

A

Parenteral

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37
Q

Hep C vaccine?

A

No

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38
Q

Hep D incidence

A

rare, must have coexisting Hep B to be infected

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39
Q

Hep D vaccine?

A

No but getting the Hep B vaccine will likely keep you from getting Hep D

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40
Q

Hep E transmission

A

fecal-oral route

Mostly seen in Asia and Africa

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41
Q

fulminant hepatitis

A

A severe, acute and often fatal form of hepatitis

Liver cells fail to regenerate and necrosis takes over

42
Q

When is hepatitis considered chronic?

A

when liver inflammation lasts longer than 6 months

43
Q

Cause of chronic hepatitis

A

Hep B, C or B superimposed with hep D

44
Q

Complications of chronic hepatitis

A

cirrhosis and liver cancer

infections, especially the combination of HBV with HCV, HDV, or HIV infections.

45
Q

Measures to prevent HAV infection include

A

handwashing especially after handling shellfish
Receiving immunoglobulin within 14 days of virus exposure
Being vaccinated

46
Q

Clinical manifestations of hepatitis to look for on assessment

A
  • Abdominal pain
  • Changes in skin or sclera (icterus)
  • Arthralgia (joint pain) or myalgia (muscle pain)
  • Diarrhea/constipation
  • Changes in color of urine or stool
  • Fever
  • Lethargy
  • Nausea/vomiting
  • Pruritus (itching)
47
Q

Confirmatory test for HAV, HBV and HCV

A

acute elevations of liver enzymes indicating liver damage

48
Q

. Serum total bilirubin levels in hepatitis

A

elevated and are consistent with the clinical appearance of jaundice
Elevated levels are also seen in urine

49
Q

When is the presence of hepatitis A established

A

when hepatitis A virus (HAV) antibodies (anti-HAV) are found in the blood

50
Q

When is the presence of the hepatitis B virus (HBV) established

A

in the presence of hepatitis B antigen-antibody systems in the blood and a detectable viral count

51
Q

How long is the Hep B PT contagious?

A

as long as HBsAg (hepatitis B surface antigen) is present in the blood, presence after 6 months indicates a carrier state or chronic hepatitis. People who have been vaccinated against HBV have a positive HBsAb because they have immunity

52
Q

Liver biopsy

A

biopsy may be used to confirm the diagnosis of hepatitis and to establish the stage and grade of liver damage

53
Q

Interventions during the acute stage of viral hepatitis

A

aimed at resting the inflamed liver to promote hepatic cell regeneration

54
Q

Hepatitis nutrition

A

high in carbohydrates and calories with moderate amounts of fat and protein, small frequent meals, supplement vitamins

55
Q

STEATOSIS

A

Fatty liver

56
Q

Cause of fatty liver

A

accumulation of fats in and around the hepatic cells, may be caused by alcohol abuse or other factors

57
Q

Causes of Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)

A
  • Diabetes mellitus
  • Obesity
  • Elevated lipid profile
58
Q

Common findings in fatty liver disease

A

asymptomatic

elevated ALT and AST or normal ALT and elevated AST

59
Q

Tx for fatty liver

A

Weight loss, glucose control, and aggressive treatment using lipid-lowering agents

60
Q

Biproducts of protein breakdown

A

Ammonia and bacteria

61
Q

Levels of AST/ALT, bilirubin and alkaline phosphatase through liver disease

A

They will all go up until the end stage and then they will go down

62
Q

Critically low platelet value

A

40,000

63
Q

Sx of portal HTN

A

anorexia
excess fluid/3rd spacing
HF

64
Q

Teaching plan for liver disease PTs

A 
No alcohol
Watch OTC (tylenol/NSADIS)
Take rest periods
Low salt diet
Need bleeding precautions
Daily WT
65
Q

When to get liver dialysis (MARs procedure)

A

increased weakness, tremulous, change in mental status

66
Q

What to teach about meds for liver

A

Teach why they use each med
Lactulose, they dont like the diarrhea
Diuretics, Lasix, aldactone, not HCTZ (too weak)

67
Q

Why do we give aldactone?

A

decreases aldosterone levels

68
Q

Phases of hepatitis

A

Pre-icteric
Icteric
Convalescent

69
Q

Pre-Icteric phase of hepatitis

A

No jaundice but you won’t feel well

Sx: anorexia, N/V, fatigue, rash, possible RUQ pain

70
Q

Icteric phase of hepatitis sx

A

Jaundice (first seen in the sclera), itching, dark urine due to bilirubin excretion, clay colored stool, fatigue, wt loss

71
Q

Convalescent phase of hepatitis

A

PTs will feel better but they need more rest, appetite returns, no jaundice

72
Q

NAFLD is correlated with what disease?

A

Diabetes and being obese

73
Q

Stages of liver damage

A

steatosis
steatohepatitis
Cirrhosis

74
Q

Steatosis in NAFLD

A

deposits of fat cause liver enlargement

75
Q

steatohepatitis in NAFLD

A

scar tissue begins to form

76
Q

S/Sx of NAFLD

A 
Asymptomatic
RUQ discomfort (possibly)
Fatigue
Belly fat (very common              
Diabetes
HTN
Hyperlipidemia
Hepatomegaly (especially when they are in the inflammatory phase)
Splenomegaly
Acanthosis nigricans
77
Q

Tx for NAFLD

A

No FDA approved treatment
TZD possibly statins
TLC = therapeutic lifestyle changes (lose 10% of body wt)

78
Q

Complications of cirrhosis

A 
Portal hypertension
Ascites
Bleeding esophageal varices 
Coagulation defects
Jaundice
Portal systemic encephalopathy (Hepatic Encephalopathy)
Hepatorenal syndrome
Spontaneous bacterial peritonitis
79
Q

Tx for portal HTN

A

TIPS procedure (trans-jugular intrahepatic portal shunt.)

80
Q

Portal HTN

A

caused by obstruction of blood through the portal vein
Can result in ascites, esophageal varices, anorexia
Over years, it can result in HF

81
Q

Issues with albumin and ascites

A

Free fluid in peritoneum pulls albumin with it.
Need to give albumin post paracentesis
If liver unable to make albumin then have oncotic pressure issues in the blood vessels

82
Q

Sx and Tx of bleeding esophargeal varicies

A

Sx: hematemesis, melana
Tx: Endoscopy to stop bleeding, Banding, Sclerosing

83
Q

Portal Systemic Encephalopathy (Hepatic Encephalopathy) cause

A

Unknown cause, possibly due to toxins, not due to ammonia

84
Q

Portal Systemic Encephalopathy (Hepatic Encephalopathy)

A

causes changes in LOC and personality

There are 4 stages of severity

85
Q

Sx seen in early stage of Portal Systemic Encephalopathy (Hepatic Encephalopathy)

A

asterixis (flapping) of the hands when hands are put up

86
Q

Hepatorenal Syndrome

A

As liver fails the kidneys fail

Prognosis is poor

87
Q

Hepatorenal Syndrome sx

A

Sudden decrease in urine output
↑ BUN/Cr, urine osmolarity
↓ urine sodium
GFR declines

88
Q

Spontaneous Bacterial Peritonitis

A

Seen in ESLD

Translocation of bacteria from intestines into peritoneal fluid

89
Q

Spontaneous Bacterial Peritonitis sx

A

ascites, rigid abdomen, belly button may be popping out, caput medusa, Gynecomastia, palmar erythema, abnormal bruising, and spider angiomas.

90
Q

Spontaneous Bacterial Peritonitistx

A

Low Na, fluid restriction, vitamin/nutrition supplements, diuretics, Rifaximin, paracentesis

91
Q

Spontaneous Bacterial Peritonitis labs

A

Increased: AST/ALT, Alkaline phosphatase, Bilirubin, Coags
Decreased: Albumin, Platelets, RBCs

92
Q

TIPS procedure

A

creates a tunnel in the liver, connects the portal vein to a hepatic vein, stent is placed to keep open

93
Q

Nursing interventions post TIPS procedure

A

Bedrest, assess for fluid leaking or abd distention, monitor urine, check VS

94
Q

4 problems seen in ESLD patients

A

Decreased bile production
Anemia
Coagulation issues
Decrease in albumin and other proteins

95
Q

S/Sx seen when bile production is decreased

A

Steatorrhea
Jaundice
Decrease in fat-soluble vitamins (that’s a biggie)
High cholesterol (because the bile doesn’t carry it out)

96
Q

Why are ESLD Pts anemic?

A

liver bifurcates the heme from the globin and store it and produce it

97
Q

Nursing interventions for decreased bile production

A

Modify diet: decreased fat, increase protein, supplement vitamins
Skin care: no hot soapy water, anti-itch cream

98
Q

Interventions for anemia

A

if Hct is < 25%, administer blood, try to reduce liver toxins

99
Q

Interventions for coagulation problems

A

FFP, Vitamin K, Bleeding precautions, administer platelets

100
Q

Interventions for decreased albumin

A

small frequent high protein meals, give albumin, low salt, diuretics, beta blockers

101
Q

Ways to promote appetite in liver disease

A

Paracentesis relieve pressure)
Dark chocolate will relieve portal HTN
Maintain clean environment
Administer anti-emetics cautiously (can be toxic to liver)

Nursing 283 (10 decks)

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