week 3 - liver disease/ cirrhosis Flashcards
rotation 2
Cirrhosis is a chronic progressive disease, where the cells degenerate and get destroyed, which organ is this the disease of?
the liver
The liver cells do attempt to regenerate, but that process becomes disorganized, what kinds of things are causing this? (3)
-abnormal blood vessel/ bile duct formation
-new fibrous tissue can distort the structure + impede blood flow
-poor cellular nutrition = hypoxia
is cirrhosis more common in men or women?
men
What are the 4 kinds of cirrhosis?
- alcoholic (aka portal or nutritional)
- Post-necrotic
- biliary
- cardiac
what does excessive alcohol intake/ abuse cause accumulation of in the liver cells?
And what does continued alcohol intake cause the formation of?
accumulation of fat.
scar formation
Post-necrotic cirrhosis is a possible complication of what 3 kinds of hepatitis?
scar tissue forms
-viral
-toxic
-idiopathic
- what causes biliary cirrhosis?
- The obstruction is then causing _______ of the liver + _________.
- chronic biliary obstruction
- fibrosis; jaundice
Cardiac cirrhosis is due to long standing, severe ______ sided heart failure.
right
GI disturbances are usually the early manifestations of cirrhosis, what kinds of things is the patient going to experience?
-anorexia + weight loss
-dyspepsia
-flatulence
-N/V
-change in bowel habits
-ABD pain
-fever
-lassitude
-enlarged liver or spleen
Portal hypertension is a complication of cirrhosis, it is defined as a pressure >______. where as a normal pressure is 5-10.
12
What does portal hypertension put the patient at risk of developing?
variceal bleeding in the esophagus + ascites
Jaundice is the result of the body not being able to excrete bilirubin through liver cells. Does this occur in the early or late stages of cirrhosis?
the late stages
Pruritis is caused by the accumulation of what?
bile salts
Skin lesions can also appear due to the increase of ______, this hormone is increased because the liver is unable to metabolize hormones.
estrogen
what are the small dilated blood vessels that appear on the body with a bright red center and spiderlike branches due to high estrogen levels or liver disease.
spider angiomas
what is it called when the palms of the hand(s) are reddened, but blanchable?
palmar erythema
what are some endocrine related complications due to the bodies (liver) inability to metabolize hormones?
-altered hair distribution (estrogen)
-hyperaldosteronism
Splenomegaly occurs due to a backup up of blood in the _____ vein. this patient is also a risk for bleeding tendencies due to decreased ________ _______ _______.
-portal
-hepatic clotting factors
Peripheral neuropathy occurs due to the deficiencies of :
-
thiamine
folic acid
vitamin B 12
what complications will you see with portal hypertension?
increased venous pressure
splenomegaly
ascites
large collateral veins
esophageal varices
systemic hypertension
Which complication is the most life threatening that leads to hemorrhage?
esophageal varices
What kind of edema will you see in a patient with portal hypertension
At the ankles and presacral edema
What are some manifestation of hepatic encephalopathy, due to ammonia toxicity from inability to excrete?
-changes in level of responsiveness
-asterixis
-fetor hepaticus “feeder” - musty/ sweet breath
A serious complication of cirrhosis is hepatorenal failure, which is renal failure associated w/ cirrhosis - what 3 things occur with this complication?
-azotemia
-oliguria
-intractable ascites
ALT is an enzyme mainly found in the liver and its the best test for detecting what?
hepatitis
the ALP enzyme is related to the bile ducts, when they are blocked, the level will _________.
increase
Total Bilirubin is measuring all the bilirubin in the ________. while direct bilirubin is measuring a form that is combined with another compound in the ________.
blood; liver
Albumin is a very important protein made in the liver, when the blood test is done, were looking for…….
whether or not the liver is making enough
What part of a blood test is measuring for albumin level and levels of all the other proteins found in the blood?
total protein
when teaching a patient with cirrhosis, it is important for them to know to avoid alcohol and what 3 types of medication?
-NSAIDs
-aspirin
-acetaminophen
what 3 thigs are included in the management of ascites?
-high carb/ low salt diet
-paracentesis
-diuretics
a peritoneovenous shunt is another treatment used to manage ascites, but not a first line therapy, where the fluid is reinfused from the abdomen into the vena cava. What are 4 pretty significant complications of this therapy?
-DIC
-fluid overload
-thrombosis
-infection
A big goal is to avoid bleeding and hemorrhage when esophageal varices are present. We want the patient to avoid irritating foods, aspirin and _________.
alcohol
if bleeding does occur, the patient should be stabilized by managing their airway and IV therapy. They will also be given IV vasopressin to control their bleeding, what other medication will be given in combination to decrease the side effects of vasopressin?
nitroglycerin
what is endoscopic sclerotherapy and how does it treat esophageal varices?
this is where scleromate is injected into the enlarged/ bleeding veins (varices). this substance causes inflammation, and thromboses and obliterates the distended veins and over time causes the vein(s) to close off and allow scar tissue to form
balloon tamponade controls hemorrhage by ___________ the esophageal varices. What kind of tube is used to complete this procedure?
- compressing; - Blakemore tube
which procedure is the banding of the esophageal varices, with fewer complications than sclerotherapy?
endoscopic ligation
Which medication will be given as long term management for GI bleeding (varices) to prevent recurrent bleeding?
propranolol - and this works by lowering the pressure of the blood in the varices
this is a nonsurgical procedure where a shunt is placed between the systemic and portal system to redirect portal flow, decrease pressure and decompress the varices. what is this procedure called?
TIPS - Trans-jugular Intrahepatic Portosystemic Shunt
Which surgical procedure is used for emergency situations to decrease bleeding episodes; but this does not prolong life and can cause hepatic encephalopathy?
portocaval shunt
Which surgical procedure leaves the portal venous flow intact, decreases the incidence of hepatic encephalopathy by diverting blood flow away from the portal vein + reduces pressure and swelling?
DSRS - Distal Spleno-Renal Shunt AKA a warren shunt
what medication are we giving to a patient with cirrhosis to decrease ammonia formation?
lactulose
if a patient with cirrhosis doesn’t have any complications, what will their diet look like?
high calorie, with the majority being carbohydrates (CHO) and low fat
if a patient has ascites and edema what will we make sure their diet is low in?
sodium
chronic ___________ and hepatitis should be included and asked about in assessing past medical history.
alcoholism
with cirrhosis which ABD quadrant will the patient experience pain?
RUQ
what 4 things need to be measured by you as the nurse, while taking care of your patient with cirrhosis?
-I/O’s
-weight
-ABD girth
-extremities (edema)
What should you have your patient do immediately before paracentesis is performed?
void
what position should the patient be in for paracentesis?
high fowlers or the side of the bed
what 2 things need to be monitored after paracentesis?
electrolytes for imbalances and the dressing for bleeding/ leakage
how is the placement of the balloon verified in a balloon tamponade procedure?
x-ray
how often should the balloon be deflated after a balloon tamponade procedure?
every 8-12 hours
after a balloon tamponade, what is used to remove the blood and prevent aspiration?
saline lavage and the NG tube placement
what is the most common clinical manifestation of hepatic encephalopathy?
altered level of consciousness
after a liver biopsy which side should you have the patient lay on to help control bleeding?
the right side
if the patient starts to aspirate while a Blakemore balloon is placed to control the bleeding for esophageal varices, what should be at the bedside to manage this situation and why?
you need scissors to
what dietary component do you restrict if the patients ammonia level is high?
protein
