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AH Exam 2 - Liver
Terms in this set (92)
Functions of the liver*
1. Carb metabolism
2. Protein metabolism
3. Fat metabolism
5. Steroid metabolism
6. Bile production/metabolism
7. Storage (glycogen, vitamins, minerals)
8. Mononuclear phagocyte system (breakdown of blood cells)
Concentration of bilirubin in blood abnormally increased
White - sclera and skin
Black - hands, feet, mouth
Inflammation of the liver
Kupffer cells lyse
Bile flow is interrupted
Can liver cells regenerate after a hepatitis infection?
Yes if acute
Can hepatitis lead to cirrhosis?
Yes if chronic
Hepatitis A route of transmission
Ingestion of infected foods
When can hep A be detected?
In feces 2 or more weeks before onset of symptoms
S/s of hep A
Flu-like to jaundice
Which hep can be chronic?
Hep B and C
Hep B route of transmission
Transmitted perinatally by infected mothers, sexual contact, percutaneously:
Needles/ IV drug use
Mucosal exposure to infectious blood and/or body fluids
How long can the hep B virus live on an inanimate object?
up to 7 days so is very infectious
What can hepatitis lead to?
Acute liver failure and cirrhosis
Hep C route of transmission
Percutaneously - needles
What three viruses are co-infections in IV drug abusers?
HIV, Hep B, and Hep C so check for all
SO high risk for progression of cirrhosis and cancer
Why is hepatitis hard to dx?
May be asymptomatic during acute phase
Clinical manifestations (if present) of hepatitis during acute phase
Malaise, fatigue, nausea, vomiting, abdominal pain, anorexia, low grade fever, jaundice
Physical exam findings of hepatitis
hepatomegaly, lymphadenopathy, jaundice, dark urine, clay stools, pruritus
Which hepatitis is most likely to progress to liver disease and cirrhosis?
When are hep pt's most infectious?
During acute phase
Complications of Hepatitis (5)
1. Lifelong viral infection
2. Fulminant Hepatic failure
3. Chronic hepatitis
5. Liver transplant*
Acute and life threatening
Severe impairment or necrosis of liver cell and potential liver failure
Also causes kidney failure
What risk factors put a pt at a higher risk for complications of hepatitis?
Males, alcoholics, and iron deposits in liver, DM
Treatment for hepatitis
1. Rest to promote liver regeneration
2. Antiemetics, interferon
3. Proper nutrition
Tests for hepatits
Immune globin test to look for antibodies
Liver enzyme panel
What type of hepatitis is there NO vaccine for?
Extensive degeneration and destruction of the liver parenchymal cells
Poor cellular perfusion
Four types of cirrhosis
2. Post necrotic-post viral, toxic hepatitis
3. Chronic biliary obstruction/infection
4. Cardiac from right sided heart failure
Early cirrhosis s/s
Nausea and vomiting
Skin lesions-spider angiomas
Late cirrhosis s/s
What does the cirrhosis liver look like the in very advanced stages?
Small and nodulous
What complication of cirrhosis is the most life threatening?
Varices since they are fragile and likely to burst and cause major hemorrhage
Esophageal/gastric varices from cirrhosis
Tortuous veins at lower end of esophagus enlarged and swollen from portal hypertension
Very fragile and potential major bleeding
Can varices tolerate high blood pressure?
S/s of bleeding varices
Melena or hematemesis to massive hemorrhage
Treatment of varices
Avoid alcohol, ASA, and irritating foods
What should you do if bleedings of the varices occurs?
Stabilize with blood products and meds
Balloon Tamponade (inflates to stop bleeding)
Risks of using balloon tamponade
Aspiration, esophageal rupture, or erosion
Accumulation of serous fluid in the peritoneal or abdominal cavity
BP elevated in liver = proteins move from blood vessels into lymph space = leaks into peritoneal cavity
Effects of ascites
1. Hypoalbuminemia - Decreased colloidal oncotic pressure
1. Abdominal distention
2. Weight gain
3. Dehydration - low BP, dry mucous membranes
4. Decreased potassium level
5. Decreased urine output
Nursing care of ascites
1. Bed rest
2. Na restriction
5. Monitor for bleeding
6. Reduce ammonia and protein formation
What position should pt with ascites be in?
High Fowler's to prevent pleural effusion
Considerations for diuretics
Watch lab values - K, Na, Cl
Kidney function - BUN and creatine
What is a pt at risk for after a paracentesis?
Terminal complication of liver disease
Liver damage causes ammonia to enter the systemic circulation
Toxic neurologic manifestations
S/s of encephalopathy
Agitation, sleep disturbance, lethargy, coma, violence
Flapping tremors of wrist and fingers
Sign of encephalopathy
Musky-sweet odor of pt's breath
What are hepatic encephalopathy pt at a high risk for?
Falls, pulling out IV lines, self-injury
Make sure they are in a safe environment
High priority assessment for pt with cirrhosis or hepatic enceph.
Level of consciousness - orientation, reflexes, motor abnormalities, electrolyte imbalances
Effect of dehydration on hepatic enceph.
Increases the risk of developing enceph so make sure pt stays hydrated
Fulminant/Acute liver failure syndrome
Severe impairment of liver function associated with hepatic enceph
Causes of Fulminant/Acute liver failure syndrome
Drugs, alcohol, hepatitis, mushroom poisoning
Is acute LF gradual or rapid?
S/s of acute LF
Coagulation, liver enzymes, bilirubin abnormalities
Complication of acute LF
If both the liver and kidneys are failing, what does that increase the need for?
Most common reason for liver cancer
Also, meta site
Acute inflam of pancreas
Can be life threatening
Pancreas digests itself
Causes of pancreatitis
1. Biliary tract disease - Gallbladder disease, biliary sludge biostasis, anemia
Trauma, virus, meds, surgeries
1. Abdominal pain in LUQ radiates to back* piercing
3. Nausea and vomiting
5. Increased HR, decreased BP
6. Paralytic ileus may occur
7. Crackles in lungs
Does pancreatitis pain worsen or better with eating?
Fatty foul smelling stool
Sign of pancreatitis
What can severe pancreatitis lead to?
Intravascular damage due to circulating trypsin and cyanosis
Cullen's and grey turner's
Grey Turner's sign
Bluish flank discoloration due to intravascular damage
Bluish periumbilical discoloration from the intravascular damage
Complication of pancreatitis
Primary - serum amylase and lipase elevated
Ultrasound, CT, ERCP
Low BP, tachy, airway or resp. compromise
What is always the first priority?
Treatment of shock
Treatment for shock
IV Fluids - NS or LR
Volume expanders - dextran or albumin
Surgery if necessary
What needs to be monitored for if pancreatitis pt goes into shock?
Necrotizing pancreatitis due to infection
Nursing interventions for acute phase of pancreatitis
Observe for resp. infections
No alcohol, caffeine, smoking, fatty foods
Two big complications of pancreatitis
Pseudocyst or abscess
Cavity around pancreas with necrotizing products
Pain and n/v
Result of extensive necrosis and may become infected or perforate
Abdominal pain, mass, fever
Pulmonary complications of pancreatitis
Pleural effusion, atelectasis, pneumonia
Effect (complication) of pancreatitis on BP
Effect (complication) of pancreatitis on Ca levels*
Watch for tetany!
Sign of SEVERE pancreatitis
MEDS FOR PANCREATITIS PG. 1121 TABLE 44-21
Chronic pancreatitis is caused by (2)
1. Obstruction from gallstones or biliary disease
2. Calcification of pancreas and duct = sclerosis
3. Alcohol abuse
Chronic pancreatitis s/s
Abdominal Pain or Tenderness
Weight loss r/t Malabsorption
Mild jaundice with dark urine
Chronic pancreatitis nursing care
1. Dietary control
2. Control of DM
3. Taking pancreatic enzymes
Inflam of the gallbladder r/t stones
Leukocytosis / Fever
Pain and tenderness in the right upper quadrant referred to the right shoulder
When is pain present for Cholelithiasis/Cholecystitis?
Pain 3 to 6 hours after heavy meal
Signs of total obstruction due to gall stones
Jaundice, clay colored stools, pruritus, steatorrhea
Elevated WBC, Bilirubin, Alkaline phosphatase, ALT, AST, amylase may be elevated
Treatment of Cholelithiasis/Cholecystitis
Low fat diet
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