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Terms in this set (15)
What is hepatic encephalopathy (HE) and it's symptoms?
In this disorder, ammonia enters the brain and stimulates GABA which decreases function of the nervous system. S/sx include disturbance and reversal of diurnal sleep pattern, asterixis (liver flap), fetor hepaticus (smell of old wine/grass), changes in LOC, incr risk for infections and dehydration. It occurs w/profound liver failure.
What is the tx and med mgt for HE?
Treatment includes id'ing and removing cause, if possible; monitoring respiratory status/neuro/I&Os, reducing protein in diet, administering Lactulose PO to trap and expel ammonia in feces, giving neomycin as ordered, avoid toxins AND sedation.
If you palpate a pt's liver (RUQ) and it is tender, what might this indicate?
This would indicate viral or infectious hepatitis, not cirrhosis or alcoholic hepatitis.
What does a high Alk Phos indicate when compared to ALT/AST?
A high Alk Phos indicates cholelithiasis.
What does a 3:1 AST to ALT ratio indicate?
This ratio indicates alcoholic liver disease. A 2:1 ratio is suspicious, but 3:1 provides a 96% certainty.
What side do you lay the pt on if there is bleeding due to a liver biopsy?
In this case, lay pt on right side to apply pressure.
Why are most liver transplants needed?
80% of these are needed due to Hep C, alcoholic liver disease and non alcoholic liver disease.
What lab value can help grade the severity of ascites?
Albumin level can help grade the severity of this.
In ascites, what electrolyte imbalance is present?
Hyponatremia is present with this condition. Diabetes increases risk (15-30% of pts with condition are diabetic). The condition is the most common complication in cirrhosis.
What is the treatment of choice for variceal hemorrhaging?
Endoscopic vagal ligation is the tx of choice for this condition. Ocreotide may be given for active hemorrhaging to reduce portal HTN (or vasopressin and nitro). EVL can cause chest discomfort and esophageal strictures can form.
What drugs can be used prophylactically to prevent re-bleeding for pts with known varices?
Beta blockers can be used prophylactically for these pts. They are not used in acute bleeding.
MELD Score is what?
This is a measurement of mortality risk in end stage liver disease. it provides a 3 month survival. The higher the score, the lower chance of survival. A score of 5 indicates a good 3 month survival. A score of 20 shows a decline (pt may need transplant). A score of 40 indicates a 71% chance of mortality in 3 mos.
What is a common cause of fulminant failure?
Viral or other infections hepatitis is a common cause of this failure. Rapid recognition and treatment is key. Liver transplant is the tx of choice.
What is the most common liver malignancy?
Metastatic disease is the most common malignant lesion here.
What is Gilbert's disease?
This disease is usually found in males and the pt becomes jaundice when stressed, but LFTs are normal and no destruction cause is found.
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