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cirrhosis
pn 141 test 3, book: burke pg 480
| Question | Answer |
|---|---|
| what is it | a chronic liver disease that destroys the structure and function of liver lobules |
| what does it eventually lead to | death |
| what is the most common type | alcoholic cirrhosis , alcoholic liver disease |
| what is the cause | alcohol, hep Bor C, toxic liver damage from drugs or chemicals, ht failure, obstructed bile flow |
| what is pstnecrotic cirrhosis | toxic liver damage from durgs or chemicals |
| what is biliary cirrhosis | from obstructed bile flow |
| what are hepacytes | functional liver cells |
| what happens to the hepacytes | they are destroyed, distrupting the metabolic functions of the liver |
| what are the lost cells replaced by | scar tissue |
| the scar tissue does what to the liver lobules | they form constrictive bands there and disrupts blood and bile flow with in the liver |
| what does impaired blood flow through the liver do | it increases pressure in the portal venous system |
| the increased pressure in the portal venous system leads to what | portal HTN |
| what do portal veins do | they drain capillaries of the gut, they provide the majority of the liver's blood supply |
| obstructed bile outflow damages what | liver cells |
| loss of functioning liver lobules leads to what | liver failure |
| what do the manifestations and complications result from | impaired liver function and altered blood flow through the portal venous system |
| what happens to the liver early in the course of the disease | the liver is enlarged and tender |
| what kind of pain may they complain of | right upper gastric pain |
| what are early s/s | RUQ pain, liver is enlarged and tender, wt loss, weakness, anorexia |
| what s/s occur as the disease progresses | s/s of liver failure, and portal HTN |
| what is portal hypertension | elevated BP in the portal vein that carries venous blood from the gut through the liver |
| portal hypertension: higher pressure forces fluid out of the _______________; this contributes to the formation of ______________ | vessels; ascites |
| portal hypertension: blood is shunted from the vessels of the portal system into _________ ; this results in what | lower pressure vessel; congestion of the veins in the esophagus, restum and abdomen |
| what is ascites | an accumulation of serous fluid in the peritoneal cavity |
| what is the primary cause of ascites; why | portal HTN; b/c fluid is forced out of the cappilaries w/in the vessels |
| impaired liver function affects the production of what; this reduces what | plasma proteins (albumin); plasma osmotic pressure |
| when plasma osmotic pressure is reduced it does what | allows fluid to escape from BVs, leading to ascites and peripheral edema |
| what does fluid and electrolyte imbalances contribute to | edema and ascites |
| what is splenomegaly | the enlargement of the spleen |
| splenomegaly: how does it develop | as blood is shunted from the portal system into the spleenic vein |
| splenomegaly: what can it lead to | anemia, and low platelet count, and low WBCs |
| what does low platelets and decreased clotting factor production by the liver leads to increased risk for what | bleeding |
| why is infection a risk | b/c of low WBCc |
| what are esophageal varices | enlarged, overdistended veins in the distal esophagus t |
| esophageal varices: what does it result from | portal venous congestion |
| esophageal varices: pt with this are at high risk for what | bleeding |
| esophageal varices: high _______ food can lead to _________ | roughage; hemmorhage (like bacon) |
| upper _________ bleeding is a frequant complication | GI |
| what does bleeding result in | varices, gastritis, peptic ulcer |
| s/s: manis in the respiratory system | dyspnea |
| s/s: manis in the hepatic system | enlarged (early) or small (late) nodular liver, splenomegaly |
| s/s: manis in the GI system | esophageal varices, abdominal pain, anorexia, N, ascites, clay colored stools, peptic ulcers, GI bleeding, hemorrhoids |
| s/s: manis in the neurologic system | hepatic encephalapathy, paresthesias, sensory disturbances, asterixis |
| what is hepatic encephalopathy | agitation, lethargy, stupor, coma |
| s/s: manis in the CV system | bounding pulse, portal HTN |
| s/s: manis in the hematologic system | increased risk for bleeding, decreased clotting factor, thrombocytopenia, anemia |
| s/s: manis in the reproductive system | oligomenorrhea (female), testicular atrophy (male), gynecomastia (male) |
| s/s: manis in the integumentary system | jaundice, erythema of palms, spider angioma, decreased body hair, pruritis, eccymosis |
| s/s: manis in the metabolic system | hypoalbuminemia, hypokalemia, hypocalcemia, malnutrition, muscle wasting, generalized edema |
| s/s: manis in the immune system | increased susceptibility to infection |
| as the liver is progressively destroyed; its ability to metabolize what is impaired; this causes what to accumulate in what | proteins; ammonia and toxic nitrogenous wastes |
| hepatic encephalopathy: it is charecterized by what | altered LOC, cognition, and motor function |
| what is hepatorenal syndrome | it is renal failure associated with end stage liver disease |
| hepatorenal syndrome: cause | unknown |
| hepatorenal syndrome: is Tx effective | usually no |
| what is the goal of tx | to prevent further liver damage and manage the effects and complications of cirrhosis |
| diagnostic tests: why is a liver functions test done | they are elevated in cirrhosis, but not to the extent of of hepatitis |
| diagnostic tests: why is a blood chem test done | evals liver functions and its effects |
| diagnostic tests: why is a coagulation study done | to eval the pt's risk for bleeding |
| diagnostic tests: why is a abdominal ultrasound done | to eval liver size, identify nodules anddetect ascites |
| diagnostic tests: why is a liver biopsy done done | to determine the type and severity of cirrhosis |
| diagnostic tests: why is a upper endoscopy done | to assess for esophageal varices |
| liver biopsy: what is done | as pt exhales and hods breath it brings the liver and diphragm to its highest position. the needle is inserted between the 6th and seventh IC space, tissue is aspirated |
| liver biopsy: nursing care | NPO for 4-6 hrs b4, check PT and platelet count admin vit k as ordered, empty bladder bfore test, biospy takes 10-15 seconds, after: postition on right side, npo for 2 hours, avoid coughing and straining for 1-2 wks |
| what is avoided | substances that are toxic to the liver like acetaminophen, alcohol, drugs metabolized by the liver (barbiturates and sedatives, hypnotics) |
| diet: abstinence of what is important | alcohol |
| diet: what is restricted if serum ammonia levels are high | protein |
| diet: what is the sodium intake | <2 G/day |
| diet: why may fluids be limited | to control ascites, edema, and ht failure |
| diet: what vitemins are given | thimine, folate and b12 |
| diet: pt with alcohol induced will need what supplement | magnesium |
| surgery: what is the only Tx | liver transplant |
| surgery: who is liver transplant not appropriate for | pt who continue to abuse alcohol |
| surgery: what is a paracentesis | removal offluid from teh perineal cavity |
| surgery: when is a paracentesis done | when ascites is severe; to improve breathing |
| excess fluid in theperitoneal cavity puts pressure where; this excess prssure increases the work of what | on the diaphragm; breathing fluid will reaccumulate unle |
| fluid will reaccumulate unless the cause of ___________ is corrected | ascites |
| surgery: why is albumin given after a paracentesis | b/c it increases the intravascular oncotic pressure and slows the development of ascites |
| liver transplant: nursing care | admin drugs to prevent rejection, monitor infection, monitor renal function, monitor for signs of rejection, |
| liver transplant: s/s of rejection | increased temp, discomfort over transplant site, anorexia, decreased bile drainage from drain, arthalgia, abnormal liver function |
| paracentesis: what is the nrusing care | wt pt and baseline vs, void b4 to avoid puncture of the bladder, sitting position, |
| transjuglar intrahepatic portosystemic shunt (TIPS): what is it for | to relieve portal HTN fir ot |
| transjuglar intrahepatic portosystemic shunt (TIPS): what is done | the shunt directs venous blood from the portal vein to the hepatic vein, allowing it to bypass the liver |
| transjuglar intrahepatic portosystemic shunt (TIPS): where is it done | in the vascular cath lab, no need for surgery |
| transjuglar intrahepatic portosystemic shunt (TIPS):nursing care following the procedure | bleedingat insertion site (juglar vein) or internally, vs, color and LOC |
| endoscopic sclerotherapy or endoscopic band ligation: what is it used for | for bleeding esophageal varices (potentially life threatening) |
| endoscopic sclerotherapy or endoscopic band ligation: what is done | once the varices have been identified, a schlerosing agent is injected into the enlarged vessel, causing an inflammatory reaction and clotting |
| what is doen in an acute situation with the bleeding varices | a multiple lumen GI tube is inserted to tamponade (place pressure on) the bleeding |
| why is wt any issure (excess fluid volume) | impaired salt, water regulation caused by cirrhosis can lead to problems such as peripheral edema ascites and ht failure |
| why is girth measured daily | this is an accurate measure of ascites |
| why is thought processes disturbed | b/c of accumulation of nitrousous waste |
| why is vit K given | to increase clotting |
| what balloon should be deflated first in the sengstaken-blakemore/ multiple lumen NG tube | the esophageal balloon before deflating the gastric balloon |
| cause: why could gullbladders be an issue | the ducts could be blocked |
| what is the issue with fibrous scar tissue | the scar tissue does not stretch |
| can the liver regenerate if someone quits drinking | yes, problem can be reversed if caought in time |
| labs: what will CBC show | s/s of anemia |
| high bilirubin causes what | jaundice |
| labs: why are there high lipids | because there is more deposits of fat in the blood stream b/c body cannot break down fats |
| labs: what is albumin lvels; why | it is low; b/c the liver creates it and if it cannot make it will be low |
| what happens if albumin is low | body cannot keep fluid in the cells and pt will have edema ascitis it can impair wound healing |
| what are the 2 big reasons for ascities | low albumin and portal HTN |
| varices : increaes risk for what ; why | gi bleed; b/c portal HTN is there and varices are weak also there is a high INR |
| what is the Tx for high amonia | lactulose |
| side effects of lactulose | increased explosive diarrhea |
| scarred and fibrous tissue blocks blood where | thru the liver |
| portal HTN: where does blood back up into | the esophagus, gastric, S&L intestines and the spleen |
| portal HTN: why are beta blockers used | to decreased BP |
| tx for ascites | parasentisize to drain |
| why is abdominal girth measured | to see if it is getting bigger |
| what is hematochezia | blood in stool |
| portal HTN: what happens when it presses on the spleen; why does this increase the risk for bleeding | the spleen stores the platelets and this can decrease the platelet count which increases risk for bleeding |
| why is protein needed; why is it not | for low albumin, b/c protein can increased serum amonia |
| when is protein limited | if amonia levels are high |
| why is there ineffective breathing patterm | b/c of ascities |
| why is there risk for impaired skin integrity | b/c of jaundice and the itching |
| surgery: what is the tips procedure; why is it done | or SQ shunt, the portal vein bypasses the liver , this helps with ascites |
| surgery: tips procedure- is it a cure | no only palliative |
| who can't be on the transplant list | cancer, drinking, aids, chronic diseases |
Created by:
jmkettel
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