Hepatic Disorders (Cirrhosis/Cancer)
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What is some general info about cirrhosis?
- Accumulation of fat in cells (alcoholic)
- • Cell necrosis
- • Fibrosis (scarring) and nodules
- – Altered structure in liver alters blood flow, lymphatic and bile flow
- • Bile stasis leads to jaundice
What are the early SnSs of cirrhosis?
- – Insidious
- – GI symptoms
- – Abdominal pain
- – Fever
- – Enlarged liver and spleen
What are late SnSs of cirrhosis?
- – Jaundice
- – Peripheral edema (low albumin)
- – Ascites
- – Skin lesions
- – Hematologic disorders
- – Endocrine problems
- – Periph. Neuropathies
- – Small, nodular liver
- Fector hepaticus: poop-smelling burps
- Asterixis: inability to keep hands flexed when arms are held out in front of pt.
- Palmar erythema: will not blanch.
Possible complications related to cirrhosis?
- • Structural changes
- – Obstruct portal vein circulation
- – Back up & congestion-->portal vein hypertension.
- • Varices
- – Caput medusae
- – Hemorrhoids
- • Splenomegaly
- • Bruits
- • Esophagealvarices: if portal hypertension-->inability of liver to accomodate blood-->distention of esophageal vein distention-->rupture (exsanguinate)
- – Common
- – Bleed
- • Slow
- • Hemorrhage:emergent
What is the etiology of acites related to cirrhosis?
Portal hypertension–->Hypoalbuminemia–-> Hyperaldosteronism
Cirrhosis complications hepatic encephalophathy
- Clinical Manifestations
- – CNS disturbance r/t serum ammonia levels
- – Early
- • Irritable, confused, lethargy, slow speech, impaired judgement
- – Later
- • Disorientation
- • Asterixis (liver flap)
- • Coma
What is hepatorenal syndrome (HRS)
- • Renal failure
- – Azotemia
- – Oliguria (usually dark brown, sludgy)
- – Intractable ascites
- • Etiology complex
- • Reversible with liver transplantation
What diagnositics can you use for cirrhosis?
- Elevated liver enzymes
- – AST, ALT & GGT
- • Decreased total protein & hypoalbuminemia
- • Anemia
- • Prolonged prothrombin time (PT)
- • Liver biopsy
True or false: there are effective treatments to correct cirrhosis.
- False. have to treat the symptoms.
- Rest: reduces demand on liver
- Ascites: sodium restriction, limit fluids, diuretics, paracentesis, shunt fluid back to high volume vessel (ie inferior vena cava)
- Esophageal verices: Rx (Octreotide, vasopresin, NTG, beta blockers), endoscopic procedures, balloon tampenode, care for acute bleeding
- --FFP + PC, Vit K, H-2 blockers, laculose/neomycin
What are some long term interventions to care for long term esophageal verices
- – Beta blockers
- – Repeat endoscopic procedures
- • Sclerotherapy
- • Ligation
- • Shunt
- – Shunting procedures
- • Transjugular intrahepatic portosystemic shunt (TIPS)
- • Portosystemic shunts
Collaborative care for cirrhosis
- Hepatic Encephalopathy
- – Reduce ammonia:
- – Protein restriction
- – Lactulose
- – Neomycin: prevents additional protein buildup.
- – Treat causes
- – Liver transplantation
- Nutritional Therapy
- – Hi CHO, low fat
- – Protein varies
- Low:encephalopathy, hepatic failure
- – Tube feedings
- • Travasorb Hepatic or
- – Low sodium
- • Ascites, edema
What are some nursing diagnosis related to cirrhosis?
- – Imbalanced nutrition: less than body requirements
- – Impaired skin integrity
- – Ineffective breathing pattern r/t giant ascites.
- – Risk for injury
- – Risk for infection
What are nursing measures for liver cancer?
- Comfort measures
- ...because of poor prognosis.
- If transplant
- emotional support and pt teaching.
Know which Rx you don't want to give to a pt with liver failure.
These drugs don't necessarily mean they will be toxic to someone with renal failure.
What would you like to do?
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