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2013-03-06 16:54:25

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  1. ____ is extensive, irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis.

    most common causes are hepatitis C, alcoholism, and biliary obstruction
  2. In early stages of cirrhosis the liver is _____ and it is _______ in late stages.
    • early - enlarged, firm, hard
    • late - shrinks in size, resulting in decreased liver function
  3. In cirrhosis

    Clinical manifestations of loss of hepatic function
    • portal HTN
    • ascites and esophageal varices
    • coagulation defects
    • jaundice
    • Portal-systemic encephalopathy with hepatic coma
    • hepatorenal syndrome
    • spontaneous bacterial peritonitis
  4. capput medusae
    veins around umbilicus become extended and engorged
  5. ___ & ___ share the common bile duct
    pancreatic duct combines with the common bile duct before entering the duodenum
  6. Hepatic encephalopathy
    • A complex cognitive syndrome that results from liver failure and cirrhosis (reversible with early intervention)
    • Early stages:  sleep & mood disturbances, mental status changes, speech problems
    • Later: neurologic symptoms include altered LOC, impaired thinking processes, neuromuscular problems
  7. In hepatic encephalopathy what do you think about when giving meds?
    • Meds usually don't metabolize well due to liver dysfunction
    • lower doses will be needed
  8. Meds for hepatic encephalopathy
    • Lactulose - 
    • goal is 3-4 stools/day
    • want ammonia levels <80
    • if ammonia builds, lactulose dose needs to be increased
    • side effect diarrhea
  9. Hepatic Renal syndrome
    • Manifested by:
    • sudden decrease in urinary flow <500mL/24hrs
    • elevated BUNand creatinine with abnormally decreased urine sodium excretion
    • Increased urine osmolarity
  10. Complications of cirrhosis
    • Portal HTN:
    • Ascites
    • Esophageal varices
    • splenomegaly-results from backup of blood into spleen.  Enlarges spleen estroys platelets increasing risk for bleeding.  Thrombocytopenia is often 1st sign of liver dysfunction
    • Biliary obstruction:
    • Production of bile in liver is decreased.  This prevents the absorption of fat-sol vits.  Withoug vit K, clotting factors aren't produced in sufficient quantities.  Puts pts at risk for bleeding.
    • Jaundice-liver can't excrete biliruben
    • *pts with jaundice often report puritis (itching)
  11. Clinical manifestations of hepatic encephalopathy
    • Build up of ammonia
    • icterus-yellowing of sclera
    • jaundice- buildup of biliruben (puritis)
    • urine - cola colored
    • asterisis - hand flapping
    • ecchymosis
    • spider angiomas
    • personality changes
    • peripheral dependent edema
    • muscle twitching