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What is cirrhosis? Cause? how does it develop?
- irriversible scarring usually caused by hep C or abuse (drugs and alcohol)
- develops slowly, has stages, ends with end stage liver disease(fatal)
- Early stages- liver is firm and hard
- Shrinks in size over time with disease progression
What is portal hypertension? Cause? WHat does it lead to?
- an increase in pressure of the portal vein due to clogged liver
- caused by increased obstruction of lood flow through portal vein
- blood backs up into spleen leading to spleenomegaly
- surrounding veins become dilated
- Leads to ascites, esophageal varices, abdominal vein engorgment and hemorroids
What is ascites?
- A collection of fluid in the abdominal cavity
- fluid third shifts from intravascular space to abdominal cavity
- Patient may be dehydrated within vascuar space and have ascites (the fluid is serum)
What are esophageal varices; What is the nursing care?
- esophageal veins become engorged from portal HTN
- bleeding esophageal varices is life threatening event results in hypovolemia
- NSG care:large container for bloody vomiting, serial H&H, call blood bank for TXM, start 18 gauge IV, sit patient up. Look for dark stools, decreased LOC, decreased BP, increased HR. HCP will insert NG tube EGD with endoscopic banding, baloon tamponade(blackmore tube), aspiration
What is Bilirubin? What is jaundice?
Bilirubin is formed when hemoglobin is broken down (during RBC replacement). Bilirubin is filtered by the liver, dupmed into blood stream, and eliminated in stool; cirrhotic liver cells cannot excrete bilirubin, and bili builds up and patient turns yellow, can be seen in whites of eyes
What is hepatic encephalopathy?
- results from cirrhotic liver and the toxins that are emitted by the liver;
- look for mental stauts change, mood changes, sleep disturbancs, slurred speech (during early stages;later stages the pt wil be comatose)
- Ammonia (byproduct of protein breakdown) levels increase
What are the stages of liver disease?
- Healthy liver: filters blood of drugs/alcohol, breaks down fat to produce cholesterol, can regenerate when damaged, makes bile for digestion
- Inflammation: becomes tender and enlarged
- Fibrosis: scarring begins in replaces healthy tissue; can still eal at this stage
- Fatty Liver: can be reversed, ma be asymptomatic, beginning stage of liver disease
- Cirrhosis: patient bleeds or bruises easily, ascites and peripheral edema, jaundice sets in, pruritis occurs(due to increased ammonia), loss of muscle mass, pt goes into kidney failure, poor meabolism of meds,(sensitive to effects and side effects, encephalopathy develops, light colored stools (no bile) lier is bumpy instead of smooth, needs liver transplant
- Liver Failure: life threatening, comatose (usually the end)
How is Liver disease diagnosed?
- PE: palpation, liver is bumpy and not smooth
- Liver function tests (AST, ALT, Bilirubin, ALP)
- CT, US: most helpful
- Bx: for staging
- Diagnostic laparscopy: see the liver
What is worse, binge drinking or daily drinking?
What is non-alcoholic fatty liver disease? What are the S&S? What is the treatment? What is the nursing care?
- Build up of fat around the liver not caused by alcohol
- Occurs most often in people are obese, DM
- May be asymptomatic
- S&S: fatigue, weakness, nausea and vomiting, abdominal pain, pruritis, jaundice, peripheral edema, ascites, mental confusion, hepatomegaly
- Increased liver enzymes, prologed prothrombin time
- Tx: diet, exercise, and limited alcohol and meds
- Abdominal girth- measure for ascites. AT end of exhalation, mark flanks to ensure accuracy
- daily weights I&O, electrolytes, assess edema, assist with paracentesis
- * may cause Fetor hepaticus- fruity or musty breath(hallmar sign) amenorrhea, testicular atrophy, gynecomstia, impotence Due to lack of hormones, mental status and personality changes, may cause tremors, sleep pattern disturbances, continued abuse,
What are the labs needed?
- PT: pronloged dute t decreased production of prothrombin
- Decreased RBC, WBC
- increased ammonia
What is serum AST?
- elevated with hepatitis cirrhosis, drug induced injury, CA mets
- used when hepatocellular disease is suspected
- liver cells lyse ad the protein AST is released
- the higher the results, the worse the disease
- WNL: is 0-35 units/L (many drugs cause increase)
- For acute disease values rise and fall
- For chronic disease, values remian elevated; increases as disease gets worse
What is serum ALT
- Damaged liver releases enzymes into blood stream. Hepatocellular disease, ALT/AST ratio is <1
- Viral hepatitis, ALT/AST ratio is > 1
- Aids in hepatitis diagnosis
- many drugs cause an increased ALT level
- DX hepatitis, cirrhosis, hepatotoxic drugs (send drugs list to lab)
WHat is serum phosphatase?
- WNL: 30-120 units/L
- exreted by liver into the bile
- increased with obstructive biliary disease
- Many drugs can cause increase and decrease of ALP
- increased with cirrhosis, biliary obstrction (unique to this), liver tumor, ect
What is serum bilirubin?
- Normal: 0.3-1.0 mg/dL (critical = > 12 mg/dL)
- RBCs break down and spill into bowel
- usually caused by hepatitis, cirrhosis or gall bladder
- protect sample from sunlight
- many drugs increase and decrease levels( send drug list to lab)
What is serum prothrombin?
- Normal: 11-12.5 seconds (critical is >20 seconds)
- Full anticoagulant therapy: 1.5 - 2 X normal
- clotting factors are produced in liver
- cecreased clotting factors occur with hepatocellular dysfuntion, bile duct obstruction and gall stones
What is a Upper GI series?
- (Upper GI, barium swallow)
- has been replaced witg EGD
- fluoroscopic study of the esophagus, stomach and duodenum
- NPO x 8 hours before the test
- patient drinks barium (thick chalky, radiopaque) outlines areas where barium is
- Rotating table moves the barium by gravity to visualize structures
- Teach patient to drink liquid for the rest of the day to prevent constipation; stools will be chalky at first
What is a lower GI series?
- ( lower GI, barium enema)
- A lubricated enema tip is inserted into the rectum
- The colon is filled with barium and a baloon is filled so the barium doesnt come out too soon
- X-Rays are taken with the barium in place
- PY may have cramping (bowel is irrtated easily)
- the tube is removed along with most f the barium
- have pt drink liquid to expel barium
What is a colonoscopy?
- Direct visualization of the larg bowel by endoscopy every 5-10 years after age 50
- provider can take tissue bx, snare polyps rinse tissue and locate bleeders
- Clear liquid diet day before, drink golytely bowel prep the day before an morning of exam
- avoid red, purple or orange foods/drinks
- NPO 4-6 hours directly before procedure
- Watery diarrhea will begin shortly after golytely
- done under MAC (versed, propofol, fentanyl)
- pt is placed on left side, knees bent fetal position
- Tissue samples may be taken -send to lab
- VS q 15 after colonoscopy
- put Side rails up, NPO until fully alert and passing gas
- Narcan on hand to reverse opiates
- observe for hemorrhage (puncture) Will need trasportation home
What is the gallbladder?
- Small sac-like structure that lies beneath the right lobe of liver (gallbladder bed)
- its primary function is the storage ad concentration of bile
What is cholecystitis?
- inflammation of the gallbladder
- can be acute or chronic
What is cholelithiasis?
- chemical irritation and inflammation resulting from gallstones
- can be in gallbladder or common bile duct
What are the S&S of cholelithiasis? Diagnostics? tx?
- can very
- pain-moderate to severe
- profile: female, fair, fat, forty, fertile, flatulant
- Diagnostic studies: ultrasound, lab tests (bili, AST, ALT, ALP)
- Choleangiogram: iodine dye injected intravenously into the bloodstream. Travels to the heptic system and outlines the gallbladder and looks for obstruction or stones
- Cholecystectomy: removal of gall bladder by either lateral incision or lapl patient will have T-tube in Common bile duct if open procedure (drainage may be yellow/green and a little bloody)