Thrombocytopenia, leukopenia, and anemia - splenomegaly (caused by backup of blood from portal vein into spleen) causes overactive spleen, increasing removal of blood cells from circulation
Bleeding disorders - liver incapable of producing prothrombin and other clotting factors, causing decreased coagulation ability
Endocrine - liver incapable of metabolizing adrenocortical hormones, estrogen, and testosterone; in men, gynecomastia, alopecia (axillary/pubic), testicular atrophy, loss of libido; in women, amenorrhea in menopausal women or vaginal bleeding in postmenopausal women; hyperaldosteronism causes sodium and water retention and potassium loss
Lab values - high sodium, low potassium
Peripheral neuropathy - dietary deficiency in thiamine, folic acid, and cobalamin
Complications of cirrhosis.
Portal hypertension resulting in esophageal varices, peripheral edema and ascites, hepatic encephalopathy (coma), and hepatorenal syndrome.
Define portal hypertension.
Hypertension in the portal vein and its tributaries (veins from intestines to liver)
Symptoms caused by blood being forced down alternate channels rather than into the portal system
Symptoms include ascites, hepatic encephalopathy, bacterial peritonitis, hepatorenal syndrome, splenomegaly, caput medusae (distended paraumbilical veins), and esophageal, gastric, and anorectal varices
Define esophageal varices.
Distention of esophageal veins; bleed easily
Most life-threatening complication of cirrhosis
Risk factors - ingesting poorly masticated or coarse foods or alcohol, acid reflux, increased pressure r/t nausea, vomiting, straining at stool, coughing, sneezing, lifting heavy object
Treatment of esophageal varices.
No aspirin, alcohol, or irritating foods; chew food 28 times or eat mechanical soft diet
A&P: Some of the esophageal veins drain into the portal vein (esophageal veins -> left gastric vein -> portal vein)
Problem: Hepatitis causes blood to congest in liver, back up into portal vein and cause venous distention and esophageal varices
Solution: Create a bypass from the portal vein to the hepatic vein so that some blood is routed past the liver, relieving pressure in portal vein
How: Using the jugular vein as an entrance, a shunt is guided down the superior to inferior vena cava and into the hepatic vein, punctured out the hepatic vein, and directed towards and anchored into the portal vein
Contraindications: Severe hepatic encephalopathy, hepatic carcinoma, and portal vein thrombosis
Complications: Increased levels of serum ammonia and resultant encephalopathy (ammonia is filtered by the liver, bypassing liver decreases filtering)
Hepatic encephalopathy - define and treat.
Define: Neuropsychiatric manifestation of liver damage, caused by excess ammonia in systemic circulation (liver filters ammonia)
How: Disorder of protein metabolism and excretion with nitrogenous
Problem: Considered terminal complication of liver disease
"Stop a Bus" Test: Put hands straight out, palms out, like hand signal to stop a bus, if high ammonia, hands will flap
Nursing considerations: Seizure precautions, suction in room, lactulose for life (3-4x daily), neomycin to bring down bacterial load in gut
Resolution: When ammonia levels decrease, mental state clears
Ascites - define and treat.
Define: Accumulation of serous fluid in the peritoneal or abdominal cavity causing increased weight, increased girth, striae, dehydration, decreased potassium, and decreased urine output
How: Proteins move from blood vessels into capillaries and into lymph space; lymphatic system unable to carry off excess proteins and water; osmotic pressure of proteins pulls additional fluid into peritoneal cavity
Treat: Paracentesis, shunting, salt restriction, diuretics, water restriction
Fulminant hepatic failure - define and treat.
Define: Acute liver failure, severe impairment of liver function associated with hepatic encephalopathy
Cause: Most commonly drug use, usually acetaminophen with alcohol; second most common is HBV; also mushroom poisoning ("death cap" mushroom)
How: Drug disrupts essential intracellular processes or causes buildup of toxic metabolic products
Treat: Liver transplant
Nursing Considerations: Frequent mental status checks for decline in LOC; quiet environment to minimize agitation; seizure precautions; I&O for renal function; oral and skin care to avoid breakdown and infection; monitor renal function, glucose, F&E; watch for increased ICP; HOB at 30 degrees
Metastatic carcinoma of the liver is more common than primary carcinoma
80% of liver cancer patients also have cirrhosis of liver
Hep C responsible for 50-60% of liver cancers
Hep B responsible for 20% of liver cancers
Clinical manifestation similar to cirrhosis
Liver biopsy is definitive test
Management similar to cirrhosis; lobectomy or liver transplant
If no signs of metastasis, treatment options may include radiofrequency ablation, cryoablation, percutaneous ethanol injection or percutaneous acetic acid injection
Prognosis is poor; cancer grows rapidly, death within 4-7 months from hepatic encephalopathy or massive blood loss from GI bleed