1. what is the etiology of cirrhosis
    • 1. Alcohol
    • 2. viral hepatitis
    • 3. Autoimmune hepatitis
    • 4. steatohepatitis (Fatty hepatitis)
    • 5. Drugs and toxins
    • 6. Biliary disease
  2. what are some more etiologies of Cirrhosis with Metabolic/Genetic
    • -hemachromatosis- (excessive iron storage)
    • -Wilson's disease (disorder of copper metabolism)
    • -Alpha antitrypsin deficiency
    • -cystic fibrosis
  3. what is the etiology of Cirrhosis with Cardiovascular disease
    Right sided heart failure
  4. how is Cirrhosis diagnosed (Lab studies)
    • AST, ALT, LDH, ALK PHOS, Bilirubin, Protein, Albumin, PT/INR, PLT, CBC, Ammonia
    • Liver biopsy
    • Ct scan, ultrasound
    • Endoscopy (EGD) esophageal variecs
    • Barium studies
  5. what are some early signs and symptoms of Cirrhosis
    • HX of failing health
    • nausea and vomiting
    • anorexia
    • indigestion
    • flatulence
    • constipation
    • weight loss with water retention
  6. what are some more early signs of Cirrhosis
    • malnutrition
    • RUQ pain
    • Pruitus (from Jaundice)
  7. what are some later signs and symptoms of cirrhosis
    • Ascites
    • Jaundice/Icterus
    • Edema
    • Rashes/dry skin/ palmer erythema
    • petechiae/ ecchymosis
    • spider angiomas on nose, cheeks, upper thorax and shoulders
    • bleeding/Anemia/Melena
  8. more signs and symptoms of Cirrhosis
    • Fetor hepaticus (liver Breath)
    • Gynecomastia
    • Asterixis
    • Hepatomegaly
  9. what is liver flap
    when someone with cirrhosis hand cannot stay straight it moves back and forth
  10. what is the treatment of Cirrhosis with drugs
    • depends on signs and symptoms
    • -vitamin K
    • -Diuretics
    • -Folic acid and Thiamine especially in alcoholics
    • -vitamins and minerals
    • -Albumin IV (if having a paracentesis, fluid in the ab.)
  11. how would you treat the symptoms of someone with Cirrhosis
    manage the symptoms
  12. what should be monitored in someone with Cirrhosis
    monitor bleeding
  13. what should be supported in someone with Cirrhosis
    support respirations
  14. what should be done with the CNS
    neurologic monitoring
  15. what else should be monitored with Cirrhosis
    • fluid and electrolyte balance
    • prevent infection
    • prevent bleeding and falls
    • promote nutrition
    • control itching
    • skin care
    • promote positive self esteem
  16. how should someone with Cirrhosis treatment be (diet)
    • restrict sodium
    • fluids may be restriced
  17. someone with cirrhosis may need a paracentesis what is it
    fluid taken out of the abdomin
  18. more treatments of Cirrhosis
    • GI intubation/Blakemore tube
    • Endoscopic O Bands/Sclerotherapy
    • Blood Transfusions
    • Surgeries
  19. what type of surgeries for Cirrhosis
    • Peritoneovenous Shunt
    • Portcaval Shunt
    • Tips (Transjugular intrahepatic portal systemic shunt) shunt blood to another part of the body
    • Alcohol control
  20. Esophageal Varices issues
    • most dangerous
    • primary prophylaxis
    • if bleeding establish source
    • lavage with NG tube
    • Meds, Vasopressin, Inderal, Sandostatin
  21. more esophageal varices issues
    • Surgery
    • Shunts (TIPS, Surtgical Shunts)
    • balloon tamponade (blakmore tube, Intensive care)
    • Sclerotherapy (can inject Saline)
    • NG tube placed by physician not nurse
  22. caused by a disturbance in bilirubin metabolism (hepatocellular as the liver cells cannot effectively excrete bilirubin)
  23. may also result from hemolysis and/or obstruction of biliary ducts (intrahepatic obstruction)
  24. the higer the bilirubin
    the more yellow
  25. can be seen in skin, mucous membranes, sclera, tissues, and other body fluids
  26. what is a major side effect of jaundice
    Itching (treat the itching) little bit of benadryl
  27. how should someone with Jaundice clothes be
    loose, cool clean and also their bedding
  28. should someone with jaundice use creams and lotions
  29. what else can be given for itching
  30. what type of environment should someone with jaundice be in
  31. how should someone with jaundic baths be
    Tepid, not hot baths
  32. what should someone with Jaundice avoid
    activities causing sweating and increased temperature
  33. what type of activities should they be involved in
    divertional activities?
  34. the accumulation of free fluid in the peritoneal cavity
  35. Increased pressure in the portal circulation (Ascites)
    portal hypertention
  36. Increased capillary plasma hydrostatic pressure
  37. Impaired production of albumin decreased capillary plasma oncotic pressure
  38. fluid moves out of the vessel and into the peritoneum
  39. what is the treatment for Ascites
    • Paracentesis with IV albumin
    • PV shunt
  40. Decrease in the synthesis of Bile
    Coagulation Defects
  41. prevents the absortption of vitamin K
    Coagulation Defects
  42. clotting factors II, VII, IX and X are not produced
    coagulation defects
  43. susceptible for bleeding and bruising
    abnormal prothrombin times (PT) high
    Coagulation Defects
  44. when PT is high what does it cause
  45. when PT is low what does it cause
  46. splenomegaly (coagulation defects)causes what
    casuses thrombocytopenia
  47. a persistent increase in pressure within the portal vein
    portal hypertension
  48. Development of collateral circulation in high pressure areas
    portal hypertention
  49. what can result from portal hypertention
    • esophageal varices
    • hemorroids
    • splenomegaly
    • ascites
  50. acute or chronic
    liver is unable to metabolize and cleanse the blood of ammonia and mercaption what is this
    portal systemic encephalopathy (hepatic coma) (PSE)
  51. what is the end product of protein metabolism
    ammonia (PSE)
  52. toxins produced from the metabolism of sulfur containing compounds
    Mercaptions (PSE)
  53. 4 stages of PSE
    • prodroma
    • impending
    • stuporous
    • comatose
    • may progress through the stages or fluctuate among the 4 stages, symptoms vary and may occur quickly or gradually over a few days
  54. what are the symptoms of PSE portal systemic encephalopathy (hepatic coma)
    • Alerations in the level of consciousness
    • Decrease in interlectual function
    • Changes in behavior and personality
    • Changes in neuromuscular function
  55. what are some meds to decrease ammonia levels in portal systemic encephalopathy (PSE)
    • Lactulose (chronulac) decrease ammonia levels and also a laxitive
    • Neomycin Sulfate
    • Metronidazole (Flagyl)
  56. what is the most common med to decrease ammonia levels
  57. what are some precipitation factors we need to identify and treat in PSE
    • High protein levels, Infections
    • HYPOvolemia HYPOkalemia
    • GI hemorrhage (causes large protein load in the intestines)
    • drugs
  58. Sudden kidney failure for no Known cause in a patient with worsening liver failure (MOM)
    hepatorenal syndrome
  59. sudden decrease in urinary flow
    hepatorenal syndrome
  60. elevated Bun and Creatinine levels, with decreased urine sodium excretion
    Hepatorenal syndrome
  61. Increased urine Osmolarity and poor prognosis
    Hepatorenal Syndrome
  62. fever, chills, abdominal pain and tenderness what is this disease
    Spontaneous Bacterial Peritonitis
  63. with Spontaneous bacterial peritonitis what what should be done for treatment and testing
    • send a sample of fluid for culture
    • treat with antibiotics
  64. Hepatitis B infection
    tylenol overdose
    combination of tylenol with alcohol or other drugs what can happen
    acute liver failure
  65. poison mushrooms (to get High)
    what disease
    acute liver failure
  66. a sudden massive necrosis of hepatocytes in a previously healthy person. all liver function is lost
    Acute liver failure
  67. 75% die within days of onset (Patty)
    Acute liver failure
  68. what are some signs and symptoms of Acute Liver Failure (think of Patty)
    • Rapid onset,
    • Cerebral Edema
    • Jaundice
    • mental status changes
    • multi organ failure
  69. what are some more signs and symptoms of Acute Liver Failure
    • Multiple organ dysfunction syndrome
    • -kidneys
    • -Lungs
    • -circulatory system
  70. how would the blood be in someone with ALF acute liver failure
    rapid decrease in coagulation ability (bleeding)
  71. what kind of encephalopathy will the pt. with ALF have
    clinical encephalopathy
  72. what is the treatment for Acute liver failure (Patty)
    • treatment is liver transplant, but it is not always available
    • not alot of time to get the liver transplant
  73. the progressive, irreversible destruction of liver function over time (MOM)
    Chronic liver Failure
  74. End stage liver disease (MOM)
    Chronic liver failure
  75. Cirrhosis of the liver is the typical presentation (MOM)
    Chronic Liver failure
  76. they are doing more live liver transplants but what is a disadvantage
    dangerous for the donor
  77. localized to one portion of the liver
    Focal Hepaocellular Disorders
  78. Abscess
    Trauma (stabbing)
    Tumor (cancerous)
    one portion of the liver
    • Focal Hepatocellular disorder
    • key is focal is like local (one area)
  79. very dangerous can get septic
    liver abscess
  80. comes from gut to liver
    Amebic (liver abscess)
  81. reaches liver through biliary, vascular, or lymphatic systems
    • Pyogenic (liver Abscess)
    • High mortality rate
  82. penetrating injuries (GSW, Stabbing)
    Pyogenic (Liver Abscess)
Card Set
Mrs Pavel summer semester exam 3