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26 Cards in this Set
- Front
- Back
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Causes of liver cirrhosis
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Alcoholic liver disease, hepatitis, biliary disorders, cardiovascular disease (L side HF), drug and chemical toxins
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Most common hepatitis in liver failure worldwide
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Hep B
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How does biliary obstruction cause cirrhosis?
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excessive bile leads to liver cell destruction and formation of nodules in the lobes
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Cardiac cirrhosis
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Seen with R side HF
liver engorged with venous blood which results in anoxia, cell necrosis, and fibrosis |
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Complications of liver failure
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Portal hypertension, ascities, varicies, coag defects, jaundice, PSE, hepatorenal syndrome
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Portal hypertension
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Results in obstruction of blood flow through the portal vein so it backs up into abdomen and GI tract causing distention leading to varicies
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Ascities
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Accumulation of plasma in the peritoneal cavity, plasma contains albumin so circulating proteins are decreased, then 3rd spacing, decrease in pressure and hypovolemic in the VASCULAR space, etc
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Varicies
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Occur anywhere in GI tract especially esophageal, hemmorhoids
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What should you never do with a pt who has esophageal varicies?
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NEVER put an NG tube because varicies can rupture and they can bleed out
Can also be caused by chemical irritants or increase esphageal pressure |
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Explain how coagulation defects can occur from liver failure?
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decreased synthesis of bile prevents vit K absorption, w/out vit K insufficient clotting factors are produced so they are suseptible to bleeding
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Why would someone with liver failure have prolonged prothombin time?
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coagulation defects, spleen is engorged and starts breaking down platelets
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This can be one of the first signs of liver failure
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thrombocytopenia
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What causes jaundice?
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cannot metabolize bilirubin so it builds up, obstruction clogs bile ducts so can't excrete
One of 1st places jaundice is seen is the sclera |
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Patho of Portal systemic encephalopathy
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AKA hepatic coma,can be rapid or slow onset,caused by impaired ammonia metabolism, liver cannot convert ammonia to urea to be excreted by kidneys
This increase in serum ammonia levels is toxic to the nervous system |
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what to do if LF pt is acting confused
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check their ammonia level
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what is liver flapping/asterixis?
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put BP cuff on arm-if arm starts flapping it is a sign of increased ammonia levels
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Stages of PSE:
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1) prodromal-subtle chgs-fatigue, labile, impaired thinking
2) Impending-contd mental deterioration 3) Stuporous-drowsy but arousable, abnormal EEG, musle twitching, hyperreflexia 4) Comatose-responds only to painful stimuli, seizures, no more asterixis, positive Babinski's sign |
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Primary cause of death with hepatic failure/cirrhosis:
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Hepatorenal Syndrome-kidneys cannot excrete ammonia and bilirubin which results in tubular necrosis
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S/S of hepatorenal syndrome:
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sudden decrease in UO (,500cc in 24hrs), increase BUN, creatinine, urineosmolarity, decrease in Na excretion, asterixis, decrease LOC, spider angiomas, jaundice, dec. hair production, increase pigmentation, parasthesias, papular erythmea, pruitis (itching), caput medusa (spider angioma around umbilicus), abdominal pain, ascities, clay colored stools, n/v, diarrhea, varicies, gi bleeding, dysrhythmias, edema, gynecomastia, inc aldosterone, ADH, dyspnea, hypoxia, DIC, low k+, Ca, Mg, Na or high Na, leukopenia
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When will you not do a liver biopsy?
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End stage liver disase b/c they may bleed out
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Mgmt of liver failure:
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Diet: dec Na, inc carbs and protein, moderate fats, fluid restriction (<=1500 cc/day), banana bags (vitamins), diuretics for ascities, monitor I/O, daily weights abdominal girth, HOB 30, paracentesis, shunts
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post op care for shunts:
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same w/ any abd sx, watch for fluid overload, bleeding, measure abd girth q shift, watch for peritonitis
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Post care for paracentesis:
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frequent VS and monitoring b/c they can go into shock
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Mgmt of hemmorhage from varicies:
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esophagogastric balloon tamponade, blakemore tube (not done much b/c of aspiration/airway obstruction), transfusions, BB to dec HR BP, IV sandostatin, sclerotherapy, endoscopic variceal ligation
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Portal systemic encephalopathy mgmt:
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high carb, moderate fat, high protein diet, may need TPN, lactulose, neomycin, flagyl, contol GI bnlled-NPO, Gtube, neuro checks-limit use of opioidsanalgesics, barbs, monitor for asterixis and fector hepaticus (smell to breath)
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what is lactulose used for?
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To excrete ammonia through feces, you want them to have 2 - 5 stools per day but monitor for hypokalemia
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