Cirrhosis

Front 1

What is Cirrhosis?

Back 1

Cell necrosis occurs. Destroyed liver cells are replaced with scar tissue that does not regenerate. Normal architecture becomes nodular.

Front 2

What are the four types of Cirrhosis?

Back 2

Alcoholic (lannech's)
Postnecrotic (Viral hepatitis)
Biliary Obstruction
Cardiac cirrhosis

Front 3

In cirrhosis is Albumin Increased or Decreased? What is the normal value for Albumin?

Back 3

Decreased, 4.0-5.5

Front 4

In cirrhosis several other labs are affected name some...

Back 4

Increased Bilirubin, Increased PT, Increased AST, Increased ALT, Increased Ammonia, Increased Na, Decreased K

Front 5

Compensated Early symptoms for Cirrhosis consist of what?

Back 5

Usually insidious: Abdominal pain, anorexia, dyspepsia, flatulence, N&V, change in vowel habits, enlarged liver & spleen, slight weight loss, fatigue

Front 6

Decompensated Symptoms (Late) for Cirrhosis include:

Back 6

Jaundice
Spider angiomas, palmar erythema
Endocrine disturbances
Heamtologic disorders
Peripheral neuropathy
Small, firm, nodule Liver

Front 7

What are 3 possible complications of cirrhosis?

Back 7

Portal Hypertension
Peripheral edema & ascites
Hepatic encephalopathy

Front 8

What are 4 characteristics of portal hypertension?

Back 8

Increased venous pressure in portal circulation
Splenomegaly
Esophageal varices
Systemic hypertension

Front 9

What are 3 normal functions of the spleen?

Back 9

Destroying old and defective RBCs
Stores lymphocytes (WBCs, immune response)
Stores platelets (clotting)

Front 10

Ascites is characterized by what?

Back 10

A fluid shift into the peritoneal space containing small amounts of protein (3rd space shifting)

Front 11

Why does ascites lead to hepatic encephalopathy?

Back 11

Circulating ammonia damages brain cells

Front 12

What kind of diet would be recommended for someone with ascites?

Back 12

High carbs
Low proteins (liver unable to process it -> encephalopathy)
Low sodium

Front 13

Why are diuretics used in the treatment of Ascites?

Back 13

Improve hypertension, fluid is no longer being pushed out of plasma

Front 14

Intervntions for Ascites include:

Back 14

Diet
Diuretics
Adequate Rest
Fluid removal: Paracentesis, peritoneovenous shunt

Front 15

What are esophageal varices?

Back 15

Complexes of tortuous veins, enlarged and swollen as a result of portal hypertension
Located at the lower end of the esophagus
Do not tolerate high pressure well -> distended & bleed easily

Front 16

Interventions for Esophageal Varices include:

Back 16

Avoid alcohol, apirin, and irritating foods
If bleeding occurs, stabilize pt and manage the airway
Endoscopic sclerotherapy or ligation
Balloon tamponade

Front 17

What health problem related to decompensated cirhosis is of most concern?

Back 17

Esophageal varices

Front 18

How does a balloon tamponade work?

Back 18

Provides pressure to bleeding site

Front 19

Sclerotherapy is described as...

Back 19

Material injected in to varices causing thromboses and obliterates the distended veins

Front 20

What is hepatic encephalopathy and when does it occur?

Back 20

Changes in neurological and mental function, ranging from lethargy to deep coma
Occurs when ammonia enters the systemic circulation without detoxification by the damaged liver

Front 21

Intervention for hepatic encephalopathy...

Back 21

Protein restriction (0-40g/day)
Sterilization of GI tract with antibiotics (e.g. neomycin)
lactulose (Cephulac) - traps ammonia in gut
levodopa (anti-parkinsons)

Front 22

What should the diet consist of for the pt with cirrhosis but without complications?

Back 22

High calories
High carbs
Moderate to low fat
Amount of protein varies with degree of liver damage

Front 23

What interventions should be considered when treating a patient with cirrhosis, in order of priority?

Back 23

1. Rest
2. avoidance of alcohol and anticoagulants
3. Management of ascites
4. Prevention and management of esophageal variceal bleeding
5. Management of encephalopathy

Front 24

What is fetor hepaticus?

Back 24

Musty, sweetish odor detected on the pt's breath from accumulation of undigested by-products

Front 25

Why is splenomegaly present in portal hypertension?

Back 25

Back pressure caused by portal hypertension leads to chronic passive congestion as a result of increased pressure in the splenic vein

Front 26

What causes esophageal varices as a result of portal hypertension?

Back 26

Increased blood flow through the portal system results in dilation and enlargement of the plexus veins of the esophagus and produces varices

Front 27

Explain caput medusae

Back 27

Collateral circulation involves the superficial veins of the abdominal wall leading to the development of dilated veins around the umbillicus
A compensatory mechanism

Front 28

There are 2 causes of the late manifestations of cirrhosis. What are they?

Back 28

Hepatocellular failure: unable to store fat-soluble vitamins properly
Portal hypertension

Front 29

What are the 7 diagnostic test used to diagnosis cirrhosis?

Back 29

Liver function tests
Liver biopsy
Liver scan
Liver ultrasound
Esophagogastroduodenopscopy
Prothrombin time
Testing stool for occult blood

Front 30

At what age is the highest incidence of cirrhosis?

Back 30

40-60

Front 31

Is cirrhosis more common in men or women?

Back 31

Men

Front 32

What are 2 drugs used in the treatment of Cirrhosis and when are they indicated?

Back 32

lactulose - hepatic encephalopathy
neomycin - hepatic encephalopathy

Front 33

What is the action of neomycin?

Back 33

Decrease the number of ammonia-producing bacteria in the gut - Inhibits protein synthesis in bacteria at level of 30S ribosome.

Front 34

What should the nurse be aware of when caring for a pt on neomycin?

Back 34

Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy. Hepatic Encephalopathy: Monitor neurologic status. Prior to administering oral medication, assess patient's ability to swallow.

Front 35

What is the action of lactulose?

Back 35

Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels.

Front 36

What should the nurse be aware of when caring for a pt on lactulose?

Back 36

Decreased blood ammonia concentrations by 25-50%. May cause increased blood glucose levels in diabetic patients. Monitor serum electrolytes periodically when used chronically. May cause diarrhea with resulting hypokalemia and hypernatremia. When used in hepatic encephalopathy, adjust dose until patient averages 2-3 soft bowel movements per day. During initial therapy, 30-45 mL may be given hourly to induce rapid laxation.