Jaundice, Hepatitis, Cirrhosis, and Liver Cancer Study Guide

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Hepatitis A -Incubation period -Mode of transmission

-15 to 50 days -Fecal-oral route

Hep B vaccine

-3 IM injections -Initial/One month/6 months

Hepatitis B -Incubation period -Mode of transmission

-45-180 days avg.56-96 -Sexual contact, exposure to blood products

Teach pt with Cirrhosis to avoid hepatotoxic drugs such as...

-Acetaminophen (Tylenol) -Amiodarone (Cordarone) -Isoniazid (INH)

Causes of Jaundice

-Altered bilirubin metabolism -Altered flow of bile in hepatic or biliary duct systems

Hepatitis B -Infectivity period

-Before and after symptoms appear -Infectious for 4-6 months

Hepatitis C -Sources of infection/spread of disease

-Blood and blood products -Needles/syringes -Sex

Causes of hemolytic jaundice

-Blood transfusion reaction -Sickle cell crisis -Hemolytic anemia

Extrahepatic obstructive jaundice

-Common bile duct obstruction r/t stones, biliary strictures, sclerosing cholangitis -Bilirubin fails to enter intestines resulting in clay colored stools

Hepatitis B -Sources of infection/spread of disease

-Contaminated needs, syringes, and blood products -Sexual activity w/contaminated parteners

Hepatitis A -Sources of infection/spread of disease

-Crowded conditions -sanitation -hygiene -sexual conduct -IV drug users

CC for pt with ascites

-Decrease Na intake -Fluid restriction -Diuretics (Aldactone)-K sparing -Paracentesis -Peritoneovenous Shunt

*Drug alert for Adefovir and Tenofovir

-Drugs are nephrotoxic -Monitor serum creatine, especially in patients at risk such as those having preexisting renal disease or taking nephrotoxic drugs

Symptoms of chronic hepatitis

-Easily fatigued -Hepatomegaly -Elevated liver enzymes

Three types of Hep A vaccine

-Havrix -Vaqta -Avaxim

Nutritional therapy to treat Cirrhosis

-High calorie diet, 3000 kcal/day -Hi Carbs, low fat -Low Na diet -TPN or tube feedings may be needed

CC for hepatitis patient

-High calorie/protein diet-Low fat diet *Rest *No hepatotoxic drugs

Late symptoms of Cirrhosis

-Jaundice -Pruitis -Skin lesions -Thrombocytopenia -Coagulation disorders

Complications for hepatitis

-Liver failure -Cirrhosis -Majority recover completely

Symptoms of acute hepatitis

-Malaise -Anorexia -Fatigue -Abdominal discomfort -Jaundice

Complications of Cirrhosis

-Portal hypertension -Esophageal varices -Peripheral Edema and Ascites -Ascites -Hepatic encephalopathy -Hepatorenal syndrome

Hepatitis A vaccine

-Single dose administered IM in the deltoid muscle with a follow up 6-12 months later -Twinrix for HAV and HBV

Treatments for pt with liver cancer

-Surgery (Lobectomy) -Transplant -Radiofrequency ablation -Cryosurgery -Alcohol injection -Chemo

Hepatic Encephalopathy

-Terminal complication -Liver fails to convert ammonia to urea and excreted by the kidneys

How is the prognosis of Liver cancer?

-Very poor -Spreads rapidly -4-7 months death r/t encephalopathy, blood loss, gi bleeding

HBV drug therapy

-a-Interveron-subq 3x/week -Nucleoside analogs *EpiVIR, AdefoVIR, EntecaVIR

Hepatitis C -Infectivity period

1-2wks before symptoms appear and continues during clinical course

Esophageal varices

A complex of tortuous veins at the lower end of the esophagus, enlarged and swollen as a result of portal hypertension

CC for pt with Hepatic encephalopathy

*Goal is to reduce ammonia formation -Antibiotics-Flagyl, Vanc, Xifaxan -Neomycin sulfate -Lactulose

CC for pt with Esophageal/gastric varices

*Goal to Avoid bleeding/hemorrhage -Avoid alcohol, aspirin, irritating foods -Sandostatin, vasopressin, Nitro, B-blockers -Balloon tamponade

Prevention of liver cancer includes...

*Focus on treatment for chronic hep B & C -Monitor liver function

Early symptoms of Cirrhosis

*Insidious -Anorexia, dyspepsia, flatulence -Abdominal pain -Fever

What are the three types of jaundice?

1. Hemolytic 2. Hepatocellular 3. Obstructive

Hepatitis C -Incubation period -Mode of transmission

14-180 days avg.56 days

Jaundice

A Yellowish discoloration of body tissues, results from an alteration in normal bilirubin metabolism or flow of bile into the hepatic or biliary duct systems -First detected in sclera of eye

Cirrhosis

A chronic progressive disease of the liver charcterized by extensive degeneration and destruction of the liver parenchymal cells

What is the primary cause of Cirrhosis?

Alcoholism

Diagnosing Hepatitis

Anti HAV, HBV, and HCV tests -AST, ALT, GGT

Intrahepatic obstructive jaundice

Damage to the liver cells r/t tumor, hepatitis, or cirrhosis

Obstructive jaundice

Decreased or obstructed bile flow through liver or biliary ducts

Decreased fluid absorption in the LGI may result in what kind of bowel movement?

Diarrhea

Increased fluid secretion in the LGI may result in what kind of bowel movement?

Diarrhea

What should the nurse do immediately before a paracentesis and why?

Have the patient void to prevent puncture of the bladder

Causes of hepatocellular jaundice

Hepatitis Cirrhosis Hepatic Ca

Hepatocellular jaundice

Liver unable to take up, conjugate, or excrete bilirubin

Portal hypertension

Increased venous pressure in the portal circulation, as well as splenomegaly, large collateral veins, ascites, systemic hypertension, and gastric and esophageal varices

Hepatitis

Inflammation of the liver

Hepatitis A -Infectivity period

Most infectious during 2 wks before onset of symptoms

Hep C vaccine

No vaccine to prevent

Hemolytic Jaundice

R/T increased RBC breakdown -Liver can't handle increased load

Why is liver cancer difficult to diagnose?

Symptoms very similar to Cirrhosis

What is the most important function of the large intestine?

The absorption of water and electrolytes

Ascites

The accumulation of serous fluid in the peritoneal or abdominal cavity


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