Hepatic Disorders

Possible Complications of Paracentesis

hypovolemia bleeding peritonitis bladder perforation

The common causes of cirrhosis are:

Copper Toxicity Protein Malabsorption Hepatitis Infections Drug-Induced Alcohol Hemochromatosis

Hepatitis

inflammation of the liver

Clinical Manifestations of Ascites

-increased size of abdomen -Caput Medusae (periumbilical varices) -Weight gain -difficulty breathing -some peripheral edema is present

Elevated Alanine Aminotransferase (ALT)

level increases primary in liver disorders monitor hepatitis or cirrhosis or effects of treatment that could be toxic to the liver

Manifestations of Cirrhosis

liver enlargement dull, aching pain weight loss weakness anorexia altered bowel function

Hepatocellular Jaundice

liver injury impairing conjugation of bilirubin hepatitis virus, yellow fever virus, cerosis nausea, fatigue, etc. may not be obvious

Hepatitis A is popular where?

over-crowded areas, overpopularization

Ascites is caused by: (3)

portal hypertension (primary) decreased serum proteins and albumin increased aldosterone

Pathway to Ascites

portal hypertension --->splenache arterial vasodilation ---> decrease in circulating arterial blood volume --->activation of angiotension, SNS, and antidiuretic hormone---->kidney retaining sodium and water---->hypervolemia---> persistent sodium and water retention----> continuous arterial filling Ascites! Fluid can be removed but it is chronic

Hepatitis Dx:

presence of specific antibody/antigen in serum

Elevated Aspartate Aminotransferase (AST)

present in tissues of high metabolic activity detect tissue death, not specific to liver disease but can detect hepatitis, cirhosis and liver cancer

Normal Liver Function

production bile conjugation of bilirubin clotting factors

Hepatitis Treatment

rest activity as tolerated nutrition hydration

A nurse is teaching self-management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching?

rest frequently throughout the day -do not donate blood 6 months after -protein yes but no high protein..high carb -acetaminophen could injure the liver further, NSAID

Esophageal Varices

signs of hemorrhage -hematemesis, melena -hypotension, tachycardia -medical emergency!!! can lead to hemorrhage or hypovolemic shock

A nurse admitting a client who has hepatitis C, which of the following precautions should the nurse implement?

standard precautions C: circulation, blood

Paracentesis

surgical puncture to remove fluid from the abdomen ALWAYS WANT CLIENT SITTING

What happens when the liver becomes impaired?

-decrease albumin -elevated ammonia -increase infection risk -hypo/hyperglycemia -metabolism in drugs altered -impaired fat absorption -unable to conjugate bilirubin (jaundice)

Liver Health History

-exposure to hepatoxic substances -occupational, recreational travel -history of alc/drug -medication usage -sexual practices

Serology Markers

(often hepatitis) viral antigens and their specific antibodies to identify the virus and its state of activity in liver

Hepatitis A & E

(vowel comes from bowel) transmission: fecal, oral route there is a vaccine for A, not E

Hepatic Encephalopathy

*Life threatening* complication of liver disease -accumulation of ammonia (cannot convert ammonia to urea to be excreted) Ammonia can eventually reach the brain and interfere with neurotransmitters, causes cerebral edema and progress to coma

Management of Esophageal Varices

-Endoscopy (banding) -Sclerotherapy -Balloon Tamponade -Medications

Pharm Management of Hepatic Encephalopathy

-Lactulose (Cephulac) to reduce serum ammonia levels and promotes excretion of ammonia in stool -antibiotics -glucose

Hepatitis Tx:

-Prevention! -vaccines -disease treatment : antiviral agents: decrease inflammation and fibrosis of the liver)

Management of Ascites

-daily weight -abdominal measurement -diuretics -low-sodium diet (2 gram) -fluid restriction -assess respiratory status -paracentesis

Liver Assessment

-jaundice -muscle atrophy -edema -skin excoriation (scratching) -petechial/ecchymosis areas (bruises) -spider angiomas -palmar arythema -cognitive status -asterixis -ascites -right quadrant tenderness

Priority Nursing when Paracentesis

-monitoring respiratory status and vitals -monitoring risk for bleeding

Nursing Management of Hepatic Encephalopahty

-neuro assessment -mental status -I&O, weight -monitor VS

Nursing Dx for Hepatitis

-risk for infection -fatigue -imbalanced nutrition -knowledge deficit -disturbed body image, impaired skin integrity

Priority Nursing Diagnosis/Interventions for Hepatic Encephalopathy

1. Excess Fluid Volume -weigh daily -low sodium diet -fluid restriction 2. Risk for Acute confusion -mental status -re-orient -safe environment -administer meds 3. Ineffective Protection -monitor bleeding -bleeding precautions -vitals 4. Impaired Skin Integrity -prevent dry skin -prevent scratching -administer antihistamines to relieve itching 5. Imbalanced Nutrition -weigh daily -small meals with snacks -consult dietitiian -vit/minerals -ferrous sulfate and folic acid

Medications for Esophageal Varices

1. Octreotide (decreases bleeding) 2. Vasopressin (urgant situations, constricts distal esophageal and proximal gastric veins, reduced inflow into portal system, therefore decreases portal pressure 3. Beta Blocker such as propanolol

What Labs could show liver disorder

1. elevated bilirubin 2. decreased albumin 3. decreased fibrinogen/decreae PT/INR 4. elevated serum ammonia 5.hyponatremia 6.hypokalemia 7. decreased platelet count 8. serum glucose

Which serum blood test is the most useful to diagnose the cause of liver dysfunction? why

Alkaline Phosphatase (ALP) bc it measures liver function, serum enzyme activity

Hepatitis B

B= blood and body fluids, sexual contact transmission: blood, semen, saliva there is a vaccine for B

Hepatitis C (HCV)

C- Circulation transmission: blood, semen no vaccine

Clinical Manifestations of Hepatic Encephalopathy

Early: minor mental changes, motor disturbances Asterixis: flapping tremor of hands confusion, disorientation

A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal hypertension. The nurse recognizes which of the following laboratory findings as indicating the client's gastrointestinal (GI) tract is digesting and absorbing blood?

Elevated Blood Urea Nitrogen elevated BUN is an indication of GI bleed chloride levels are not affected, bilirubin levels RISE with cirrhosis

Complications of Cirrhosis

Portal Hypertension (esophageal varices) -splenomegaly -ascites -hepatic encephalopathy -hepato-renal syndrome -spontaneous bacterial peritonitis -malnutrition

A nurse is teaching a client who has hepatitis A about preventing transmission of the virus. Which of the following strategies should the nurse include in teaching?

Practice effective hand hygiene

Long term portal hypertension can cause:

Varices in cupoot madusa, esophageal Splenomegaly (enlargement of spleen) Ascites (protein rich fluid in abdominal cavity)

Vasopressin is contraindicated in pts:

Pulmonary Artery Disease

Hepatitis S/S

RUQ discomfort n/v, anorexia, wt loss fever chills jaundice dark urine history of potential exposure

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level?

Reduce clients intake of protein--can assist in decreasing ammonia

What diuretics are given to Ascites pts?

Spironolactone (Aldactone) Lasix

Hepatitis D

Super infection with HBV transmission: blood no vaccine

Jaundice

flow of bile is impeded or excessive destruction of RBC, resulting in increased bilirubin concentration in the blood

A nurse is assessing clients in a health clinic for risk factors for contracting hepatitis. Which of the following clients is at risk for developing hepatitis C?

a client who has multiple tattoos C-circulation, blood

Other Diagnostic Evals for Liver

abdominal ultrasound (doppler studies) endoscopy liver biopsy

Ascites

accumulation of plasma rich fluid in the abdominal cavity chronic

A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan?

administer furosemide (to reduce fluid accumulation in abdomen) implement low sodium diet (control fluid accumulation) measure the client's abdominal girth do NOT administer warfarin or encourage wt lifting due to high risk of bleed

Causes of Cirrhosis

alcohol biliary posthepatitic (from hepatitis)

Hemolytic Jaundice

from RBC's being broken down in large quantities hemolytic transfusion reactions, etc

Why is Hepatitis A so contagious in children?

because it has milder symptoms than adults, this goes undetected with more time to spread jaundice is normally not present

Obstructive Jaundice

bile ducts are obstructed (by gall stones) so bile cannot drain out of the liver and overflows into the blood

Portal Hypertension Patho

blood seeks collateral pathways around the high pressure areas (flows to LOWER pressure areas such as esophagus, anterior abdominal wall, duodenum, and rectum)

Hepatitis B and Moms

can be spread perinatally, so need to screen pregnant women

Portal Hypertension

caused by disorders that obstruct or impede blood flow through the portal venous system causes high blood pressure in the portal venous system (normal is 3, elevated to 10)

A nurse is administering an IM injection to a client who has hepatitis C. Before placing the syringe and needle in a puncture resistant container, which of the following actions should the nurse take?

dispose of the needle uncapped prevents a needle stick with a contaminated needle

Esophageal Varices

distended veins at the bottom of the esophagus vessels may rupture! high risk for bleeding, significant blood loss can be caused by portal hypertension-blood is backed up from the liver and cant be filtered

Hepatic Cirrhosis

end stage of liver disease -irreversible destruction of liver structure and function -cells are replaced by scar tissue -progressive s/s will get worse

Elevated Alkaline Phosphatase (ALP)

enzyme that increases with blocked bile ducts, liver cancer and hepatitis