Jaundice, Hepatitis, Cirrhosis, and Liver Cancer Study Guide
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
