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Questions and Answers
What is the major cause of cirrhosis in the USA?
What is the major cause of cirrhosis in the USA?
Which of the following describes jaundice in patients with cirrhosis?
Which of the following describes jaundice in patients with cirrhosis?
What complication of cirrhosis affects 50% of patients?
What complication of cirrhosis affects 50% of patients?
Which hepatitis virus requires HBV to replicate?
Which hepatitis virus requires HBV to replicate?
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What is a primary treatment option for esophageal varices?
What is a primary treatment option for esophageal varices?
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What symptom is commonly seen in advanced liver cancer?
What symptom is commonly seen in advanced liver cancer?
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What is a significant consequence of ascites in patients with cirrhosis?
What is a significant consequence of ascites in patients with cirrhosis?
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Which treatment option has a high cure rate for Hepatitis C?
Which treatment option has a high cure rate for Hepatitis C?
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Study Notes
Care of Patients with Liver Problems
- Cirrhosis is liver scarring, a major cause in the USA is chronic alcoholism, followed by Hepatitis C. In other countries, Hepatitis B and D are major causes.
Pathophysiology of Cirrhosis
- Fibrotic bands of connective tissue form
- Hepatic inflammation occurs
- Liver cells are destroyed
- Nodular tissue forms
Liver Function Tests
- AST (Aspartate Transaminase) elevated (8-48 U/L)
- ALT (Alanine Transaminase) elevated (7-55 U/L)
- Alkaline Phosphatase elevated (45-115 U/L)
- Total Bilirubin elevated (0.2-1.2 mg/dL)
- Albumin decreased (3.5-5.0 mg/dL)
Types of Liver Cirrhosis
- Laennec's (alcoholic)
- Post-necrotic
- Biliary
- Cardiac
Complications of Cirrhosis
- Portal Hypertension
- Bleeding esophageal varices
- Jaundice (yellow discoloration of the skin), caused by hepatocellular disease or intrahepatic obstruction
- Ascites (fluid buildup in the peritoneal cavity) caused by decreased circulating plasma protein, reduced albumin production, and decreased colloid osmotic pressure
- Esophageal varices affect 50% of patients.
- Hematemesis (vomiting blood) and Melena (black tarry stools) are complications
- 30% of patients with varices will hemorrhage within 2 years of diagnosis
- 50% mortality rate for patients who experience hemorrhage
Treatment for Esophageal Varices
- Fluid resuscitation
- Blood transfusions (normal 150,000-450,000 platelets, <150,000 is thrombocytopenia)
- Fresh frozen plasma
- Vasopressin (Pitressin)
Additional Treatment for Esophageal Varices
- Beta-blockers (Propanolol, Nadolol)
- Sengstaken-Blakemore tube
- Mechanical ventilation
Endoscopic Procedures
- Endoscopic Variceal Ligation (EVL)
- Endoscopy Sclerotherapy (EST)
Portal Systemic Encephalopathy
- Complication of cirrhosis
- Mechanism is unclear
- Ammonia levels are high
Nutritional Therapy
- Collaborate with a nutritionist
- Include families
- Consider cultural sensitivity
Drug Therapy for Encephalopathy
- Lactulose
- Neomycin Sulfate
- Metronidazole
Nursing Management
- Assess for loss of consciousness (LOC)
- Check for asterixis (liver flap)
- Check for fetor hepaticus (liver breath)
Viral Hepatitis
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Hepatitis D virus (HDV)
- Hepatitis E virus (HEV)
Hepatitis A
- Route of transmission is fecal-oral
- Incubation period is 2-4 weeks
- Can be asymptomatic
- Diagnosis by serological testing (IgG and IgM antibodies)
Hepatitis B
- Prevalent worldwide
- About 300 million people have chronic HBV infection
- More than one million in the US
Hepatitis C
- Transmission is blood-to-blood (IV drug use, needle sticks, etc.)
- Intranasal cocaine sharing
- Pharmacological treatment (Epclusa, Harvoni) cure rates range from 95-99% after 12 weeks
- High cost ($26,000-78,000 for treatment without insurance)
Hepatitis D
- Requires the presence of HBV to replicate
- Transmitted by blood
- More severe than other viral hepatitis
Hepatitis E
- One of the most common causes of acute hepatitis
- Waterborne
- Prevalent in Asia, Africa, Middle East, South and Central America
Cancer of the Liver
- Early stages are often asymptomatic
- Later symptoms include weight loss, anorexia, weakness, RUQ pain, jaundice, and bleeding
Treatment of Liver Cancer
- Surgical intervention
- Chemotherapy (not often an option)
- Transplantation
Liver Transplantation
- Best candidates are those with end-stage liver disease or primary liver cancer
- Patients with active alcoholism, substance abuse, or metastatic tumors are not usually candidates
Post Transplantation
- Common complications include graft rejection and infection
- Immunosuppressant therapy (Cyclosporine, Tacrolimus) can cause hypertension and renal insufficiency
- Steroids (Prednisone) can cause hypertension and hyperglycemia
- Vaccinations and antibiotics are important
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Description
This quiz covers essential information about liver problems, particularly cirrhosis, including its causes, pathophysiology, liver function tests, types, and complications. Understanding these aspects is crucial for effective patient care and management in clinical settings.
