Cirrhosis Overview Quiz

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Questions and Answers

What is the main characteristic of cirrhosis?

  • Extensive degeneration of liver cells and scarring of the liver tissue.
  • Extensive degeneration of liver cells and replacement of liver tissue with scar tissue and regenerative nodules. (correct)
  • Extensive degeneration and destruction of liver cells.
  • Degeneration of the liver cells followed by fibrosis.

What are the most common causes of cirrhosis in the United States?

  • Chronic HCV infection, NASH, and alcohol-induced liver disease. (correct)
  • Extreme dieting, malabsorption, and obesity.
  • Viral hepatitis, alcohol use, and biliary causes.
  • Long-standing, severe, right-sided heart failure.

Which of the following is NOT a common cause of cirrhosis?

  • Chronic bacterial infection. (correct)
  • Chronic hepatitis.
  • Alcohol use.
  • PBC and PSC.

How does alcohol use contribute to the development of cirrhosis?

<p>All of the above. (D)</p> Signup and view all the answers

What is the effect of the regenerative process in cirrhosis?

<p>It results in abnormal blood vessel and bile duct architecture. (C)</p> Signup and view all the answers

Which of the following is a late manifestation of cirrhosis?

<p>Portal hypertension. (D)</p> Signup and view all the answers

How does impaired blood flow contribute to the development of cirrhosis?

<p>All of the above. (D)</p> Signup and view all the answers

What is the role of fibrosis in the development of cirrhosis?

<p>It blocks blood flow and hampers liver function. (D)</p> Signup and view all the answers

Which of the following symptoms is NOT a common late manifestation of cirrhosis?

<p>Hypertension (A)</p> Signup and view all the answers

What is the primary reason for jaundice in individuals with cirrhosis?

<p>Decreased ability to conjugate and excrete bilirubin (C)</p> Signup and view all the answers

What is the primary cause of splenomegaly in cirrhosis?

<p>Backup of blood from the portal vein (D)</p> Signup and view all the answers

What is the common cause of anemia in individuals with cirrhosis?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a potential cause of coagulation problems in cirrhosis?

<p>Increased blood viscosity (C)</p> Signup and view all the answers

What is the primary cause of gynecomastia in men with cirrhosis?

<p>Increased estrogen production (B)</p> Signup and view all the answers

Which of the following is a hallmark of portal hypertension?

<p>Enlarged collateral veins (B)</p> Signup and view all the answers

What is the most life-threatening complication of cirrhosis?

<p>Ruptured esophageal varices (C)</p> Signup and view all the answers

Why is peripheral edema a common finding in individuals with cirrhosis?

<p>Decreased protein levels in the blood (B)</p> Signup and view all the answers

What is the difference between compensated and decompensated cirrhosis?

<p>Compensated cirrhosis has no complications, while decompensated cirrhosis does (C)</p> Signup and view all the answers

Which of the following is a common complication of portal hypertension?

<p>All of the above (D)</p> Signup and view all the answers

What is the mechanism of ascites development in cirrhosis?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary cause of peripheral neuropathy in alcoholic cirrhosis?

<p>Dietary deficiencies (C)</p> Signup and view all the answers

Which of the following is a characteristic of hepatic encephalopathy?

<p>Confusion, lethargy, and sleepiness (A)</p> Signup and view all the answers

What is the primary cause of hepatic coma?

<p>Liver failure (A)</p> Signup and view all the answers

Which of the following is NOT a common laboratory finding in cirrhosis?

<p>Increased albumin (A)</p> Signup and view all the answers

Which of the following is NOT a mechanism of ascites formation?

<p>Increased renal blood flow leading to increased glomerular filtration (C)</p> Signup and view all the answers

What is the primary cause of hypokalemia in patients with ascites?

<p>Increased potassium excretion due to hyperaldosteronism (A)</p> Signup and view all the answers

Which of the following is NOT a manifestation of ascites?

<p>Weight loss (C)</p> Signup and view all the answers

Which of the following is a common complication of hospitalized patients with cirrhosis and ascites?

<p>Spontaneous bacterial peritonitis (B)</p> Signup and view all the answers

Which of the following is NOT a contributing factor to the development of hepatic encephalopathy?

<p>Increased production of antidiuretic hormone (A)</p> Signup and view all the answers

What is the most common source of ammonia in individuals with hepatic encephalopathy?

<p>Bacterial and enzymatic deamination of amino acids in the intestines (A)</p> Signup and view all the answers

What is the primary function of a transjugular intrahepatic portosystemic shunt (TIPS) in the context of hepatic encephalopathy?

<p>To reduce portal hypertension by diverting blood flow around the liver (B)</p> Signup and view all the answers

Which of the following is a characteristic manifestation of hepatic encephalopathy?

<p>Asterixis (flapping tremors) (A)</p> Signup and view all the answers

What is the primary characteristic of hepatorenal syndrome?

<p>Renal failure with no structural problems in the kidneys (C)</p> Signup and view all the answers

Which of the following is NOT a risk factor for developing hepatorenal syndrome?

<p>Increased physical activity (C)</p> Signup and view all the answers

Which of the following liver function tests is typically elevated in the early stages of cirrhosis?

<p>Alkaline phosphatase (C)</p> Signup and view all the answers

Which of the following liver function tests is typically decreased in the end-stage liver disease?

<p>Serum total protein (D)</p> Signup and view all the answers

What is the purpose of a liver biopsy in the diagnosis of cirrhosis?

<p>To assess the extent of liver cell damage and fibrosis (B)</p> Signup and view all the answers

Which of the following is NOT a potential consequence of severe ascites?

<p>Increased risk of pulmonary embolism (C)</p> Signup and view all the answers

Which of the following is NOT a common finding in patients with severe ascites?

<p>Increased urine output (C)</p> Signup and view all the answers

What is the primary mechanism by which ammonia contributes to the development of hepatic encephalopathy?

<p>Interfering with neurotransmitter function (C)</p> Signup and view all the answers

Which of the following is NOT a potential complication of cirrhosis?

<p>Kidney stones (C)</p> Signup and view all the answers

Which of the following is a non-invasive test used to quantify the degree of liver fibrosis?

<p>Ultrasound elastography (C)</p> Signup and view all the answers

Sodium restriction is a key component of managing which complication of cirrhosis?

<p>Ascites (B)</p> Signup and view all the answers

Which diuretic is often used in combination with a potassium-sparing drug for ascites management?

<p>Furosemide (D)</p> Signup and view all the answers

What is the primary goal of treating esophageal and gastric varices?

<p>Both A and B (A)</p> Signup and view all the answers

Which of the following medications is NOT typically used to treat bleeding varices?

<p>Acetaminophen (B)</p> Signup and view all the answers

What is the primary mechanism of action of octreotide and vasopressin in managing bleeding varices?

<p>Reduce portal blood flow (B)</p> Signup and view all the answers

Which of the following procedures is used to place a small rubber band around the base of a varix?

<p>Endoscopic variceal ligation (A)</p> Signup and view all the answers

Which of the following is NOT a supportive measure during acute variceal bleeding?

<p>Antibiotics (C)</p> Signup and view all the answers

Which of the following procedures creates a shunt to redirect portal blood flow, thus reducing portal venous pressure and decompressing varices?

<p>TIPS (C)</p> Signup and view all the answers

What is the primary goal of managing hepatic encephalopathy?

<p>Reduce ammonia formation in the intestines (C)</p> Signup and view all the answers

What is the primary mechanism of Lactulose and Rifaximin in managing hepatic encephalopathy?

<p>Decrease ammonia production in the gut (A)</p> Signup and view all the answers

Which of the following is NOT a contraindication for TIPS?

<p>Mild to moderate hepatic encephalopathy (A)</p> Signup and view all the answers

Which of the following is a surgical procedure used to treat recurrent variceal bleeding?

<p>TIPS (C)</p> Signup and view all the answers

Which drug is a resin that binds bile salts in the intestine?

<p>Cholestyramine (A)</p> Signup and view all the answers

What is the main goal of conservative therapy for cirrhosis?

<p>Both B and C (C)</p> Signup and view all the answers

What is the recommended diet for a patient with cirrhosis without complications?

<p>High in calories, high in carbohydrates, and moderate to low in fats (D)</p> Signup and view all the answers

Which of the following is NOT recommended for patients with cirrhosis?

<p>Acetaminophen (B)</p> Signup and view all the answers

What are the common risk factors for cirrhosis?

<p>Excessive alcohol consumption, malnutrition, viral hepatitis, and biliary obstruction (A)</p> Signup and view all the answers

Which of the following is a potassium-sparing diuretic used to treat ascites in patients with cirrhosis?

<p>Spironolactone (C)</p> Signup and view all the answers

What is the role of lactulose in the management of hepatic encephalopathy?

<p>To decrease ammonia production in the intestines (A)</p> Signup and view all the answers

Which of the following procedures involves withdrawing fluid from the abdominal cavity to relieve pressure and discomfort?

<p>Paracentesis (A)</p> Signup and view all the answers

Which of the following is a common problem in patients with cirrhosis on diuretics?

<p>Hyponatremia (B)</p> Signup and view all the answers

Which of the following is a potential complication of TIPS?

<p>Increased risk for hepatic encephalopathy (C)</p> Signup and view all the answers

What type of nutritional therapy is given for severe malnutrition in patients with cirrhosis?

<p>Parenteral nutrition (PN) or enteral nutrition (EN) (C)</p> Signup and view all the answers

What is the goal of health promotion in patients with cirrhosis?

<p>To prevent or delay the progression of cirrhosis (D)</p> Signup and view all the answers

What is the main focus of acute care for patients with cirrhosis?

<p>To manage complications of cirrhosis (A)</p> Signup and view all the answers

Which of the following is a measure to relieve itching associated with jaundice in a patient with cirrhosis?

<p>Using cholestyramine or hydroxyzine (D)</p> Signup and view all the answers

Which of the following is NOT a commonly used surgical shunt for decreasing portal hypertension?

<p>Transjugular intrahepatic portosystemic shunt (TIPS) (D)</p> Signup and view all the answers

In the management of hepatic encephalopathy, which of the following is essential to minimize ammonia buildup?

<p>Maintaining regular bowel movements (C)</p> Signup and view all the answers

Which of the following is a drug that may be given to patients with hepatic encephalopathy who do not respond to lactulose?

<p>Rifaximin (B)</p> Signup and view all the answers

What measure can help relieve itching associated with cirrhosis?

<p>Taking a warm bath with baking soda (B)</p> Signup and view all the answers

What is a potential complication of using a balloon tamponade to control bleeding varices?

<p>Risk of esophageal rupture (B)</p> Signup and view all the answers

What is a common sign of fluid overload in a patient with cirrhosis?

<p>Edema in the lower extremities (C)</p> Signup and view all the answers

What is a nursing intervention for a patient with cirrhosis who is experiencing dyspnea?

<p>All of the above (D)</p> Signup and view all the answers

What nursing intervention is crucial to prevent skin breakdown in a patient with edema due to cirrhosis?

<p>Using an alternating-air pressure mattress (C)</p> Signup and view all the answers

Which of these is NOT a potential sign of hypokalemia in a patient with cirrhosis?

<p>Increased thirst (A)</p> Signup and view all the answers

What is a key aspect of nursing care for a patient with hepatic encephalopathy?

<p>Monitoring the patient's neurologic status frequently (A)</p> Signup and view all the answers

What is a common complication associated with cirrhosis that can lead to life-threatening bleeding?

<p>Bleeding varices (C)</p> Signup and view all the answers

Which nursing intervention is important in managing a patient with bleeding varices?

<p>Maintaining the patient's airway (C)</p> Signup and view all the answers

Which of the following nursing interventions is appropriate for a patient with cirrhosis who is experiencing abdominal discomfort?

<p>Both B and C (A)</p> Signup and view all the answers

What is a common assessment finding in a patient with cirrhosis and jaundice?

<p>Dark brown urine and gray or tan stool (B)</p> Signup and view all the answers

Which of the following statements is TRUE about ascites in a patient with cirrhosis?

<p>Accurate measurement of abdominal girth helps monitor the severity of ascites (B)</p> Signup and view all the answers

What is a common nursing intervention for a patient with cirrhosis who is taking diuretics?

<p>Both A and C (D)</p> Signup and view all the answers

What nursing intervention is essential for a patient with cirrhosis who is experiencing altered body image?

<p>Providing education and support regarding their condition (D)</p> Signup and view all the answers

When a balloon tamponade is used for bleeding varices, what is a priority nursing intervention?

<p>Checking the patency of the balloons regularly (C)</p> Signup and view all the answers

What is the primary rationale for encouraging fluids in patients with cirrhosis?

<p>To prevent dehydration and support overall health. (D)</p> Signup and view all the answers

Which medication should be monitored closely in patients due to the risk of diarrhea and electrolyte loss?

<p>Lactulose (A)</p> Signup and view all the answers

What is an important lifestyle change for patients with cirrhosis attributed to chronic alcohol use?

<p>Abstaining from alcohol. (A)</p> Signup and view all the answers

Why is it crucial for patients and caregivers to understand the need for continual health care?

<p>To manage potential life-threatening complications and ensure timely intervention. (C)</p> Signup and view all the answers

What type of community support program is recommended for patients dealing with chronic alcohol use?

<p>Alcoholics Anonymous (A)</p> Signup and view all the answers

What is a critical aspect of home care for a patient with cirrhosis?

<p>Helping the patient with activities of daily living while ensuring wellness. (C)</p> Signup and view all the answers

What should patients be educated about regarding potential complications of cirrhosis?

<p>When to seek medical attention and signs of complications. (D)</p> Signup and view all the answers

Which of the following outcomes is expected for a patient with cirrhosis?

<p>Have normal fluid and electrolyte balance. (A)</p> Signup and view all the answers

Flashcards

Cirrhosis

The end stage of liver disease, marked by liver cell degeneration and fibrous replacement.

Fibrosis

Replacement of liver tissue with scar tissue due to chronic damage.

Chronic Liver Disease

Long-term liver conditions leading to cirrhosis, including hepatitis or alcohol use.

NASH

Nonalcoholic steatohepatitis, a common precursor to cirrhosis influenced by obesity.

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Cardiac Cirrhosis

Liver damage due to long-term right-sided heart failure leading to blood congestion.

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Clinical Manifestations of Cirrhosis

Symptoms indicating liver failure, ranging from fatigue to portal hypertension.

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Early Manifestations

Initial signs of cirrhosis often have few symptoms like fatigue or enlarged liver.

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Late Manifestations

Symptoms that appear as liver failure progresses, including severe portal hypertension.

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Hepatic Venous Congestion

Blood back-up in the liver due to heart failure leading to liver damage over time.

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Jaundice

A yellowing of the skin due to increased bilirubin in the blood.

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Ascites

Accumulation of fluid in the abdominal cavity often due to liver disease.

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Portal Hypertension

Increased blood pressure in the portal vein due to liver cirrhosis.

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Spider Angiomas

Small, dilated blood vessels that appear spiderlike, found on the skin.

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Palmar Erythema

Redness of the palms, due to liver dysfunction and increased estrogen.

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Thrombocytopenia

Low platelet count in the blood, often due to spleen enlargement.

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Peripheral Edema

Swelling caused by excess fluid in tissue, commonly in the lower limbs.

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Esophageal Varices

Enlarged veins in the esophagus that can bleed due to portal hypertension.

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Hepatic Encephalopathy

A decline in brain function due to severe liver dysfunction.

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Gynecomastia

Enlargement of male breast tissue due to hormonal imbalances from liver disease.

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Coagulation Problems

Issues with blood clotting due to liver's inability to produce clotting factors.

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Hematologic Problems

Blood-related issues such as anemia and leukopenia arising from cirrhosis.

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Dark Urine

Urine that is dark due to increased bilirubin excretion from liver dysfunction.

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Light-Colored Stools

Pale stools resulting from a lack of bile in the intestines due to liver disease.

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Compensated vs. Decompensated Cirrhosis

Compensated has no obvious complications; decompensated exhibits significant health issues.

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Cirrhosis Diagnosis

Cirrhosis can be assessed using ultrasound but it's not reliable.

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Ultrasound Elastography (Fibroscan)

A noninvasive test to measure liver fibrosis severity.

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Ascites Management

Management includes sodium restriction, diuretics, and fluid removal.

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Sodium Restriction

Patients with ascites limit sodium intake to 2 g/day.

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Diuretic Therapy

Diuretics help remove excess fluid in ascites treatment.

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Spironolactone

A potassium-sparing diuretic used in ascites management.

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Paracentesis

A procedure to remove fluid from the abdominal cavity.

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TIPS Procedure

TIPS is used to treat ascites resistant to diuretics.

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Endoscopic Band Ligation

A method to treat esophageal varices by placing bands.

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Nonselective β-blockers

Medications to reduce portal pressure and bleeding risk.

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Octreotide

A medication that decreases portal blood flow to treat varices.

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Balloon Tamponade

Technique to control major variceal bleeding by mechanical compression.

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Hepatic Encephalopathy Treatment

Managed with antibiotics and lactulose to reduce ammonia.

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Liver Biopsy

A procedure to sample liver tissue for diagnosis.

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Fluid and Electrolyte Monitoring

Essential in managing patients with ascites and cirrhosis.

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GI Bleeding and Encephalopathy

GI bleeding can worsen symptoms of encephalopathy, a brain dysfunction related to liver disease.

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Preventing Falls

Instituting measures to prevent falls is crucial for patients with encephalopathy to avoid injuries.

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Minimizing Constipation

Reducing constipation in cirrhosis patients lowers ammonia production and helps manage symptoms.

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Lactulose Assessment

Monitoring patients on lactulose is important for diarrhea and electrolyte balance.

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Importance of Abstinence

Abstinence from alcohol is vital for cirrhosis patients and usually improves their condition.

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Community Support Programs

Programs like Alcoholics Anonymous provide support for patients struggling with chronic alcohol use.

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Activities of Daily Living (ADLs)

Home care for cirrhosis patients focuses on assisting with ADLs while promoting wellness.

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Expected Outcomes in Cirrhosis Care

Expected outcomes for cirrhosis patients include adequate nutrition, skin integrity, and treatment acknowledgment.

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TIPS

A nonsurgical procedure creating a shunt between portal and systemic veins to reduce pressure.

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Lactulose

A medication that reduces ammonia levels in the intestines by trapping it.

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Antibiotics in Hepatic Encephalopathy

Rifaximin is an antibiotic used when lactulose is ineffective in lowering ammonia.

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Cirrhosis Diet

High-calorie diet (3000 cal/day) rich in carbs and low in fat for cirrhosis patients.

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Portacaval Shunt

A surgical procedure that connects the portal vein to the inferior vena cava to reduce portal hypertension.

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Distal Splenorenal Shunt

A surgical procedure that connects the splenic vein to the renal vein to reduce portal hypertension.

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Fluid Imbalance

A challenge for cirrhosis patients where fluid retention may lead to ascites.

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Preventing Constipation

Essential for minimizing ammonia buildup in patients with hepatic encephalopathy.

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Sodium Restricted Diet

Diet for cirrhosis patients with ascites and edema, limits sodium intake.

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Physical Assessment in Cirrhosis

Examining signs of jaundice, edema, and other physical manifestations in cirrhosis patients.

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Nutritional Compromise

A clinical problem in cirrhosis where nutritional intake is insufficient.

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Preventing Pneumonia

Key nursing management for patients on bed rest to maintain lung health.

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Cholestyramine

A resin that helps relieve itching by binding bile salts for excretion.

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Ammonia Formation Reduction

Goal in managing hepatic encephalopathy to prevent toxic levels in the blood.

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Edema

Swelling caused by fluid accumulation in tissues due to decreased colloidal oncotic pressure.

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Hypoalbuminemia

Low levels of albumin in the blood, contributing to decreased osmotic pressure and fluid retention.

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Hyperaldosteronism

Increased aldosterone levels leading to sodium retention and fluid buildup.

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Asterixis

A tremor of the hands characterized by intermittent lapses in posture, often seen in hepatic encephalopathy.

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Fetor Hepaticus

A musty or sweet odor of the breath associated with liver disease.

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Hepatorenal Syndrome

Kidney failure due to liver disease, characterized by azotemia and oliguria without structural kidney damage.

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Spontaneous Bacterial Peritonitis

Infection of ascitic fluid, often caused by enteric bacteria in patients with liver cirrhosis.

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Serious Fluid Accumulation

Excess fluid in the peritoneal cavity due to various mechanisms in liver disease.

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Low Serum Total Protein

Decreased protein levels in blood often seen in liver diseases like cirrhosis.

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Prolonged PT Time

Increased prothrombin time indicating impaired liver function and clotting ability.

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Common Side Effects

Nausea, vomiting, diarrhea, constipation, and skin reactions from medications.

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Drug Interactions

Medications may bind with others, affecting efficacy and safety.

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Itching Relief Measures

Using baking soda, moisturizing oils, calamine lotion, antihistamines, and temperature control.

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Assessing Jaundice

Dark brown urine and gray or tan stools indicate jaundice presence.

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Monitoring Edema

Record intake, output, daily weights, and measure extremities for swelling assessment.

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Patient Positioning for Dyspnea

Semi-Fowler's or Fowler's position improves breathing efficiency.

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Skin Care in Edema

Meticulous skin care prevents breakdown in swollen tissues.

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Diuretic Monitoring

Check serum sodium, potassium, chloride, bicarbonate, and renal function.

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Signs of Hypokalemia

Dysrhythmias, hypotension, tachycardia, muscle weakness indicate low potassium.

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Nursing Care for Varices

Watch for hematemesis/melena; prepare for emergency interventions.

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Hepatic Encephalopathy Care

Focus on safety, reducing ammonia, and assessing neurologic status.

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Monitoring Oxygen Levels

Regularly check O2 levels and vital signs for respiratory assessment.

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Maintaining Self-Esteem

Support patients coping with body image changes from liver disease.

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Coughing and Deep Breathing

Implement exercises to prevent respiratory problems in patients.

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Study Notes

Cirrhosis: Overview

  • Cirrhosis is the final stage of liver disease, marked by extensive liver cell damage and replacement with scar tissue (fibrosis) and regenerative nodules.
  • It typically develops after many years of chronic liver disease.

Etiology and Pathophysiology

  • Common causes in the US include chronic hepatitis C virus (HCV) infection, non-alcoholic steatohepatitis (NASH), and alcohol-induced liver disease. Malnutrition exacerbates alcohol-related cirrhosis.
  • Other causes include extreme dieting, malabsorption, and obesity.
  • Chronic inflammation and cell death (necrosis) from viral hepatitis lead to progressive fibrosis and cirrhosis. Alcohol use synergistically accelerates liver damage when combined with chronic hepatitis.
  • Biliary causes include primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).
  • Cardiac cirrhosis is a result of long-term severe right-sided heart failure, causing liver congestion, damage, and fibrosis.

Pathogenesis of Cirrhosis

  • Liver cells attempt disorganized regeneration, leading to abnormal blood vessel and bile duct structures.
  • Excessive fibrous connective tissue disrupts normal liver lobules, causing irregular size/shape and hindering blood flow.
  • Eventually decreased liver function due to poor blood flow, nutrition, and hypoxia (low oxygen).

Clinical Manifestations

Early Manifestations

  • Often asymptomatic.
  • Symptoms may include fatigue, or an enlarged liver.
  • Liver function tests may be normal (compensated cirrhosis).

Late Manifestations

  • Result from liver failure and portal hypertension.
  • Symptoms include jaundice, peripheral edema, and ascites.
  • Other manifestations include skin lesions, hematologic problems, endocrine problems, and peripheral neuropathy.
  • In advanced stages, the liver is small and nodular with greatly impaired function.

Manifestations of Cirrhosis (Specific Aspects)

  • Jaundice: Decreased bilirubin excretion into the intestines due to compression of bile ducts by scar tissue, elevated bilirubin levels, ranging from mild to severe.
  • Skin Lesions: Spider angiomas (telangiectasia) and palmar erythema, caused by elevated estrogen levels due to impaired liver hormone metabolism.
  • Hematologic Problems: Thrombocytopenia, leukopenia, anemia, and coagulation problems (due to portal hypertension and splenomegaly). Impaired clotting factors and poor blood cell production also contribute.
  • Ascites: Accumulation of fluid in the abdominal cavity due to portal hypertension, hypoalbuminemia (low albumin), and hyperaldosteronism. Symptoms include abdominal distension, weight gain, and possible umbilicus eversion.
  • Peripheral Edema: Swelling in lower extremities, potentially present before or with ascites.
  • Splenomegaly: Enlargement of the spleen due to portal hypertension, leading to increased removal of blood cells.
  • Varices: Enlarged, fragile veins, especially esophageal and gastric, caused by portal hypertension. Risk of severe hemorrhaging.
  • Endocrine Problems: Altered hormone metabolism leads to gynecomastia, testicular atrophy, loss of body hair, menstrual irregularities in women, and increased/decreased hormone levels.
  • Peripheral Neuropathy: Commonly seen in alcoholic cirrhosis, possibly as a result of deficiencies of thiamine, folic acid, and cobalamin.
  • Hepatic encephalopathy: Neuropsychiatric manifestation with symptoms ranging from sleep problems to coma. Caused by elevated ammonia levels (due to impaired liver function) crossing the blood-brain barrier.
  • Hepatorenal syndrome: Renal failure (azotemia, oliguria) associated with cirrhosis, resulting from complications of portal hypertension, vasodilation, and decreased blood volume.

Diagnostic Studies

  • Liver function tests (abnormal in various ways)
  • Liver biopsy: gold standard for diagnosis
  • Ultrasound/Fibroscan: detects cirrhosis but isn't as definitive.

Management & Treatment

  • Goals: Slow cirrhosis progression, prevent complications, and maintain normal lifestyle.
  • Conservative Therapy:
    • Rest
    • B vitamins
    • Avoid alcohol and hepatotoxic drugs (like acetaminophen in high doses)
  • Specific Treatment:
    • Ascites: Sodium restriction, diuretics (spironolactone, furosemide), paracentesis (fluid removal).
    • Esophageal & Gastric Varices: Endoscopic banding/sclerotherapy, balloon tamponade, TIPS (transjugular intrahepatic portosystemic shunt), beta-blockers, octreotide, vasopressin.
    • Hepatic Encephalopathy: Antibiotics (rifaximin), lactulose, manage risk factors (GI bleeding)
    • Nutrition: High-calorie, high-carbohydrate, moderate-low fat diet for most; protein supplements for alcoholic cirrhosis; low-sodium diet for ascites/edema.
    • Nursing Interventions: Monitor vital signs, intake/output, weight, skin, fluid & electrolyte balance, monitor for complications and bleeding, support, explanations to the patient.

Complications

  • Portal hypertension
  • Esophageal and gastric varices
  • Peripheral edema
  • Abdominal ascites
  • Hepatic encephalopathy
  • Hepatorenal syndrome
  • Compensated vs. decompensated cirrhosis

Prevention and Early Treatment

  • Identifying and mitigating risk factors (alcohol use, malnutrition, viral hepatitis, etc.)
  • Promoting early and adequate nutrition, especially for those at risk.
  • Treating acute hepatitis to prevent progression to chronic liver disease.

Ambulatory Care

  • Longterm management, health education, and community support programs (like Alcoholics Anonymous)
  • Emphasizes lifestyle changes, especially alcohol abstinence.

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