Liver Complications and Management

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Questions and Answers

What symptoms would indicate internal bleeding after a liver biopsy?

  • Increased blood pressure and decreased heart rate
  • Bruising and rigid abdomen (correct)
  • Excessive urination and fever
  • Dry skin and weight loss

Which medication should be avoided to prevent rupture of varices in patients with portal hypertension?

  • Lactulose
  • Propranolol
  • Ibuprofen (correct)
  • Octreotide

Which intervention is critical if a patient experiences a rupture of esophageal varices?

  • Prepare for balloon tamponade with a Sengstaken-Blakemore tube (correct)
  • Schedule a follow-up appointment for endoscopy
  • Administer oral fluids immediately
  • Increase the patient's protein intake

What condition describes the buildup of fluid in the third space, commonly seen in patients with ascites?

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

Which dietary modification is advised for a patient with ascites?

<p>Reduce sodium and increase potassium intake (A)</p> Signup and view all the answers

What is the hallmark sign of hepatic encephalopathy?

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

When managing hepatic encephalopathy, what should be monitored to assess the effectiveness of treatment?

<p>Patient's level of consciousness (B)</p> Signup and view all the answers

Which clinical finding is NOT associated with ascites?

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

What is a potential side effect of lactulose when used for treating hepatic encephalopathy?

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

What should be the priority action if a patient with portal hypertension shows signs of variceal bleeding?

<p>Establish IV access for fluids and medications (A)</p> Signup and view all the answers

Flashcards

Liver Biopsy Bleeding Risk

Liver biopsies have a higher risk of bleeding due to liver's vascular nature.

Internal Bleeding Signs

Dropping blood pressure (low BP), fast heart rate (high HR), bruising, rigid abdomen, and distended abdomen are signs of internal bleeding.

Portal Hypertension Varices Prevention

Preventing variceal rupture includes avoiding straining, coughing, and bearing down, along with medications like propranolol or nadolol, and avoiding alcohol and NSAIDs.

Sclerotherapy/Ligation in Active Bleeds

In active bleeding, sclerotherapy or ligation isn't used to treat portal hypertension varices. It won't work on active bleeding.

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Ascites Causes

Increased fluid in the abdominal cavity (ascites) is often caused by fluid shifting out of the blood vessels.

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Ascites Assessment

Assess ascites by looking for a distended abdomen, signs of dehydration, decreased urine output, low potassium, high sodium, elevated aldosterone, weight gain, and low albumin levels.

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Ascites Management

Managing ascites includes monitoring daily weight, measuring abdominal girth, a low-sodium and high-potassium diet (AVOID canned/processed foods), fluid restrictions, and medications like diuretics and albumin.

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Hepatic Encephalopathy Causes

Hepatic encephalopathy is caused by ammonia buildup, as the liver isn't processing ammonia into urea effectively.

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Hepatic Encephalopathy Signs

Changes in mental status (LOC), restlessness, flapping tremors (asterixis), and a musty odor (fetor hepaticus) are signs of hepatic encephalopathy.

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Hepatic Encephalopathy Management

Managing hepatic encephalopathy includes providing fluids, medications like lactulose to lower ammonia, and a low-protein diet.

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Study Notes

Liver Biopsy Complications

  • Bleeding Risk: Liver is highly vascular, increasing risk of bleeding.
  • Symptoms of Internal Bleeding: Decreased blood pressure, increased heart rate, bruising, rigid abdomen, abdominal distention.
  • Post-procedure Positioning: Patient should be positioned on the right lateral side.

Portal Hypertension with Varices

  • Severity: Pooling of varices can rupture, causing airway problems; an emergency.
  • Preventing Rupture: Avoid straining, coughing, bearing down (use stool softeners). Administer propranolol or nadolol to lower blood pressure. Avoid alcohol and NSAIDs.
  • Post-Rupture Care: Treat with Sengstaken-Blakemore tube (balloon tamponade; mechanical ventilation before). Avoid ligation/sclerotherapy for active bleeds. Have scissors and suction readily available for airway emergencies. Administer medications (PPIs, Ondansetron, Octreotide), fluids, and Vasopressin for bleeding, ensuring IV access.

Ascites

  • Cause: Fluid shifts from the vascular space to the third space.
  • Assessment: Distended abdomen, signs of dehydration, decreased urine output, hypokalemia, hypernatremia, increased aldosterone, weight gain, decreased albumin.
  • Management: Monitor daily weight, abdominal girth. Dietary restrictions: low sodium, high potassium (e.g., avocado), fluid restrictions. Avoid canned foods, frozen meals, and sauces. Medications: diuretics (monitor potassium levels), and albumin (require consent).
    • Diuretic Choice: Spironolactone if potassium low; Furosemide if potassium high; both if potassium normal.
  • Paracentesis: For severe pain/shortness of breath, draining fluid, measuring the fluid; obtain consent, patient voids before procedure. Patient is supine with raised head of bed. Apply pressure to puncture site. Maintain bed rest post-procedure.
  • Evaluating Intervention Success: Look for rising albumin levels and decreasing abdominal girth.

Hepatic Encephalopathy

  • Cause: Ammonia builds up because the liver can't convert it to urea. Contributing factors include too much protein and constipation.
  • Presentation: Changes in level of consciousness (LOC), agitation, restlessness, asterixis (flapping tremors), and fetor hepaticus (musty/sweet odor, like rotten eggs/garlic/fish).
  • Management: Administer fluids and lactulose (reduces ammonia). Monitor for hypokalemia due to lactulose. Implement a low-protein diet.
  • Evaluating Intervention Success: Lower ammonia levels, and return to alert and oriented status (AAOx4).

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