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Questions and Answers
What symptoms would indicate internal bleeding after a liver biopsy?
What symptoms would indicate internal bleeding after a liver biopsy?
Which medication should be avoided to prevent rupture of varices in patients with portal hypertension?
Which medication should be avoided to prevent rupture of varices in patients with portal hypertension?
Which intervention is critical if a patient experiences a rupture of esophageal varices?
Which intervention is critical if a patient experiences a rupture of esophageal varices?
What condition describes the buildup of fluid in the third space, commonly seen in patients with ascites?
What condition describes the buildup of fluid in the third space, commonly seen in patients with ascites?
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Which dietary modification is advised for a patient with ascites?
Which dietary modification is advised for a patient with ascites?
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What is the hallmark sign of hepatic encephalopathy?
What is the hallmark sign of hepatic encephalopathy?
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When managing hepatic encephalopathy, what should be monitored to assess the effectiveness of treatment?
When managing hepatic encephalopathy, what should be monitored to assess the effectiveness of treatment?
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Which clinical finding is NOT associated with ascites?
Which clinical finding is NOT associated with ascites?
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What is a potential side effect of lactulose when used for treating hepatic encephalopathy?
What is a potential side effect of lactulose when used for treating hepatic encephalopathy?
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What should be the priority action if a patient with portal hypertension shows signs of variceal bleeding?
What should be the priority action if a patient with portal hypertension shows signs of variceal bleeding?
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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.
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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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Description
This quiz covers essential complications associated with liver biopsies, portal hypertension, and ascites. Learn about the bleeding risks, emergency procedures, and management strategies to ensure patient safety. Test your knowledge on positioning, medication protocols, and emergency interventions.
