Podcast
Questions and Answers
Which of the following statements accurately describes the role of the liver in glucose metabolism?
Which of the following statements accurately describes the role of the liver in glucose metabolism?
- The liver excretes excess glucose from the bloodstream via urine.
- The liver produces insulin to regulate glucose uptake by cells throughout the body.
- The liver primarily functions to store glucose as glycogen and release it when needed by the body, helping to maintain blood sugar levels. (correct)
- The liver facilitates the digestion of complex carbohydrates into simpler sugars for absorption in the small intestine.
A patient with advanced cirrhosis is exhibiting confusion and altered mental status. Which impaired liver function is most likely contributing to these neurological symptoms?
A patient with advanced cirrhosis is exhibiting confusion and altered mental status. Which impaired liver function is most likely contributing to these neurological symptoms?
- Impaired bile formation, leading to fat malabsorption and nutrient deficiencies.
- Decreased drug metabolism, leading to toxic accumulation of medications in the bloodstream.
- Inability to convert ammonia to urea, resulting in hyperammonemia and hepatic encephalopathy. (correct)
- Reduced vitamin and iron storage capacity, causing anemia and fatigue.
A patient has been newly diagnosed with Hepatitis C. They are asymptomatic. Based on the information provided, what is the most important intervention for the nurse to include in the patient's education plan?
A patient has been newly diagnosed with Hepatitis C. They are asymptomatic. Based on the information provided, what is the most important intervention for the nurse to include in the patient's education plan?
- Emphasis on the importance of frequent handwashing to prevent fecal-oral transmission.
- Information about the availability of antiviral treatments and the importance of regular monitoring for disease progression. (correct)
- Education on avoiding alcohol consumption and maintaining a low-fat diet to reduce liver stress.
- Instructions on proper needle disposal and safe sexual practices to prevent further transmission.
A patient with cirrhosis develops esophageal varices. What is the primary pathophysiological mechanism that leads to the formation of these varices?
A patient with cirrhosis develops esophageal varices. What is the primary pathophysiological mechanism that leads to the formation of these varices?
Which of the following assessment findings would be most indicative of impaired bilirubin excretion in a patient with progressive liver disease?
Which of the following assessment findings would be most indicative of impaired bilirubin excretion in a patient with progressive liver disease?
A patient with increased spleen activity has decreased platelets. How would this most likely manifest during a physical assessment?
A patient with increased spleen activity has decreased platelets. How would this most likely manifest during a physical assessment?
Which intervention is the priority when managing esophageal varices?
Which intervention is the priority when managing esophageal varices?
A patient with esophageal varices is undergoing balloon tamponade. What is an important nursing consideration during this procedure?
A patient with esophageal varices is undergoing balloon tamponade. What is an important nursing consideration during this procedure?
What is the underlying cause of spontaneous bacterial peritonitis (SBP) in patients with ascites?
What is the underlying cause of spontaneous bacterial peritonitis (SBP) in patients with ascites?
Which assessment finding is most indicative of spontaneous bacterial peritonitis (SBP)?
Which assessment finding is most indicative of spontaneous bacterial peritonitis (SBP)?
A patient with hepatic encephalopathy exhibits asterixis, confusion, and handwriting changes. What is the primary cause of these manifestations?
A patient with hepatic encephalopathy exhibits asterixis, confusion, and handwriting changes. What is the primary cause of these manifestations?
Which factor is least likely to precipitate hepatic encephalopathy?
Which factor is least likely to precipitate hepatic encephalopathy?
Which dietary modification is most appropriate for a patient with hepatic encephalopathy?
Which dietary modification is most appropriate for a patient with hepatic encephalopathy?
A patient with cirrhosis develops ascites. Which of the following pathophysiological mechanisms contributes directly to this condition?
A patient with cirrhosis develops ascites. Which of the following pathophysiological mechanisms contributes directly to this condition?
A patient with liver cirrhosis exhibits gynecomastia and spider nevi. What is the underlying cause of these findings?
A patient with liver cirrhosis exhibits gynecomastia and spider nevi. What is the underlying cause of these findings?
A patient with cirrhosis is scheduled for a paracentesis to manage ascites. Which of the following nursing interventions is most important to perform before the procedure?
A patient with cirrhosis is scheduled for a paracentesis to manage ascites. Which of the following nursing interventions is most important to perform before the procedure?
Which laboratory finding is most indicative of impaired prothrombin production in a patient with cirrhosis?
Which laboratory finding is most indicative of impaired prothrombin production in a patient with cirrhosis?
A patient with cirrhosis develops splenomegaly. What is the most likely pathophysiological mechanism causing this enlargement of the spleen?
A patient with cirrhosis develops splenomegaly. What is the most likely pathophysiological mechanism causing this enlargement of the spleen?
Which diagnostic test would be most useful in differentiating between different etiologies of liver disease, such as alcoholic liver disease versus non-alcoholic fatty liver disease (NAFLD)?
Which diagnostic test would be most useful in differentiating between different etiologies of liver disease, such as alcoholic liver disease versus non-alcoholic fatty liver disease (NAFLD)?
A patient with cirrhosis and ascites is prescribed spironolactone. What is the primary mechanism by which this medication helps manage ascites?
A patient with cirrhosis and ascites is prescribed spironolactone. What is the primary mechanism by which this medication helps manage ascites?
Which of the following is not typically included in a standard hepatic function panel (chemistry profile) used to assess liver function?
Which of the following is not typically included in a standard hepatic function panel (chemistry profile) used to assess liver function?
A patient with cirrhosis is admitted with sudden decreased urine output, elevated BUN and creatinine, and increased urine osmolality. Which condition is most likely indicated by these manifestations?
A patient with cirrhosis is admitted with sudden decreased urine output, elevated BUN and creatinine, and increased urine osmolality. Which condition is most likely indicated by these manifestations?
A patient with hepatic failure is at risk for several complications. Which nursing diagnosis is most directly related to the patient's increased risk of bleeding?
A patient with hepatic failure is at risk for several complications. Which nursing diagnosis is most directly related to the patient's increased risk of bleeding?
What is the priority nursing intervention when caring for a patient with hepatic failure who exhibits subtle changes in mental status?
What is the priority nursing intervention when caring for a patient with hepatic failure who exhibits subtle changes in mental status?
A patient with acute pancreatitis is experiencing severe abdominal pain. Which intervention should the nurse prioritize to provide immediate relief?
A patient with acute pancreatitis is experiencing severe abdominal pain. Which intervention should the nurse prioritize to provide immediate relief?
A patient with chronic pancreatitis develops steatorrhea. Which dietary modification is most important for the nurse to teach the patient?
A patient with chronic pancreatitis develops steatorrhea. Which dietary modification is most important for the nurse to teach the patient?
A patient is diagnosed with acute pancreatitis. Which laboratory result would the nurse expect to be most elevated?
A patient is diagnosed with acute pancreatitis. Which laboratory result would the nurse expect to be most elevated?
Which intervention is most important for the nurse to include in the plan of care for a patient with acute pancreatitis to minimize further pancreatic stimulation?
Which intervention is most important for the nurse to include in the plan of care for a patient with acute pancreatitis to minimize further pancreatic stimulation?
What information is most important for the nurse to include in the discharge teaching for a patient recovering from acute pancreatitis?
What information is most important for the nurse to include in the discharge teaching for a patient recovering from acute pancreatitis?
A patient with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy. When should the nurse instruct the patient to take these enzymes?
A patient with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy. When should the nurse instruct the patient to take these enzymes?
A patient with acute pancreatitis develops a rigid abdomen, fever, and mental confusion. These findings most likely indicate which complication?
A patient with acute pancreatitis develops a rigid abdomen, fever, and mental confusion. These findings most likely indicate which complication?
Flashcards
Cirrhosis
Cirrhosis
A chronic liver disease characterized by irreversible scarring and damage.
Glucose Metabolism (Liver)
Glucose Metabolism (Liver)
Conversion of glucose to glycogen for storage or breakdown of glycogen to glucose when needed.
Ammonia to Urea Conversion (Liver)
Ammonia to Urea Conversion (Liver)
The liver converts ammonia, a toxic waste product, into urea, which is then excreted by the kidneys.
Protein Metabolism (Liver)
Protein Metabolism (Liver)
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Hepatitis A
Hepatitis A
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Etiologies of Liver Disease
Etiologies of Liver Disease
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Liver Biopsy
Liver Biopsy
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Spider Nevi
Spider Nevi
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Palmar Erythema
Palmar Erythema
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Gynecomastia
Gynecomastia
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Jaundice
Jaundice
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Ascites
Ascites
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Splenomegaly
Splenomegaly
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Thrombocytopenia in Liver Disease
Thrombocytopenia in Liver Disease
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Esophageal Varices
Esophageal Varices
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Esophageal Varices Treatment
Esophageal Varices Treatment
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Balloon Tamponade
Balloon Tamponade
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Spontaneous Bacterial Peritonitis
Spontaneous Bacterial Peritonitis
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Hepatic Encephalopathy
Hepatic Encephalopathy
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Hepatic Encephalopathy Triggers
Hepatic Encephalopathy Triggers
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Hepatic Encephalopathy Meds
Hepatic Encephalopathy Meds
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Hepatorenal Syndrome
Hepatorenal Syndrome
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Hepatorenal Syndrome Manifestations
Hepatorenal Syndrome Manifestations
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Acute Pancreatitis: Common Causes
Acute Pancreatitis: Common Causes
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Acute Pancreatitis: Pathophysiology
Acute Pancreatitis: Pathophysiology
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Acute Pancreatitis: Initial Manifestations
Acute Pancreatitis: Initial Manifestations
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Acute Pancreatitis: Key Lab Findings
Acute Pancreatitis: Key Lab Findings
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Acute Pancreatitis: Radiology Tests
Acute Pancreatitis: Radiology Tests
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Acute Pancreatitis: Collaborative Care Goals
Acute Pancreatitis: Collaborative Care Goals
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Chronic Pancreatitis: Manifestations
Chronic Pancreatitis: Manifestations
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Chronic Pancreatitis: Surgical Options
Chronic Pancreatitis: Surgical Options
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Study Notes
- Progressive liver disease can lead to liver failure as a result of chronic hepatitis.
- Cirrhosis of the liver can be defined by its characteristics.
Functions of the Liver
- Glucose metabolism
- Conversion of ammonia to urea
- Protein and fat metabolism
- Vitamin and iron storage
- Drug metabolism
- Bile formation
- Bilirubin excretion
- The Liver, Gallbladder, Pancreas and Bile Passage each have distinct anatomical locations and functions.
Hepatitis Types A, B, and C
- Hepatitis A is transmitted via the fecal-oral route and presents with fever, malaise, anorexia, nausea, diarrhea, vomiting, abdominal pain, and jaundice.
- Hepatitis B is transmitted via blood, saliva, and semen, and presents with anorexia, fever, dyspepsia, abdominal pain, body aches, malaise, and weakness.
- Hepatitis C is transmitted via bloodborne or sexual intercourse, with most people being asymptomatic for years or decades.
Cirrhosis of the Liver
- Cirrhosis etiologies include ETOH, Hepatitis (B&C), Auto-immune, Non-Alcoholic Fatty Liver, and Bile Duct Disease.
- Cirrhosis can be categorized as Compensated or Uncompensated.
Liver Disease Diagnostics
- Liver diseases can be diagnosed through a liver biopsy or labs.
- Labs include serum alkaline phosphatase, serum aminotransferase studies (AST/ALT), prothrombin time, NH4 (ammonia), and CBC.
- Additional diagnostics are chemistry profile (SMA-7, CMP) and pigment studies (Bilirubin- direct, total, urine).
- Imaging techniques like ultrasound, CT scan, and MRI may be used.
Signs and Symptoms of Cirrhosis
- External symptoms: Icteric sclerae, alopecia, spider angioma.
- Palmar erythema, gynecomastia, caput medusae, ascites.
- Altered hair distribution, testicular atrophy, and edema.
- Internal symptoms include encephalopathy, esophageal varices, portal hypertension, cirrhosis, hepatorenal syndrome, tea-colored urine, and clay-colored stool.
- Signs like Spider Nevi and Palmar Erythema are attributed to increased estrogen levels
- Gynecomastia is also a result of increased Estrogen levels.
- Jaundice is a result of high bilirubin levels.
Portal Hypertension
- Portal hypertension is a major complication of cirrhosis and is characterized by increased pressure in the portal venous system.
Caput Medusae
- Caput Medusae is caused from portal hypertension.
Pathophysiology: Ascites
- Ascites is due to portal hypertension, splanchnic artery dilatation, and failure to metabolize aldosterone.
- Ascites also occurs due to retention of Na and Water, low levels of albumin, and loss of fluid initiates more retention
- Ascites can be assessed via a Fluid Thrill (Wave) Test
- Another method to assess is Shifting Dullness
Management of Ascites
- Management includes medications such as diuretics (spironolactone, furosemide), dietary modification (sodium restriction), paracentesis, procedures to Control Portal HTN and TIPS (p657).
Splenomegaly
- Splenomegaly occurs as a result of portal hypertension.
Coagulation Defects
- Coagulation defects stem from decreased absorption of fat-soluble vitamins and prothrombin production.
- Coagulation defects can cause decreased production of clotting factors VII, IX, X
Esophageal Varices
- Esophageal Varices occurs as a result of Portal Hypertension.
Collaborative Management of Esophageal Varices
- Methods for esophageal varices IV fluids, Blood Products, vasopressin (Pitressin) Drip.
- Other methods include octreotide (Sandostatin) Drip, Endoscopy with Sclerosing agents or Bands.
- Balloom tamponade (Sengstaken-Blakemore)
- Balloon Tamponade can treat Esophageal Varices.
Spontaneous Bacterial Peritonitis
- Peritonitis occurs as a result of decreased immune function.
- Gut bacteria reach the ascitic fluid via lymphatics.
- This can cause fever, chills, abdominal pain and tenderness, and increased WBC in ascitic fluid.
- Treatment involves IV antibiotics.
Hepatic Encephalopathy
- Encephalopathy is a serious and late complication of liver disease/end stage.
- This is due to increased build up of ammonia.
- Symptoms include asterixis, confused, mental changes, and handwriting changes.
- Fetor Hepaticus can also be present.
Precipitating Factors for Hepatic Encephalopathy
- Factors include GI bleeding and bacterial Infections.
- Other factors are: Hypovolemia, Electrolyte/ AB Imbalance, Constipation, Drugs (hypnotics, Opioids, diuretics, etc.), Paracentesis and TIPS
Collaborative Management of Hepatic Encephalopathy
- Decrease ammonia formation with medications (Cathartics: Lactulose).
- Antibiotics: Rifaximin, Neomycin can be used but are Ototoxic and Nephrotoxic.
- Diet restrictions include small meals and Complex Carbohydrates to avoid protein loading.
- Protein 1.2- 1.5g/kg daily.
- Substitute veggie protein for animal protein as often as possible.
Hepatorenal Syndrome
- Hepatorenal syndrome carries a poor prognosis and is a leading cause of death in patients with cirrhosis.
- Causes are often bacterial infection, acute alcoholic hepatitis, upper GIB, and spontaneous bacterial peritonitis.
- Manifestations include a sudden decrease in urine output, Elevated BUN and creatinine, and Increased urine osmolality
Nursing Diagnosis- Hepatic Failure
- Nursing diagnoses: Imbalanced Nutrition, Activity Intolerance, Risk of Fluid Volume Excess, Impaired Skin Integrity, and Ineffective breathing pattern.
- Additional diagnoses: Risk for injury (bleeding and confusion) and Risk for Infection
Nursing Interventions
- Eliminate causative agent and promote rest.
- Reduce risk for injury and assess every 2- 4 hrs for mental status.
- Observe for bleeding tendencies / avoid causing bleeding.
- Provide special skin care and monitor fluid and electrolyte status.
- Improve nutritional status.
- Educate Patient / family.
- Constantly monitor ALOC, VS, Labs, I/O and weigh patients.
- Monitor Abdominal girth and stool for occult blood.
Acute Pancreatitis: Etiology
- A major cause is Biliary Tract disease
- Alcoholism, Trauma, Infection, Autoimmune Disease, and Drugs can cause acute pancreatitis.
Acute Pancreatitis: Pathophysiology
- Pathophysiology includes autodigestion, vasodilation ,inflammation, necrosis and hemorrhage
Acute Pancreatitis: Manifestations
- Initial symptoms include Pain, N/V, ABD Distention, and a possible palpable mass.
- Severe pancreatitis presents with a rigid ABD.
- Other symptoms of severe pancreatitis are retro-peritoneal bleed, fever, jaundice, mental confusion, hypotension, and SOB.
Acute Pancreatitis: Lab Tests
- Serum amylase is increased (Normal 23-85)
- Serum lipase is increased (Normal 0-160)
- Other signs are hyperglycemia, serum Bilirubin is increased, hypocalcemia, and leukocytosis
- Urine amylase is increased (Normal 24-4)
Acute Pancreatitis: Radiology Tests
- Flat plate of the abdomen.
- Abdominal/endoscopic ultrasound.
- Endoscopic retrograde cholangiopancreatography (ERCP).
- CT of pancreas.
Acute Pancreatitis: Collaborative Care
- Relieve pain along with improve breathing.
- Monitor/ Manage complications and nutritional status.
- Protect and improve skin integrity.
- Remove cause and educate patient.
Chronic Pancreatitis: Manifestations
- Manifestations feature reoccurring attacks and progressively more severe, frequent attacks
- Additionally, weight loss, steatorrhea and diabetes Mellitus
Collaborative Care
- Non-Surgical: No alcohol, pain management, nutritional management, treatment of DM, PPI and pancreatic enzyme replacement
- Surgical: Pancreatojejunostomy, Whipple resection and endoscopic Procedures
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Description
Explore liver function, disease, and related symptoms, including glucose metabolism, cirrhosis, hepatitis C, and esophageal varices. Understand the impact of impaired liver function.
