Liver Functions and Disorders: Hepatitis & Cirrhosis
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Questions and Answers

Which of the following is NOT a primary function of the liver?

  • Detoxing ammonia
  • Synthesizing insulin (correct)
  • Producing bile
  • Storing glycogen
  • What is the primary role of albumin in the blood?

  • Stores glycogen for energy
  • Produces clotting factors
  • Transports drugs and attracts water (correct)
  • Regulates bilirubin excretion
  • In hepatitis, which phase is characterized by vague body symptoms resembling flu?

  • Icteric
  • Preicteric (correct)
  • Posticteric
  • Convalescent
  • What can severe inflammation in the liver lead to?

    <p>Cirrhosis and liver cancer (B)</p> Signup and view all the answers

    Which of the following best describes the hepatic portal vein's function?

    <p>Pumps nutrient-rich blood from the intestines to the liver (D)</p> Signup and view all the answers

    What is the byproduct of protein breakdown that the liver detoxifies?

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

    Which form of hepatitis is NOT typically viral?

    <p>Alcohol-induced hepatitis (B)</p> Signup and view all the answers

    How does bile function in the body?

    <p>Excretes bilirubin and cholesterol (B)</p> Signup and view all the answers

    What is the primary mode of transmission for Hepatitis B, C, and D?

    <p>Blood and bodily fluids (D)</p> Signup and view all the answers

    Which treatment is specifically indicated for Hepatitis C?

    <p>Peginterferon alfa 2-a &amp; ribavirin combination therapy (D)</p> Signup and view all the answers

    What characteristic describes the carrier state of Hepatitis B and C?

    <p>Asymptomatic but infectious (B)</p> Signup and view all the answers

    How much more infectious is Hepatitis B compared to Hepatitis C?

    <p>10x (C)</p> Signup and view all the answers

    Which is true regarding immunoglobulin therapy for new infants born to Hepatitis B positive parents?

    <p>Should be administered within 12 hours of birth (C)</p> Signup and view all the answers

    What percentage of babies born to a Hepatitis B positive parent are likely to develop chronic Hepatitis B?

    <p>90% (D)</p> Signup and view all the answers

    What is the significance of universal precautions in healthcare in relation to Hepatitis B and C?

    <p>They minimize the risk of exposure due to asymptomatic carriers. (C)</p> Signup and view all the answers

    In 2021, how many cases of Hepatitis C were reported in Nova Scotia?

    <p>274 cases (D)</p> Signup and view all the answers

    Which symptom is associated with liver dysfunction due to cirrhosis?

    <p>Left upper quadrant discomfort (A)</p> Signup and view all the answers

    What mechanism primarily causes portal hypertension?

    <p>Narrowing of the portal vein due to scar tissue (C)</p> Signup and view all the answers

    Which of the following methods is NOT a recognized transmission route for hepatitis B?

    <p>Eating food prepared by someone with hepatitis B (A)</p> Signup and view all the answers

    What condition is characterized by fluid buildup in the peritoneal cavity due to portal hypertension?

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

    What risk does an individual with esophageal varices face?

    <p>Hemorrhage from ruptured veins (C)</p> Signup and view all the answers

    What is the consequence of the liver's inability to detoxify ammonia in hepatic encephalopathy?

    <p>Build-up of toxic ammonia levels (D)</p> Signup and view all the answers

    Which option describes a distinguishing feature of cirrhosis?

    <p>Transition of healthy liver tissue to fibrotic tissue (D)</p> Signup and view all the answers

    Which laboratory finding is commonly associated with ascites development due to portal hypertension?

    <p>Low albumin levels (C)</p> Signup and view all the answers

    What is the primary reason for the difficulty in Hepatitis C treatment awareness among patients?

    <p>44% of individuals with Hepatitis C are unaware they have it. (D)</p> Signup and view all the answers

    In which case is the Hepatitis D virus able to develop?

    <p>Only if Hepatitis B is also present. (C)</p> Signup and view all the answers

    What is a significant indicator of acute Hepatitis as opposed to other forms?

    <p>Dark urine and clay stools. (D)</p> Signup and view all the answers

    Which laboratory tests would most likely be monitored in cases of hepatitis?

    <p>Monitoring of AST, ALT, bilirubin, and antibodies. (A)</p> Signup and view all the answers

    What dietary recommendations should be made for patients with liver conditions?

    <p>Low fat and protein with high calorie and carbohydrate intake. (A)</p> Signup and view all the answers

    What is the primary purpose of a liver biopsy in hepatitis diagnosis?

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

    What is the best prevention measure for Hepatitis B?

    <p>Vaccination against Hepatitis B. (C)</p> Signup and view all the answers

    What symptom is commonly associated with fulminant hepatitis?

    <p>Rapid onset of severe liver failure. (A)</p> Signup and view all the answers

    What is a key neurological finding associated with liver dysfunction?

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

    What are potential symptoms of increased estrogen due to liver impairment?

    <p>Gynecomastia and spider angiomas (D)</p> Signup and view all the answers

    Which laboratory findings would be expected in a patient with late-stage cirrhosis?

    <p>High AST and ALT (D)</p> Signup and view all the answers

    What is a common complication of hepatic failure affecting the kidneys?

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

    What dietary recommendation is crucial for managing cirrhosis?

    <p>Low sodium and low fat (A)</p> Signup and view all the answers

    What observation suggests the presence of ascites in a cirrhosis patient?

    <p>Increased belly circumference (B)</p> Signup and view all the answers

    Which of the following medications would be contraindicated in a patient with liver failure?

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

    What is the indication of elevated BUN and creatinine in a cirrhosis patient?

    <p>Acute kidney injury (B)</p> Signup and view all the answers

    What is the primary purpose of creating a shunt in patients with varices?

    <p>To reduce pressure by allowing blood to bypass the liver (C)</p> Signup and view all the answers

    What statement indicates a misunderstanding about home care management for a client with cirrhosis?

    <p>I will take ibuprofen for headaches. (B)</p> Signup and view all the answers

    In the care plan for a client with cirrhosis and ascites, which nursing action is least appropriate?

    <p>Encourage the client to lie supine for comfort (C)</p> Signup and view all the answers

    Which medication should be administered to a client with elevated ammonia levels due to liver dysfunction?

    <p>Lactulose to decrease ammonia levels (B)</p> Signup and view all the answers

    What precaution must be taken prior to performing a paracentesis in a client with ascites?

    <p>Ensure the bladder is empty to prevent perforation (D)</p> Signup and view all the answers

    What is the primary purpose of lactulose in the management of liver disease?

    <p>To decrease ammonia levels through stool (C)</p> Signup and view all the answers

    Which nursing action is critical for a client undergoing paracentesis to prevent complications?

    <p>Ensure the patient's bladder is empty (C)</p> Signup and view all the answers

    What disqualifies a patient from being a candidate for a liver transplant?

    <p>Severe respiratory disease (C)</p> Signup and view all the answers

    Which of the following accurately describes the purpose of using beta blockers in portal hypertension management?

    <p>To decrease portal venous pressure (B)</p> Signup and view all the answers

    In the care plan for a client with cirrhosis, which of the following actions should be avoided?

    <p>Encouraging high protein intake (B)</p> Signup and view all the answers

    Which symptom is expected in a client suffering from hepatitis B infection?

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

    How can hepatitis B be transmitted between individuals?

    <p>Intravenous drug use (A)</p> Signup and view all the answers

    What is a significant consequence of portal hypertension related to liver dysfunction?

    <p>Fluid accumulation in the peritoneal cavity (B)</p> Signup and view all the answers

    Which condition is characterized by the enlargement of veins in the esophagus due to severe pressure from portal hypertension?

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

    What leads to hepatic encephalopathy in a patient with liver dysfunction?

    <p>Ammonia build-up in the bloodstream (B)</p> Signup and view all the answers

    Which factor contributes to the development of cirrhosis in individuals with chronic hepatitis?

    <p>Excessive alcohol consumption (B)</p> Signup and view all the answers

    What is the primary risk associated with ruptured esophageal varices?

    <p>Shock and airway obstruction (D)</p> Signup and view all the answers

    What primarily causes fluid to shift into the peritoneal cavity in ascites?

    <p>Venous congestion from portal hypertension (C)</p> Signup and view all the answers

    Which function of the liver is mainly responsible for the detoxification of ammonia?

    <p>Conversion of ammonia into urea (B)</p> Signup and view all the answers

    What is a primary result of moderate inflammation in the liver?

    <p>Obstruction of blood and bile flow (A)</p> Signup and view all the answers

    Which type of hepatitis is characterized by an autoimmune response?

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

    How does the liver primarily handle bilirubin produced from old red blood cells?

    <p>Converts it into bile for excretion (D)</p> Signup and view all the answers

    What symptom is typically seen in the icteric phase of hepatitis?

    <p>Yellowing of the skin and eyes (D)</p> Signup and view all the answers

    Which of the following best describes the primary role of albumin in the blood?

    <p>Attracting water and transporting drugs (C)</p> Signup and view all the answers

    What common misconception might someone have regarding the hepatic portal vein?

    <p>It carries oxygenated blood to the liver (D)</p> Signup and view all the answers

    Which phase of hepatitis is primarily characterized by the absence of flu-like symptoms?

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

    What is the main reason for the high rate of Hepatitis C cases, given that 44% remain unaware of the infection?

    <p>Lack of symptoms early on (D)</p> Signup and view all the answers

    Which of the following statements accurately describes the relationship between Hepatitis D and Hepatitis B?

    <p>Vaccination against Hepatitis B prevents Hepatitis D. (B)</p> Signup and view all the answers

    What dietary adjustments are recommended for a patient with acute hepatitis?

    <p>High carbohydrate, low protein (C)</p> Signup and view all the answers

    What is indicated by a positive HBsAg test result in a patient?

    <p>The patient has a chronic or active Hepatitis B infection. (B)</p> Signup and view all the answers

    What is the main purpose of performing a liver biopsy in hepatitis cases?

    <p>To assess the severity of liver damage (A)</p> Signup and view all the answers

    Which of these symptoms is most characteristic of acute hepatitis?

    <p>Flu-like symptoms with clay-colored stools (B)</p> Signup and view all the answers

    What is a potential complication of fulminant hepatitis?

    <p>Acute kidney injury (D)</p> Signup and view all the answers

    What is the key clinical finding associated with ammonia accumulation in the blood?

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

    Which laboratory finding is most closely monitored in patients with hepatitis?

    <p>Increased ALT and AST levels (C)</p> Signup and view all the answers

    Elevated levels of what substance in the blood indicate liver or hepatic dysfunction?

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

    What condition is associated with a sudden decrease in urine output and elevated blood urea nitrogen (BUN) in patients with liver failure?

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

    Which symptom is NOT commonly associated with liver impairment secondary to high estrogen levels?

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

    Which dietary recommendation is crucial for managing symptoms in patients with cirrhosis?

    <p>Low sodium and high carbohydrate intake (C)</p> Signup and view all the answers

    What is a common clinical manifestation of late-stage cirrhosis related to liver failure?

    <p>Musty breath (Hepatic Foetor) (D)</p> Signup and view all the answers

    What surgical procedure is minimally invasive for treating esophageal varices in patients with liver dysfunction?

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

    Which laboratory findings would likely be present in a patient with late-stage cirrhosis?

    <p>Increased PT/PTT/INR and Decreased Platelets (A)</p> Signup and view all the answers

    What are the two primary forms of hepatitis based on duration?

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

    Which viruses are classified as acute hepatitis infections that do not progress to chronic forms?

    <p>Hepatitis A and E (C)</p> Signup and view all the answers

    Which of the following is a common risk factor associated with hepatitis A transmission?

    <p>Ingestion of contaminated food and water (B)</p> Signup and view all the answers

    What is the primary cause of hepatocyte damage in acute hepatitis?

    <p>Liver inflammation leading to cell lysis (C)</p> Signup and view all the answers

    Which antibiotic is commonly used for pre or post-exposure to Hepatitis A infection?

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

    Flashcards

    Liver Function

    The liver stores glycogen, metabolizes drugs and fats, detoxifies ammonia, and produces bile, clotting factors, and albumin.

    Albumin Function

    Albumin transports drugs, attracts water, and binds calcium for bone strength.

    Bile Function

    Bile collects bilirubin and cholesterol and excretes them through the gastrointestinal system.

    Clotting Factors

    Clotting factors regulate PT, PTT, and INR.

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    Ammonia Detoxification

    The liver converts ammonia (a byproduct of protein breakdown) into urea, which the kidneys excrete.

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    Bilirubin Function

    The liver converts old red blood cells to bilirubin and excretes it via stool.

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    Hepatitis

    Inflammation of the liver, which can be viral, idiopathic, drug-induced, autoimmune, or alcohol-related.

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    Hepatitis Severity

    Hepatitis severity ranges from mild, which impairs hepatocyte function, to moderate, possibly obstructing blood and bile flow, to severe, causing cirrhosis, liver cancer, or liver failure.

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    Hepatitis Absorption

    Hepatitis viruses enter the body through the hepatic portal venous system, reaching the liver, where they bind to receptors on hepatocytes and enter through endocytosis.

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    Chronic Hepatitis Risk Factors

    Unprotected sex, contact with blood, substance use disorder, birth, tattoos, hemodialysis, and unscreened blood are some of the risk factors for chronic hepatitis.

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    Hepatitis C Treatment

    Hepatitis C treatment options include peginterferon alfa 2-a and ribavirin combination therapy.

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    Hepatitis B Treatment

    Hepatitis B treatment includes hepatitis B immunoglobulin therapy, given within 24 hours after exposure.

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    Carrier State

    Hepatitis B and C can exist in a carrier state where the infected person is asymptomatic and may be unaware they have the virus, even if they have a chronic low-grade infection.

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    Universal Precautions

    Universal precautions are crucial in healthcare settings to prevent the spread of hepatitis B and C due to the potential for asymptomatic carriers.

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    Hepatitis B: Transmission Risk

    Hepatitis B is significantly more infectious than Hepatitis C and HIV.

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    Hepatitis B: Birth Transmission

    Hepatitis B can be transmitted from a birthing parent to the baby, with a high risk of the baby developing chronic Hepatitis B.

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    Hep C Cure

    Hepatitis C is now curable with Direct Acting Antivirals (DAAs). Treatment is typically 8-12 weeks and patients report minimal side effects.

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    Hep C Awareness

    A significant challenge in treating Hepatitis C is that 44% of people with the virus are unaware they have it.

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    Fulminant Hepatitis

    A rare but life-threatening complication of Hepatitis, where severe liver failure occurs rapidly over hours to days.

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    Acute Hepatitis Symptoms

    Symptoms include malaise, flu-like symptoms, nausea, vomiting, diarrhea, low appetite, joint pain, low-grade fever, clay stools, dark urine, jaundice, RUQ tenderness, hepatomegaly.

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    Anti-HAV IgM

    Indicates an active Hepatitis A infection.

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    Anti-HBs IgG

    Indicates recovery from or immunity to Hepatitis B.

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    Liver Biopsy

    A small piece of liver tissue is removed and examined to assess the extent of liver damage.

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    Hepatitis B Transmission

    Hepatitis B can be spread through contact with infected blood or bodily fluids, such as sharing needles for drug use, having unprotected sex with an infected person, or using a razor used by someone with hepatitis B.

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    Cirrhosis Cause

    Cirrhosis occurs when healthy liver tissue is replaced by scar tissue, often caused by chronic hepatitis B or C infections.

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    Portal Hypertension

    Portal hypertension is increased pressure in the portal vein, caused by scar tissue in the liver that restricts blood flow. This can lead to fluid buildup in the abdomen and other complications.

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    Esophageal Varices

    Esophageal varices are enlarged, thinned veins in the esophagus caused by portal hypertension. They can rupture, leading to bleeding and potentially fatal complications.

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    Ascites

    Ascites is fluid buildup in the peritoneal cavity due to portal hypertension and low albumin levels.

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    Hepatic Encephalopathy

    Hepatic encephalopathy is brain dysfunction caused by the buildup of ammonia in the bloodstream when the liver cannot detoxify it.

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    Hepatitis B Prevention

    Hepatitis B is preventable by vaccination. Vaccination is highly effective in protecting against infection.

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    What happens to ammonia in liver failure?

    Ammonia accumulates in the blood because the liver can't detoxify it.

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    What is asterixis?

    Involuntary jerking movements of the hands, a sign of liver failure.

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    How does liver failure affect estrogen?

    The liver breaks down estrogen, so when it's impaired, estrogen levels increase.

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    What is hepatorenal syndrome?

    Progressive kidney failure that occurs alongside liver failure.

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    What are the late-stage symptoms of cirrhosis?

    Tremors, itchy skin, jaundice, confusion, ascites, edema, enlarged breasts in men, and more.

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    What kind of diet is recommended for cirrhosis?

    Low protein, low fat, high carbohydrate, and high calorie, with vitamin and mineral supplements.

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    What lab values are important to monitor in cirrhosis?

    High AST, ALT, bilirubin; Low albumin, calcium, and platelets; High PT/PTT/INR.

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    What are some treatment options for cirrhosis?

    Shunting surgery, TIPS procedure, endoscopic variceal ligation.

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    Shunt Purpose

    A shunt is a medical procedure used to reroute blood flow around the liver to reduce pressure and potentially prevent bleeding from varices. It allows some blood to bypass the liver and reduce the pressure in the portal vein.

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    Liver Transplant Criteria

    A liver transplant is a complex procedure with strict guidelines. Candidates must be medically stable with no severe cardiac or respiratory issues, metastatic cancers, or uncontrolled substance use.

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    Paracentesis Procedure

    Paracentesis is the draining of fluid from the abdominal cavity (ascites) using a needle. Before the procedure, the bladder should be emptied to prevent accidental puncture. Vital signs should be monitored, especially blood pressure, which may decrease as fluid is drained.

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    Lactulose for Liver Disease

    Lactulose is a medication used to treat hepatic encephalopathy, a brain disorder related to liver dysfunction. It works by decreasing ammonia levels in the blood by promoting its excretion through stool. Careful monitoring for low potassium levels (hypokalemia) is necessary.

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    Acetaminophen Warning

    Individuals with cirrhosis should avoid taking acetaminophen (Tylenol) due to impaired liver function, which can lead to severe damage and liver failure.

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    Hepatitis A & E

    Viral infections that cause inflammation of the liver, spread through the fecal-oral route. They are acute only and do not progress to chronic stages.

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    Hepatitis A & E Risk Factors

    Ingestion of contaminated food and water, contact with infected stool, crowded conditions.

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    Hepatitis A & E Prevention

    Vaccination for Hep A, Immunoglobulin within 2 weeks post-exposure for Hep A.

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    Hepatitis A & E Symptoms

    Jaundice, dark urine, clay-colored stools, abdominal pain, fatigue, loss of appetite.

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    Hepatitis A & E Treatment

    Supportive care, rest, fluids, and avoiding alcohol.

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    What does albumin do?

    Albumin is produced by the liver and plays a crucial role in transporting drugs and hormones throughout the body, attracting water to maintain blood volume, and binding calcium for strong bones.

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    How does the liver handle ammonia?

    Ammonia is a waste product of protein breakdown. The liver converts harmful ammonia into urea, which is safely excreted by the kidneys.

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    Bilirubin and the liver

    Red blood cell breakdown releases bilirubin. The liver converts old red blood cells into bilirubin and excretes it through the stool, giving it its characteristic brown color.

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    Hepatic Portal Vein Function

    The hepatic portal vein transports nutrient-rich blood from the gastrointestinal system to the liver. This allows the liver to filter and process nutrients before they enter the general circulation.

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    What is Hepatitis?

    Hepatitis is inflammation of the liver, causing varying degrees of damage. It has several causes, including viral infections, autoimmune diseases, and drug toxicity.

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    Types of Hepatitis

    Hepatitis can be caused by different factors, including viral infections (A, B, C, D, E), autoimmune disorders, drug toxicity, and alcohol abuse.

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    Hepatitis Progression

    Depending on the severity, hepatitis can progress from mild, causing impaired liver function, to moderate, obstructing blood and bile flow, to severe, leading to cirrhosis, cancer, and liver failure.

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    What is Hepatic Encephalopathy?

    Hepatic encephalopathy is brain dysfunction caused by a buildup of ammonia in the bloodstream. The liver is normally responsible for detoxifying this waste product.

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    What are the common symptoms of Hepatitis B?

    Common symptoms of hepatitis B include fatigue, loss of appetite, nausea, vomiting, abdominal pain, jaundice (yellowing of the skin and eyes), dark urine, and clay-colored stools.

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    Hepatitis C: Cure?

    Hepatitis C is now curable with Direct Acting Antivirals (DAAs). Treatment is typically 8-12 weeks and patients report minimal side effects.

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    Hepatitis C: Awareness Issue

    A significant challenge in treating Hepatitis C is that 44% of people with the virus are unaware they have it.

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    What is the main cause of Hepatitis D?

    Hepatitis D cannot occur without Hepatitis B! The best prevention is the Hepatitis B vaccine.

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    What is the best prevention for Hepatitis D?

    The best prevention is the Hepatitis B vaccine.

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    Hepatitis A&E: Transmission

    Viral infections that cause inflammation of the liver, spread through the fecal-oral route.

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    Ammonia and Liver Failure

    When the liver isn't working properly, it can't convert ammonia into urea, causing it to build up in the blood.

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    Asterixis

    Involuntary flapping of the hands, a sign of liver failure indicating brain dysfunction due to ammonia buildup.

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    Liver and Estrogen

    The liver breaks down estrogen. When it's damaged, estrogen levels rise, leading to symptoms like gynecomastia (breast enlargement in men), spider angiomas, and palmer erythema.

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    Hepatorenal Syndrome

    Progressive kidney failure that occurs alongside liver failure, often with a sudden decrease in urine output.

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    Late Stage Cirrhosis Signs

    Symptoms of severe liver scarring include tremor, itchy skin, jaundice, confusion, ascites, edema, enlarged breasts in men, and more.

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    Cirrhosis Diet

    A low-protein, low-fat, high-carbohydrate, and high-calorie diet with vitamin and mineral supplements is recommended for cirrhosis.

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    Cirrhosis Treatment Options

    Treatment options for cirrhosis include shunting surgery, TIPS procedure, and endoscopic variceal ligation.

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    What is a shunt used for in cirrhosis?

    A shunt creates a new channel to reroute blood flow around the liver. This bypasses the damaged liver and reduces pressure in the portal vein, potentially preventing bleeding from varices.

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    Why is acetaminophen dangerous for cirrhosis patients?

    Patients with cirrhosis have a weakened liver that can't process medications like acetaminophen effectively. Taking it can lead to severe liver damage and failure.

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    What is paracentesis?

    Paracentesis involves draining fluid from the abdomen (ascites) using a needle. It's crucial to ensure an empty bladder before the procedure and monitor vital signs throughout.

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    Lactulose: What does it do?

    Lactulose is a medication used to decrease ammonia levels in the blood. Ammonia buildup can lead to brain dysfunction in liver disease. Lactulose helps excrete ammonia through stool.

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    What are some nursing actions for ascites?

    Nursing actions for ascites include monitoring daily weight, measuring abdominal girth, assessing respiratory status, and assisting the client with care as needed.

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    Study Notes

    Infection & Inflammation: Hepatitis & Cirrhosis

    • Hepatitis is inflammation of the liver.
    • Cirrhosis is the end-stage of liver fibrosis.
    • Types of hepatitis include viral (A, B, C, D, E), idiopathic, drug toxicity, autoimmunity, and alcohol-induced.

    About the Liver

    • The liver has four main functions:
      • Storing glycogen
      • Drug and fat metabolism
      • Detoxifying ammonia
      • Producing bile, coagulation factors, and albumin

    Production (Liver Functions)

    • Albumin: Transports drugs, attracts water, and binds with Calcium for bone strength.
    • Bile: Scoops up bilirubin and cholesterol and excretes them through the GI system.
    • Clotting factors: Regulates PT, PTT, INR.

    Ammonia & Bilirubin

    • Ammonia is a byproduct of protein breakdown.
    • The liver normally converts ammonia to urea for excretion by the kidneys.
    • Bilirubin is a byproduct of red blood cell (RBC) breakdown.
    • The liver normally converts old RBCs to bilirubin and excretes it via stool.

    Hepatic Portal Vein & Artery

    • Hepatic Portal Vein: Pumps blood rich in nutrients from the GI system to the hepatocytes, filtering the blood.
    • Hepatic Artery: Pumps fresh oxygenated blood to the liver from the aorta.

    Hepatitis

    • Hepatitis is inflammation of the liver.
    • One type is hepatitis infection.

    Forms of Hepatitis

    • Hepatitis can take many forms, including virus from (A, B, C, D, and E), idiopathic, drug toxicity, autoimmunity, and alcoholism.

    Inflammation Stages

    • Mild: Impairs hepatocyte function.
    • Moderate: May lead to obstruction of blood and bile, impairing overall liver function.
    • Severe: Contributes to cirrhosis, hepatocellular cancer, and liver failure.

    Phases of Hepatitis

    • Preicteric (prodromal): Vague flu-like symptoms.
    • Icteric: Flu-like symptoms decrease, jaundice and dark urine appear from high bilirubin levels, clay stools, hepatomegaly, and pain.
    • Posticteric (convalescent): Jaundice and dark urine subside, stool normalizes, liver enzymes and bilirubin decrease and eventually normalize.

    Acute vs. Chronic Hepatitis

    • Acute: Lasting less than 6 months, usually self-limiting.
    • Chronic: Lasting over 6 months, liver deteriorates over time leading to cirrhosis, liver cancer, or liver failure.

    Hepatitis - Brief Overview

    • 0 - 1: Hepatitis Infection
    • 1 - 2: Targets the Liver
    • 2 - 3: Hepatocytes become inflamed
    • 3 - 4: Hepatocyte lysis
    • 0 - 5: Contents of hepatocytes released into the blood
    • 5 - 6: Increased ALT & AST

    Hepatitis A and E

    • Acute only, not chronic.
    • Contracted through oral-fecal route.
    • Risk factors: Ingesting contaminated food/water (especially shellfish), contact with infected stool (poor hygiene), crowded conditions.
    • Medications: Hep A vaccine (pre or post-exposure), immunoglobulin within 2 weeks post-exposure.
    • Pathophysiology (Hep A & E): Ingested, travels through digestive system; absorbed through portal vein; binds to hepatocytes, enters through endocytosis.

    Chronic Hepatitis B, C, and D

    • Hepatitis B, C, and D can become chronic.
    • Contracted via blood and bodily fluids.
      • Risk Factors: unprotected sex, contact with blood, substance use disorder, birth, tattoos, hemodialysis, unscreened blood.
    • Medications: Interferons (Hep C), Hep B Immunoglobulin (within 24 hours of potential exposure)
    • Hepatitis D cannot occur without Hepatitis B.

    Carrier State

    • Hepatitis B and C can exist in a carrier state, meaning the infected person is often asymptomatic.

    Hep B

    • 10x more infectious than Hep C.
    • 100x more infectious than HIV.
    • Vaccine available.

    Hep B & Birth

    • High risk of transmission from mother to baby.
    • Babies have a 90% chance of developing chronic Hep B.
    • Precaution: If mother is confirmed/suspected of having Hepatitis B, immunoglobulin given to the infant within 12 hours of birth.

    Hepatitis C

    • Growing concern, Nova Scotia reported 274 cases in 2021.
    • 27.6 cases per 100,000 people.
    • Curable with Direct-Acting Antivirals (DAAs).
    • 44% of people with Hep C unaware they have it.

    Fulminant Hepatitis

    • Rare, life-threatening complication.
    • Severe liver failure over hours to days.

    Acute Hepatitis Symptoms

    • Malaise (flu-like): Nausea, vomiting, diarrhea, low appetite, low-grade fever.
    • Clay stools (lack of bilirubin).
    • Dark urine.
    • Jaundice.
    • RUQ tenderness.
    • Hepatomegaly.

    Hepatitis Stages

    • Incubation (asymptomatic): Aperiodical time.
    • Acute Infection: 4-12 weeks of infection, malaise, fever, joint pain.
    • Preicteric/Prodromal: Vague flu-like symptoms.
    • Icteric: Jaundice, dark urine, clay stools, pain, hepatomegaly.
    • Posticteric/Convalescent: Jaundice subsides, stool normalizes, liver enzymes decrease, recovery.
    • Chronic Infection: Long-term infection potentially leading to complications like cirrhosis, liver failure, or hepatic cancer.
    • Fulminant Infection: Severe, life-threatening complication; liver failure occurs over hours or days.
    • Carrier State: Asymptomatic chronic infection.

    Serology for Viral Hepatitis

    • Hep A: Anti-HAV IgM (active), Anti-HAV IgG (recovered).
    • Hep B: HBsAg (surface antigen, infectious), Anti-HBs IgG (recovered/immune).
    • Hep C: Anti-HCV (antibodies), HCV RNA (in active infection).
    • Hep D: HDAg (hepatitis D antigen), Anti-HDV.
    • Hep E: Anti-HEV.

    Hep B Serology Table (Results)

    • Results for HBsAg, Anti-HBs and Anti-HBc.

    Labs to Watch in Hepatitis

    • AST
    • ALT
    • Bilirubin
    • Antibodies

    Liver Biopsy

    • Used to assess extent of liver damage.
    • A small piece of liver tissue is removed and examined.
    • Teach right-side lying to prevent post-procedure bleeding.

    Diet

    • High carbohydrates, high calories, low protein, low fat.

    Patient Teaching

    • Handwashing, personal hygiene products, activity restrictions, avoiding toxins, individual bathroom, testing, interferon, small, frequent meals.

    Cirrhosis

    • End-stage liver fibrosis.
    • Caused by chronic hepatitis (specifically B and C).

    Cirrhosis Stages

    • Healthy liver, fatty liver, liver fibrosis, cirrhosis, and potential complications such as hepatocellular carcinoma.

    Portal Hypertension

    • Portal vein narrows due to scar tissue.
    • Increased pressure, fluid shifts to peritoneal spaces, splenomegaly, varices.

    Esophageal Varices

    • Enlarged, thinned esophageal veins due to portal hypertension.
    • Risk of rupture, leading to fatal shock.

    Ascites

    • Fluid buildup in peritoneal cavity caused by portal hypertension and low albumin.

    Hepatic Encephalopathy

    • Liver cannot detoxify.
    • Ammonia buildup; ammonia crosses blood-brain barrier.
    • Alerted level of consciousness (LOC), asterixis (involuntary hand-flapping).

    Liver and Estrogen

    • Liver produces small amounts of estrogen; estrogen is fat-soluble.
    • Impaired liver functions can lead to high estrogen levels.
    • High estrogen levels can cause gynecomastia, spider angiomas, and palmar erythema.

    Hepatorenal Syndrome

    • Progressive renal failure associated with hepatic failure.
    • Sudden decrease in urine output, elevated BUN and creatinine (think AKI).

    Late Stage Cirrhosis Symptoms

    • Tremors, musty breath (Foetor), yellowing of eyes and skin, loss of appetite, increased bilirubin, varices, edema, reduced platelets, itchy skin, spider angiomas, splenomegaly, confusion/coma, ascites, palmar erythema, renal failure, and enlarged breasts (in men).

    Monitor Diet & Lifestyle (Cirrhosis)

    • Same as hepatitis diet (low protein, low fat, high carb, high calories).
    • Vitamin & mineral supplements (multivitamins, folate, thiamine).
    • Monitor glucose closely to assess for hypo/hyperglycemia
    • Low sodium (edema).
    • Avoid alcohol.

    Labs to Watch in Cirrhosis

    • High AST
    • High ALT
    • High Bilirubin
    • Low Albumin & Calcium
    • Low Platelets (thrombocytopenia).
    • High PT, PTT, INR

    Treatment Options (Cirrhosis)

    • Shunting Surgery (TIPS): Minimally invasive shunt creates a new channel to bypass the liver and reduce portal pressure.
    • Endoscopic Variceal Ligation: Varices are sclerosed or banded with small rubber bands to prevent bleeding and shrinkage.

    Liver Transplant

    • Very strict protocols.
    • Living or deceased donor.
    • Not a candidate if severe cardiac/resp disease, metastatic cancer, or ETOH/substance abuse.
    • Acute graft rejection within 4-10 days after surgery.

    Paracentesis

    • Draining fluid from ascites.
    • Prior to procedure: Ensure bladder is empty.
    • Take vital signs; monitor blood pressure.
    • Measure abdominal circumference, daily weight.
    • Drain according to orders (usually no more than 1L/day).
    • Maintain high fowlers position to promote fluid drainage and breathing.

    Pharmacology (Cirrhosis)

    • Beta blockers & nitrates: Portal HTN and varices.
    • Vitamin K: Clotting factors.
    • Lactulose: Decreases ammonia levels through stool. Monitor for hypokalemia.
    • Diuretics: Decrease fluid buildup.
    • Albumin: Helps with ascites and edema.

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    Description

    This quiz explores essential aspects of liver functions, focusing on conditions like hepatitis and cirrhosis. Delve into the roles of the liver in metabolism, detoxification, and the production of critical substances like albumin and bile.

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