Liver Problems Care PDF

Care of Patients with Liver Problems By Dr. Angela Banks, RN, PhD Cirrhosis of the Liver Scarring of the liver Major cause of Cirrhosis in USA a. Chronic Alcoholism b. Hepatitis C Major cause in ot...

Care of Patients with Liver Problems By Dr. Angela Banks, RN, PhD Cirrhosis of the Liver Scarring of the liver Major cause of Cirrhosis in USA a. Chronic Alcoholism b. Hepatitis C Major cause in other countries a. Hepatitis B b. Hepatitis D Pathophysiology of Cirrhosis  Types of Liver Cirrhosis Laennec’s or alcoholic Cirrhosis Post necrotic Cirrhosis Biliary Cirrhosis Cardiac Cirrhosis  Complications of Cirrhosis Portal Hypertension Bleeding Esophageal Varies Jaundice is a complication of cirrhosis and is describes as a yellow discoloration of the skin Two Mechanisms a. Hepatocellular Disease b. Intrahepatic Obstruction  Ascites Collection of fluid in the peritoneal cavity caused by: Decreased circulating plasma protein Decreased albumin production Decreased colloid osmotic pressure Fluid shift from the vascular system to the abdomen Results in a form of 3rd spacing  Esophageal Varices Affects 50% of patients with cirrhosis a. Hematemesis-vomiting blood b. Melena - black tarry stools 30% will hemorrhage within 2 years of diagnosis Mortality rate 50% for those that hemorrhage Treatment for Esophageal Varices Fluid Resuscitation Blood transfusions Platelets a. Normal 150,000-450,000 b. 95- 98% cure rate B. Harvoni- 12 weeks> 97-99% cure rate Cost $26,000 month x 3 months=$78,000 Generic Version is 10,000/month Copay-$9,600, insurance pays $300.00 Hepatitis D Requires the presence of HBV to replicate Transmitted by blood Clinical course more severe compared to other viruses Hepatitis E One of the most common causes of acute hepatitis Waterborne Prevalent in Asia, Africa, Middle East, South and Central America  Cancer of the Liver Early stage is without symptoms Later in the disease a. Weight loss b. Anorexia c. Weakness d. RUQ pain e. Jaundice f. Bleeding  Treatment of Liver Cancer Surgical Intervention Radiation Therapy is not an option Chemotherapy Transplantation Liver Transplantation Best Candidates for Transplantation End Stage Liver Disease Primary Liver Cancer Patients not Considered for Transplantation Active alcoholics or substance abuse Metastatic Tumors  Post Transplantation Common complications Graft rejection and infection Immunosuppressant therapy a. Cyclosporine - Hypertension and renal insufficiency b. Tacrolimus - Hypertension and renal insufficiency Steroids Prednisone – Hypertension and hyperglycemia Vaccinations and antibiotics c. COVID-19 vaccination before transplantation d. Antibiotics should be administered postoperatively if infections develops