F21 Liver Disease Student PDF

10/17/2021 LIVER DISEASE Hepatitis Cirrhosis Hepatocellular carcinoma NOF: PCC, EBP, SBP, T/C Kerry...

10/17/2021 LIVER DISEASE Hepatitis Cirrhosis Hepatocellular carcinoma NOF: PCC, EBP, SBP, T/C Kerry Sorrentino, MSN, RN 1 2 Liver Largest internal organ Where is it located? 4 lobes; functional unit is lobule Blood circulated to the liver from the stomach, intestines, spleen and pancreas Responsible for metabolism, storage, detoxification, bile production and synthesizes proteins 3 1  10/17/2021 https://ib.bioninja.com.au/options/option-d-human-physiology/d3-functions-of-the-liver/liver-structure.html 4 Hepatitis Inflammation of the liver Causes Viral (A, B, C, D, E) https://www.cdc.gov/hepatitis/hev/inde x.htm Drugs Chemicals Autoimmune Metabolic (Fe, Cu) Pathophysiology Destruction of hepatocytes leads to liver dysfunction Coagulation, bile, protein and glucose metabolism Acute Liver cells can regenerate after resolution of infection Infection → chronic inflammation→ fibrosis and cirrhosis Chronic Infection 2  10/17/2021 Hepatitis A Virus (HAV) Acute Fecal-oral Contaminated food or drinking water Poor hygiene/conditions, improper food handling, persons with subclinical infections May be transmitted through oral sex if contact with fecal material Primary Prevention Role of the Community Health Nurse 8 9 3  10/17/2021 Hepatitis B Virus (HBV) Acute/chronic Childhood infection carries risk for developing chronic disease→ chronic disease increases risk of HCC Blood and bodily fluids Infants born to infected mothers Percutaneously: IV drug use, needle-stick Exposure to infectious blood, blood products, or other body fluids (semen, vaginal fluids, saliva) Primary Prevention Hepatitis C Virus (HCV) Acute/Chronic Approx 85% of people with acute HCV develop chronic disease Leading cause of hepatocellular carcinoma Blood and bodily fluids IVDA High-risk sexual behaviors Occupational exposure/tattoo equipment Hemodialysis Perinatal exposure Blood transfusions before 1992 4  10/17/2021 Labs/Diagnostic Studies Liver Function Tests (LFTs) Acute Hepatitis Panel (A, B, C) Detects antibodies, virus or viral load Genotype testing for chronic HBV and HCV: HBV; A-J HCV; 6 genotypes Liver biopsy/Fibroscan Assess fibrosis/cirrhosis Liver Function Tests (LFTs) ALT Enzyme in the liver 7-55 IU/L AST Enzyme in the liver, heart, 10-32 IU/L muscle, kidney and brain Alkaline Phosphatase Enzyme in the bile ducts, 45-115 IU/L bones, intestines and placenta Albumin Protein made in liver; 3.5-5 g/dL Affected by liver and kidney function PT Protein made in the liver 11.0-13.7 seconds for blood clotting Bilirubin Byproduct of RBC Indirect (Unconjugated) breakdown Direct (Conjugated) 14 Clinical Manifestations: Hepatitis Malaise Weight loss Fatigue Abdominal pain Nausea/vomiting/anorexia Low grade fever Jaundice Pruritis Light-colored stools Dark-colored urine Change in reaction to foods, smells, cigarettes 5  10/17/2021 Jaundice http://phil.cdc.gov/phil_images/20030110/28/PHIL_2860_lores.jpg 16 Acute Hepatitis Panel https://www.google.com/search?q=abnormal+liver+function+test+results&espv=2&biw =1295&bih=982&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj98JzHmZLQAhVj2IM KHTXnAw4Q_AUIBygC#imgrc=XiH4fHxvpEp_eM%3A 17 HEPATITIS B 18 6  10/17/2021 Hepatitis Antibodies Specific antibody for each type of viral hepatitis IgM antibodies signal acute infection IgG antibodies signal recovery or vaccination* HAV IgM , HAV IgG HBsAg, HBcIgM, HBsAb ❖ HBV DNA quantitative test (viral load) HCVAb** ❖ HCV RNA quantitative test: detects amount of Hep C virus to confirm infection Nursing Care: Acute/Chronic Hepatitis Vitamin A, D, E, & K Well Balanced Diet Supplements Avoid ETOH & Certain Rest Periods Drugs Skincare & Contact notification/precautions 20 Drug Therapy: Chronic Hepatitis B Interferon Injections -PEG Flu-like symptoms; mood changes; neutropenia, thrombocytopenia Combination therapy Oral antiviral & interferon Synergistic activity Nucleoside and nucleotide analogs Oral Rx Reduce viral load; decrease liver damage and liver enzymes Oral, long term treatment Lamivudine, entecavir; tenofovir 21 7  10/17/2021 Drug Therapy: Chronic Hepatitis C Goals: Eradicate virus Preventing disease progression and decreasing mortality Drug regimen: genotype, cirrhosis, potential side effects, co-morbid conditions, compliance, previous treatment Combo therapy with pegylated inteferons and Ribavirin gold standard www.hcvguidelines.org 22 Direct Acting Antivirals Block the virus’s ability to replicate and infect cells Responsible for “curing” Hepatitis C Sustained virological response (SVR) Virus is undetectable 12 weeks after completing treatment Combination antiviral treatments available in one tablet Approximately $1000/tablet depending on regimen 23 Health Promotion/Disease Prevention Hepatitis A Hepatitis B Hepatitis C Infection Infection Secondary control, control, do not prevention hygiene; share (born between sanitation toothbrushes or 1945-65) Vaccination; razors, condoms Infection high-risk Vaccination; control, individuals high-risk education PrEP (travel), individuals similar to Hep B PEP PEP: HBIG (ideally within 24 hours) and vaccine 24 8  10/17/2021 Complications of Hepatitis Acute liver failure (fulminant hepatitis) (Hepatic encephalopathy) Chronic hepatitis HBV; HBC Cirrhosis Liver Cancer https://www.bing.com/images/search?view=detailV2&ccid=nzyuYG7E&id=8DA9323AD40A7F66E5093A5F02A24D5F9FEDC129&thid=OIP.nzy 26 uYG7ElXU7dT8kfkKm5wHaFk&mediaurl=http%3a%2f%2fwww.studypk.com%2fwp-content%2fuploads%2f2015%2f02%2fMnemonics- Hepatitis.jpg&exph=1202&expw=1600&q=hep+b+virus&simid=608024945820107833&selectedIndex=261&ajaxhist=0 CIRRHOSIS 27 9  10/17/2021 Cirrhosis Chronic, progressive liver disease Scar tissue replaces healthy tissue Irregular shaped and sized lobules with obstructed blood flow Biliary; Cardiac 29 Cirrhosis 1 in 400 adults in US aged 45-54 (NIDDK) Men Most Common Causes: Chronic ETOH Hepatitis C NAFLD (NASH) Chronic Hepatitis B 30 10  10/17/2021 Clinical Manifestations: Cirrhosis Early (compensated): Asymptomatic Fatigue, anorexia, weight loss, nausea Late (decompensated): Ascites, spontaneous bacterial peritonitis (SBP) Portal hypertension, varices Hepatic encephalopathy Coagulopathy Hepato-renal syndrome Splenomegaly Palmar Erythema 31 https://www.pinterest.com/pin/349732727283708960/ 32 http://dermaamin.com/site/images/clinical-pic/s/spider-naevi/spider naevi1.jpg 11  10/17/2021 Caput Medusae http://images.radiopaedia.org/images/3324841/5aa0f0d73e1d24fbd1f 22028f6d00d_big_gallery.jpg http://dermnetnz.org/reactions/img/w/palmar-erythema01.jpg Labs/Diagnostic Studies: Cirrhosis Liver Function Tests Albumin CBC, PT/INR Ammonia Ultrasound Liver Biopsy 12  10/17/2021 http://www.floridavascular.com/images/dynamic/ACF57D.jpg 37 Portal Hypertension Increased pressure in the portal vein→ blood backs up, collateral circulation develops, and fluid leaks into peritoneum Splenomegaly; Ascites; Varices Splenomegaly leads to thrombocytopenia Ascites Esophageal varices bleed easily; may be life- threatening Paracentesis; propanolol; nitrates 38 https://www.bing.com/images/s earch?view=detailV2&ccid=fIqA zNc2&id=801858E3519A6F5A1 EC78548AC83213DCBA57CD1 &thid=OIP.fIqAzNc2lQyA51Med 4VVPwEsCO&q=ascites&simid =608034759496436461&select edIndex=19&ajaxhist=0 39 https://www.bing.com/images/search?view=detailV2&ccid=l4VY%2frjs&id=0AE06CD45E633BB9AFDE4F1467B984B64D96556 D&thid=OIP.l4VY_rjsLSP0_wb8FM304gEsEK&q=ascites&simid=607991857064840960&selectedIndex=34&ajaxhist=0 13  10/17/2021 Esophageal Varices http://www.mdguidelines.com/images/Illustrations/esoph_va.jpg https://proceduresconsult.jp/UploadedImages/pcj_0185_00002206_10 40 0000_large_11022011110002.jpg 41 TIPS _hF3234 https://www.youtube.com/watch?v=O2u4_hF3234 42 14  10/17/2021 Hepatic Encephalopathy Liver is unable to convert ammonia to urea Ammonia is neurotoxic Change in consciousness; inappropriate behavior; sleep disturbances; coma Gradual to acute Stages of hepatic encephalopathy (Table 59.4) Asterixis; fetor hepaticus Lactulose; Rifaximin 43 Nursing Care: Cirrhosis Fluid Neuro Respiratory Skin GI Balance Status 44 Treatment: Cirrhosis Diet: High CHO, low fat and NA Low/Moderate-high protein due to malnutrition* Well-balanced smaller frequent meals Avoid→ ETOH; ASA; NSAIDS, acetaminophen Rest and ambulation as tolerated Medications: Beta-blockers/nitrates Diuretics: ascites Lactulose 45 15  10/17/2021 Surgical Treatment Paracentesis Ligation TIPS 46 Nursing Care: Ambulatory and Home Care Supportive measures Symptoms of complications and when to seek medical attention Written instructions with adequate explanations for patient/family Referral to community or home health nurse 47 HEPATOCELLUAR CARCINOMA 48 16  10/17/2021 Liver Cancer Primary liver cancer Hepatocellular carcinoma arises from the hepatocytes Typically develops from chronic liver disease caused by HBV, HCV, and ETOH Treatment dependent upon: Size and number of tumors Metastasis Age and overall health 49 http://www.comp.hkbu.edu.hk/v1/proj/sre/2017/pc2/images/Image_001.png http://wingsofrelief.org/img/sections/stager/liver_stages.jpg 50 Hepatocellular Carcinoma: Clinical Manifestations Similar to cirrhosis: Abdominal pain Abdominal mass N/V Weight loss Anorexia or early satiety Obstructive jaundice 51 17  10/17/2021 Diagnostic Studies Alpha-fetoprotein (AFP) Tumor marker Also used to determine response to treatment U/S; CT; MRI Liver Bx Typically done if diagnosis uncertain with imaging and for staging 52 Nursing Management Assessments Pain Management Medication Administration Education Supportive care/referrals to patients and families 53 18