Term
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Definition
chronic, progressive disease of liver
develops insidiously
widespread fibrosis "scarring" |
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Term
| for biopsy, when do you insert the needle and how are you lying |
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Definition
| on side, insert needle on exhale |
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Term
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Definition
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Term
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Definition
| necrosis after viral hepatitis |
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Term
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Definition
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Term
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Definition
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Term
| etiology unknown cirrhosis |
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Definition
| sad--->don't know how to treat :( :( :( |
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Term
| pathophysiology of cirrhosis |
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Definition
cell necrosis occurs and scar tissue replaces liver cells
this impedes normal blood flow decreases function |
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Term
| complications of cirrhosis |
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Definition
portal HTN with bleeding varices
ascites
hepatic encephalopathy |
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Term
| ascities with cadput medusae |
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Definition
| excess fluid in abdomen with distended and engored umbilical veins complication of cirrhosis |
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Term
| name 2 complications of cirrhosis |
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Definition
| ascites with caput medusa and asterixis |
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Term
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Definition
| tremor of hand when wrist is extended; bird flapping wings |
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Term
| definitive test for cirrhosis |
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Definition
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Term
| tests performed before liver biopsy |
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Definition
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Term
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Definition
turn on right side pressure stops bleeding
vs q 10-15 min avoid heaving lifting
avoid coughing, straining |
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Term
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Definition
risk for bleeing d/t bleeding tendencies
altered nutrtion d/t decreased absorption of fat vitamins
risk for ijury d/t toxins |
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Term
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Definition
treat underlying cause
diet, rest, vitamins, steroids
protect liver avoid Tylenol
control complications |
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Term
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Definition
backflow to other spaces
think PORTAL PRESSURE AND CONGESTION
increased resistance to blood flow thru liver; blood goes around high pressure areas |
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Term
| what does portal HTN cause and why is it bad? |
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Definition
| splenomegaly blood backs up in spleen which destroys RBC and platelet, increasing hemorrhage risk and anemia |
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Term
| what else does portal HTN do? |
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Definition
| dilates veins in stomach, esophagus, intestines, abdomen, and rectum causes ascites, esophageal varices, caput medusa, hemorrhoids |
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Term
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Definition
| swollen, blood engorged distended veins in esophagus |
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Term
| what causes variceal rupture? |
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Definition
portal pressure
increased pressure from coughing, nose blowing, vomiting, straiing with stools, lifting
food irritation or ETOH (rough,spicy,chips)
erosion by gastric juices |
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Term
| meds to prevent erosion by gastric juices |
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Definition
| PPI, H2 blockers, melena, hematemesis |
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Term
|
Definition
| black tarry feces gi bleeding |
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Term
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Definition
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Term
| what is a medical emergency related to varices |
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Definition
RUPTURE OF VARICES
50% MORTALITY on first bleed
control hemorrhage and replace fluids |
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Term
| medicines used to treat/prevent bleeding varices |
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Definition
| vasopressin, beta blockers |
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Term
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Definition
| scleroing agent injected into vein (vasopressin,epi) causes inflammation- |
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Term
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Definition
| chest pain, ulceraetion, perforation |
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Term
| important consideration for sclerotherapy |
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Definition
| do not insert NGT tube after thi |
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Term
|
Definition
esophageal ballon compresses the esophagus
stomach balloon COMPRESSES BLEEDS in stomach and anchors |
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Term
| tpes of balloon tamponade |
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Definition
| Minnesota tube and sengstaken Blakemore tube |
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Term
|
Definition
| scissors are kept at beside in case ballon migrates upward or stomach balloon rupture...EMERGENCY AIRWAY OBSTRUCTION |
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Term
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Definition
| potent vasoconstrictor constricts areterioles decreasing portal pressure and blood flow |
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Term
| vasopressin can precipitate |
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Definition
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Term
| what do you give iv with vasopressin and why? |
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Definition
| nitroglycerin;prevent coronary artery constriction |
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Term
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Definition
| long term therapy to decrease portal pressure |
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Term
| how do beta blockres work? |
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Definition
| decrease CO which decreases portal pressure and reduces bleeding BUT decreases HR, BP, and may maks signs of hypoglycemia |
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Term
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Definition
uses bands to ligate the bleeding varice
may be used prophylactically |
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Term
|
Definition
Transjugular
Intrahepatic
Portal systemic
Shunt |
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Term
|
Definition
| enter R juluar insert stend into hepatic and portal veins to shunt blood AROUND THE CONGESTED LIVER therefore decreasing portal pressure and risk for bleeding |
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Term
| bad effect of TIPS procedure |
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Definition
| ammonia levels increase because blood is absorbed but not filtered |
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Term
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Definition
| surgical procedure to decrease gut blood flow to liver and decrease pressure; gets rid of load on heart |
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Term
| portal-systemic shunts have a .... |
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Definition
| high mortality rate now do transplants instead |
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Term
| differen types of portal systemic shunts |
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Definition
portocaval into vena cava
warren shunt-aka splenorenal-around spleen/kidney |
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Term
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Definition
| portal HTN and low colloidal pressure, reduced circulatory volume, aldosterone production but not biotransfrmed vicous cycle...pure plasma in peritoneal cavity |
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Term
|
Definition
increased girth
fluid wave when tapped
increased weight
idry tongue, skin, sunken eyes
decreased potassium |
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Term
| tell tale assessment for ascites |
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Definition
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Term
|
Definition
| respiratory distress from pressure |
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Term
| what position for ascites? |
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Definition
| high fowler to relieve pressure |
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Term
| asses for what with ascites |
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Definition
| atelectasis and pneumonia |
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Term
|
Definition
low sodium 250-500 salted butter, canned/frozen foods bad
fluid restrictions 1000-1500 mL to reverse fluid overload give meds with meals
VITAMIN SUPP liver can't store usually IV |
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Term
|
Definition
diuretics
albumin to pull fluid off
antacids for GI symptoms
potassium supplemenets may be needed |
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Term
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Definition
| spironolactone k sparing diuretic |
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Term
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Definition
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Term
| if diet and meds do not work for ascites, do what? |
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Definition
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Term
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Definition
| relieve pressure that cause respiratory compromise and abdominal distress |
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Term
| risk associated with paracentesis |
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Definition
| FVD, vasodilation, shock, protein depletion |
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Term
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Definition
| maintain BP, look @ fluid, IV fluids, monitor S, |
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Term
|
Definition
| tachycardia, decreasedBP, loss of na, change in loc, encepholopathy |
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Term
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Definition
| surgical mgmt. for ascites. shunts fluid from peritoneum back to superior vena cava to be removed by kidney |
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Term
|
Definition
| surgical mgmt. for ascites. manual pump that the pt uses |
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Term
| complications of surgical shunts |
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Definition
| CHF, DIC, shunt clotting, infection |
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Term
|
Definition
elevations of ammonia, toxins,
liver cant convert ammonia to urea=toxin |
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Term
|
Definition
bacteria in GI tract, breakdown of blood/food
tissue metabolism
kidneys create ammonia with hypok
shunting of blood from TIPS or portal systemic shunts |
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Term
| factors precipitating encephalopathy |
|
Definition
| hemorrhage, constipation (bacteria), hypok, infection, uremia, diuretics, dehydration |
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Term
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Definition
| urea in the blood, should be in the urine |
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Term
| progression of hepatic encephalopathy |
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Definition
prodromal=subtle
impending=disorientation,asterixis
stuporous=abn ekg, muscle twitching, hyperflexia, asterix
comatose-no asterixis, muscle rigid, pos babinsky |
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Term
| stage iv comatose hepatic encephalopathy |
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Definition
| pos Babinski, fetor hepaticus, seizures, death |
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Term
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Definition
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Term
| goal of medical mgmt. of hepatic encephalopathy |
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Definition
| sustain quality of life and decrease ammonia levels |
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Term
| diet mgmt. for hepatic encepholopathy |
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Definition
| reduce protein long term low protein |
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Term
| if mental status deteriorates in hepatic encepholopathy |
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Definition
| protein may be totally eliminated. only have carbs (fruit juice) and iv fluids |
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Term
|
Definition
| toast, cereal, rice, hard candy, tea, protein free formulas |
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Term
| meds given to reduce bacterial reduction of ammonia |
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Definition
| neomycin sulfate, stool softeners, lactulose |
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Term
|
Definition
| destroys bacteria dimishing protein and amomonia |
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Term
| stool softeners prevent.. |
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Definition
| retained stools and retained bacteria |
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Term
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Definition
| promotes escretion of ammonia in the stool causes colon to be acidic |
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Term
| things to prevent in hepatic encepholopathy |
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Definition
gi bleed dumps protein in gun= more ammonia
infection=catabolism=ammonia |
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Term
|
Definition
| localized collection of pus and organisms in the parenchyma of liver |
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Term
| etiologies of liver abscesses |
|
Definition
bacterial cholangitis =obstruction
portal vein bactermia
amebiasis=ameba infestations |
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Term
| treatment for liver abscesses |
|
Definition
antibiotics no drainage for few mo.
percutaneous drainage with abt
surgical drainage with post op abt
right pleural effusion |
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Term
| biggest thing with liver abscesses |
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Definition
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Term
|
Definition
|
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Term
| most common liver neoplasms |
|
Definition
| metastatic hepatic tumors |
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|
Term
| liver is a common site for... |
|
Definition
|
|
Term
| one of most common tumors worldwide |
|
Definition
| primary hepatocellular carcinoma |
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|
Term
| primary hepatocellular carcinoma |
|
Definition
| previous liver disease cirrhosis poor prognosis |
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Term
| treatment for malignant tumors |
|
Definition
| surgical resection of of the tumor |
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Term
|
Definition
| women 20-30, increased d/t BC |
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Term
|
Definition
| rupture and hemorrhage but excellent prognosis if removed prior |
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Term
| do nots with benign tumors |
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Definition
| dc contraceptives/ do not perform biopsies |
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