Week 4: Cirrhosis and Acute Liver Injury

What is Cirrhosis also known as?

End-stage liver disease

What is cirrhosis?

Scarring or fibrosis that prevents the liver cells from doing their job

What is fibrosis?

Liver tissue becomes replaced by scar tissue

How can Hepatitis cause cirrhosis?

Virus invades and attacks the liver cells causing decreased liver function and scarring

What are causes of cirrhosis (end-stage liver disease)?

Hepatitis virus, heavy alcohol consumption, increased fat collection of the liver (obesity, hyperlipidemia, diabetes), bile duct problems, autoimmune problems

What are early manifestations for cirrhosis?

often asymptomatic, normal liver enzymes, fatigue, enlarged liver; diagnosis usually made later when more s/s are present

What is portal hypertension?

HTN of the portal vein that supplies most of the blood to the liver; causes most of the s/s

What are some of the s/s that are caused by portal hypertension and are seen in end-stage cirrhosis patients?

Esophageal varices, enlargement of the spleen (splenomegaly), rectal varices, spider angioma, caput medusae

What is transjuglar intrahepatic portal-systemic shunt (TIPS)?

Non-surgical procedure used to control long-term ascites and reduce variceal bleeding

Why can ascites be a concern?

The weight of the extra fluid can impact breathing

What are ways to help manage ascites?

Low sodium diet, diuretics, paracentesis

What are important things to do before a paracentesis procedure for ascites?

Informed consent, baseline VS, void beforehand to shrink the bladder (don’t want to hit it with aspiration needle), position in supine or high-fowlers

How are varices caused by portal hypertension managed?

Avoid alcohol and NSAIDs, bleeding precautions, beta blocker, octreotide (vasoconstricts vessels to limit bleeding), vasopressin

What are procedures that help to manage portal hypertension?

Endoscopic band ligation (prophylactic), balloon tamponade (during active bleeding), TIPS

What are bleeding precautions?

Monitor platelets, assess oral cavity, monitor for purapura/petechiae, protect from falls, NO aspirin/alcohol/spicy foods/ no injections, avoid blowing nose, avoid straining with BM, stool softeners, soft toothbrush, avoid rectal temps or enemas, apply pressure to any bleeding for 5+min, patient teaching

What is variceal bleeding?

A medical emergency; goal is to stabilize and maintain airway, IV therapy and blood transfusion, identify bleeding source and stop it

What is hepatic encephalopathy?

Reversible neuropsychiatric manifestation of impaired liver function primarily caused by excessive serum ammonia (normally converted to urea) crossing the blood brain barrier

What are the main goals of managing hepatic encephalopathy?

Reduce ammonia and maintain safe environment

What are nursing interventions for hepatic encephalopathy?

Increased calorie diet, control GI bleeding, avoid constipation, Lactulose and neomycin, assess EMV, safety precautions, teaching

What is asterixis?

Sign of ammonia build-up; when you hold your arms out the hands flap downward or tremor

What are nursing interventions for cirrhosis?

High calorie/carbohydrate diet, low fat and salt diet, promote rest, manage fluid imbalance, measure abd girth, diuretics, fluid restriction, IV albumin (given before paracentesis

Where do you measure abdominal girth?

At the level of the umbilicus

What is acute liver injury?

Rapid onset of severe liver dysfunction in someone with no hx of liver disease

What is the most common cause of acute liver injury?

Medications: acetaminophen, sulfa-containing drugs, and anticonvulsants

What are the most common causes of death related to acute liver injury?

Cerebral edema, cerebellar herniation, brainstem compression

What is the goal of treatment for acute liver injury?

Management of cerebral edema and liver transplant is needed

What are s/s of acute liver injury?

Similar to cirrhosis but rapid onset: jaundice, coagulation abnormalities, and encephalopathy, changes in cognitive function, high serum bilirubin, prolonged PT time, very high liver enzymes, hypoglycemia

What are nursing interventions for a patient with acute liver injury?

Transfer to ICU and evaluation for liver transplant, monitor for signs of renal failure, maintain adequate fluid balance, frequent neuro evals, HOB @30 degrees, avoid excessive pt stimulation, assess LOC regularly, avoid any use of sedatives

What are signs of renal failure that a nurse needs to watch out for?

Dehydration, hepatorenal syndrome, or acute tubular necrosis