NRSG 326 Week 5 - Liver Disease + Cirrhosis

Is a GI bleed an indication for pantoprazole?

Yes

What medications should be held for liver disease?

Acetaminophen, alcohol, isoniazid, sulpha drugs, NSAIDs

Cirrhosis

Fibrosis and conversion of the normal liver architecture into structurally abnormal nodules

Changes in liver function d/t cirrhosis

Decreased hepatic synthetic function, portal hypertension, decreased detox capabilities

Possible causes of cirrhosis

Alcohol use, viral hepatitis, NAFLD

Causes of acute/fulminant liver failure

Acetaminophen, hepatitis, herbal supplements

Causes of chronic liver failure

Hepatitis B or C, NASH, ETOH, autoimmune, primary biliary cholangitis, large bile obstruction

Why do patients with liver failure appear underweight

S/S of liver failure include anorexia, nausea, vomiting and decreased appetite

Portal hypertension and ammonia build up cause nausea and anorexia

Why do patients with liver failure experience drowsiness and slurred speech

Ammonia build up can cause hepatic encephalopathy. Can also be d/t blood loss if pt has bleeding esophageal varices. May also be due to alcohol use if that is applicable to the patient

Why do patients with liver failure experience tremulous hands

Ammonia build up causes hepatic encephalopathy, which can affect motor function

Why do patients with liver failure experience petechiae and reddened palms

Caused by portal hypertension. Changes in synthesis of clotting factors also makes patients more likely to bleed. Alcohol use (if applicable) also makes patients more prone to bleeding

Why do patients with liver failure experience fetor hepaticus

Due to accumulation of ammonia and toxins in the blood

Why do patients with liver failure experience ascites and edema

Due to liver inflammation and lack of albumin causing shift of proteins and fluids into peritoneal space or shift of fluid out of blood vessels in extremities

Why do patients with liver failure experience jaundice and tea coloured urine

Inability to excrete bilirubin, so it accumulates in the blood

Why do patients with liver failure experience spider veins

Related to portal hypertension and hormonal synthesis changes

Why do patients with liver failure have a palpable liver and spleen

Due to hepatomegaly and portal hypertension causing engorged spleen

Ascites

Accumulation of serous fluid in the peritoneal cavity

Due to decompensated cirrhosis, portal hypertension and low albumin

What orders are expected when a pt has albumin

Daily weights, pigtail catheter to drain fluid (slowly), albumin administration, low salt diet

Portal hypertension

Increased pressure in the portal vein, which supplies blood from the intestines/stomach/spleen to the liver

Caused by cirrhosis

Can lead to varices, splenomegaly and ascites

Esophageal banding

Used to treat varices

Rubber band cuts off the blood flow through the vein

Sclerotherapy

Used to treat varices

Injection of a chemical directly into an enlarged vein to create scar tissue and stop blood from passing through the vein

Blakemore tube

Stabilizing procedure for acutely bleeding varices

Compresses gastroesophageal junction and reduces blood flow to varices

Looks like a 3 way foley and is attached to a football helmet

NOT A TREATMENT, used for stabilization only

What percentage of patients will rebleed after a Blakemore tube is deflated

50%

Transjugular intrahepatic portosystemic shunt (TIPS)

Connection of 2 veins in the liver to decreased portal hypertension

Can decreased bleeding from varices and ascites

Not an emergency procedure, only done when pt is stabilized

Why is NPO ordered after a banding procedure

Procedure done in throat, so eating is not recommended until healed

Start off on clear fluids and monitor for bleeding

Why is pantoprazole ordered after a banding procedure

Used for GI bleed prophylaxis, PPI qualities prevent acid from irritating affected area further

Why is octreotide ordered after a banding procedure

Decreases bloodflow to GI, so it can be used to reduce portal hypertension

Why is neomycin ordered after a banding procedure

Prevents infection, reduces ammonia production by decreasing bacteria in GI that cause the conversion

Why is lactulose ordered after a banding procedure

Prevents hepatic encephalopathy by excreting ammonia

Hepatic encephalopathy

Disorder of protein metabolism and excretion

Liver cannot convert ammonia to urea, so it accumulates and crosses the BBB, causing neurotoxic s/s

Asterixis

Characteristic symptom of hepatic encephalopathy

Flapping tremors involving arms and hands

D/t inflammation of brain cells caused by ammonia or other toxins

Contraindications of liver transplant

Extrahepatic disease, malignancy, ongoing drug or ETOH use, inability to comprehend or comply with post-transplant tx

Which population has the highest death rate while waiting for transplant

Indigenous peoples

Which population has the lowest liver transplant rate

Indigenous peoples