| Mortality from Cirrhosis occurs more frequently among | African Americans than other ethnic groups |
| Primary Hepatic cancer has a higher incidence among African Americans, Asian Americans, and Inuit [Eskimos] than | Among White Americans |
| Pancreatic cancer occurs more frequently among | African Americans and Asian Americans than among White Americans |
| The incidence of Cholelithiasis increases with aging; closely observe older adults with histories of this disease for changes in the color of | Urine and stool or other s&s of gallbladder problems |
| As the body ages, the number and size of hepatic cells decrease which results in an overall reduced | Size and weight of the liver
*Liver also has decreased ability to regenerate after injury or from hepatotoxic injury; detoxification of substances is delayed |
| Older adults have a decrease in what? | Protein synthesis in the liver and possible changes in the production of enzymes that assist in the metabolism of drugs, particularly anticonvulsants, psychotropics and oral anticoagulants |
| Be alert to the S&S of drug toxicity because decreased metabolism in the liver can cause | Accumulation of the drugs |
| When does output of Pancreatic secretions steadily decline? | After the age 40 but related problems with absorption cannot be documented |
| The Pancreas exhibits ductal hyperplasia and fibrosis with aging but these changes are not necessarily | Associated with altered functioning |
| Disorders of the Biliary system are common in the US, the two most common conditions are | Cholecystitis [ inflammation of the bladder ]
and
Cholelithiasis [ presence of gallstones in gallbladder
*More commonly seen in women than men
*Native Americans
*White Americans
*African Americans
*Obese ppl, pregnant women,ppl with diabetes or use birth control |
| Cholecystitis can be caused by an obstruction, | Gallstone, Nonfunctioning gallbladder, or tumor |
| The exact stone formation in gallbladder is not known, but altered lipid metabolism and female sex hormones play a | Role in the disease; Stones usually occur in multiples but can occur singly |
| What happens when there is an obstruction caused by gallstones? or a tumor prevents bile from leaving the gallbladder? | The trapped bile acts as an irritant, causing inflammatory cells to infiltrate the gallbladder wall after 3-4 days
*A typical inflammatory response occurs and the gallbladder becomes enlarged and edematous |
| When Cholecystitis disease is severe enough, the gallbladder may become | Gangrenous, rupture, and spread infection to the hepatic duct and liver |
| What are the clinical manifestations with Cholecystitis? | Condition may be acute with sudden onset of indigestion, nausea and vomiting, severe colicky pain in upper right quadrant of the abdomen.
*Pain may be referred to the right shoulder and scapula; pain resulting from Cholecystitis sometimes is mistaken for a cardiac problem because of pain that is felt in epigastric region and radiating to the back |
| If Cholecystitis is chronic, the patient usually has had several milder | Attacks of pain and history of fat intolerance. When gallstones move through the biliary ducts, the patient often complains of pain being intensified |
| Excess formation of gases in the stomach or intestine | Flatulence |
| The pain of acute Cholecystitis is abrupt in onset, reaches peak intensity quickly and remains at that level for | 2 to 4 hrs |
| What kind of symptoms may patients experience with Cholecystitis? | Increased heart and respiratory rates and become diaphoretic [sweaty] leading them to think they are having a heart attack
*These symptoms decrease or are absent in patients with chronic Cholecystitis |
| Stools that contain fat | Steatorrhea |
| What meds are commonly used for pain for the gallbladder disease? | Meperidine [Demerol] and Ketorolac |
| What are Nursing interventions for patient potential for harm or damage to the body related to poor nutrition and prolonged clotting times? | Assist weakened pt with activities
Encourage use of electric razor and soft toothbrush |
| What are Nursing interventions for patient with insufficient nutrition related to anorexia, nausea, vomiting and altered metabolism of nutrients by the liver? | Provide diet high in Carbohydrates and low in fats
Encourage total fluid intake of 2500-3000 mL daily
Monitor I&O and daily weight
Document COCA of stool/urine
Aminister antiemetics as ordered, support and understanding
Promote adequate rest |
| Has become a practical therapeutic option for many people with end stage liver disease, generally improving their quality of life | Liver transplantation |
| What are indications for liver transplantation include? | Congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy [confined to liver], sclerosing cholangitis, and chronic end stage liver disease |
| What is the leading indication for liver transplantation? | Liver disease related to chronic viral hepatitis |
| Liver transplants are not recommended for patients with widespread | Malignant disease |
| Approximately 16,000 pp; waiting for liver transplants at present, only approx | 6000 transplants are performed annually |
| What are major postoperative complications? | Rejection and Infection
*Liver candidates must go through a rigorous presurgery screening
*Liver seems to be less susceptible t rejection than the kidney |
| A live donor only donates a portion of liver to the recipient, within weeks the recipient and the | Donor's liver will grow to the size the body needs
*Donor faces potential risks such as liver and biliary problems, postoperative infection, and common postoperative complications |
| What is the most common complications for the recipient of a liver transplant? | Rejection of the new liver tissue and infection |
| What has been used and been a major factor in improving the success rate of liver transplantation? | Use of Cyclosporine, an effective immunosuppressant drug
*It does not cause bone marrow suppression and does not impede wound healing |
| What other immunosuppressants are used in combination with other immunosuppressive agents to reduce rejection of liver? | Azathioprine [ Imuran ]
Corticosteroids
Tacrolimus [Prograf]
Mycophenolate mofetil [ Cellcept ]
Interleukin 2 receptor antagonists Simulect and Zinbryta |
| Patients who have liver disease secondary to viral hepatitis often experience reinfection of the | Transplanted liver with hepatitis B or C |
| Approx 20% to 30% of patients develop Cirrhosis of the transplanted liver by the | Fifth year posttransplantation
Approx 75% of patients survive more than 5 yrs after transplantation |
| What are the postoperative nursing care for liver transplant? | Assessing neurologic status, monitoring for signs of hemorrhage, preventing pulmonary complications, monitoring drainage, electrolyte levels and urinary output, monitoring S&S of infection and rejection |
| What are common respiratory problems associated with liver transplant? | Pneumonia, Atelectasis [collapsed lung], and pleural effusions
*Patient should use measures such as coughing, deep breathing, incentive spirometry, and repositioning to prevent these complications |
| First 2 months after surgery are critical, and a critical aspect of nursing intervention after liver transplant is | Monitoring for infection
*Fever may be the only sign of infection
*Infection can be viral, fungal or bacterial |
| Care of the patient with viral hepatitis includes | Ensuring rest, maintaining adequate nutrition, providing fluids and caring for the skin |
| What does drug therapy for Chronic hepatitis B focus on? | Decreasing the viral load, decreasing rate of disease progression, and monitoring for detection of drug resistant HBV |
| Drugs that are considered first line treatment for chronic HBV include | Pegylated interferon alfa [PEG-IFN-a], ETV and TDF |
| Combination of PEG-IFN-a, ETV, and TDF therapy eradicates the virus more effectively than | Monotherapy
*Therapy that uses one type of treatment, such as radiation therapy or surgery alone, to treat a certain disease or condition. In drug therapy, monotherapy refers to the use of a single drug to treat a disease or condition. |
| Half of all liver recipients are HCV positive, most transplanted livers eventually become | Infected with HCV but recipients can increase quantity and quality of life by avoiding risky behaviors
*A virus that causes hepatitis (inflammation of the liver). |
| Patient is not allowed alcohol for at least 1 yr and may need supportive care; most patients tolerate | Small frequent meals of low fat high carb diet, if becomes dehydrated, IV fluids are given with addition of:
Vitamin C for healing
Vitamin B to assist damaged liver's inability to absorb fat soluble vitamins
Vitamin K to combat prolonged coagulation time |
| What do you give to people who have been in direct contact with a person with Hepatitis A | Gamma Globulin or Immune Serum Globulin as soon as possible
*during the infectious period [2 weeks before and 1 week after onset of symptoms] |
| A dose of 0.1 to 0.2 mL/kg of body weight, given Intramuscularly is effective in preventing | Hepatitis A in 80% to 90% of cases
*At present, 3 vaccines are used to prevent hepatitis A: Havrix and Vaqta |
| How long do you use Enteric precautions? | 7 days after the onset of Hepatitis A
*Ues standard precautions for all patients |
| Maintaining standard precautions while exposed to blood and body fluids such as saliva, semen, and vaginal secretions is essential to prevent the transmission of | Hepatitis B |
| What helps prevent the spread of Hepatitis A? | Proper personal hygiene, good sanitation, and hep A vaccine |
| What prevents the spread of all bloodborne pathogenic diseases? | Following standard precautions |
| What do primary immunization for Hepatitis A consist of? | A single dose administered intramuscularly in the deltoid muscle
*Booster is recommended between 6 and 12 months after the primary dose to ensure adequate antibody titers and long-term protection |
| How long does the primary immunization for Hep A provide immunity for? | 30 days after a single dose |
| Until routine vaccination of children is feasible, ppl who are at risk for infection should be vaccinated for hep A ppl at risk such as: | People traveling to countries where hep A is endemic
Sexually active homosexual and bisexual men
Patients with chronic liver disease
Injecting drug users
Ppl risk for occupational infection those who work with hep A in research lab settings |
| Individuals who have been exposed to HBV via a needle puncture or sexual contact should be protected with | Hepatitis B Immune Globulin
*A dose is administered intramuscularly as quickly after exposure as possible; dose is repeated 1 month later |
| People identified as being at high risk for developing Hepatitis B should be vaccinated, these ppl include: | All health care personnel
High risk lifestyles drug users, tattoo recipients, homosexual men, prostitutes
Infants born to mothers who test positive for hep B surface antigen
Hemodialysis patients
Individuals sharing household with an infected person |
| Hepatitis B, C, D, and G are all spread through | Blood transfusions
*Blood used should be screened for elevated ALT |
| What does the protection program consist of? | Three vaccines
*Initial vaccination
*Vaccination 1 month later
*Third vaccine 6 months after the first injection
*Hepatitis B vaccine has been shown to provide protection for 3-5 years in approx 90% of the people treated |
| Spreads by direct contact through the oral-fecal route, usually by food or water contaminated with feces. The incidence of infection in the US has decreased significantly because of availability of the hep A vaccine. Ppl traveling outside US should avoid untreated water sources and uncooked food | Hepatitis A |
| Transmitted by contaminated serum via blood transfusion, contaminated needles and instruments, needlesticks, illicit intravenous 'iv drug use, and by direct contact with body fluids form infected ppl such as bresk milk and sexual contact | Hepatitis B
*an ever increasing risk comes from improper disposal of used needles and syringes sharing toothbrushes razor blades or personal items with infected person leads to exposure |
| Transmitted through needlesticks, blood transfusions, illicit IV drug use, and unidentified means. Also can be transmitted by sharing contaminated straws used for snorting cocaine | Hepatitis C HCV
*In the past, hep C could not be detected in banked blood, so it was transmitted more easily through transfusion. The advent of routine blood screening in 1992 greatly reduced the number of cases of transfusion related hep C |
