| Transmitted in the same way as hepatitis B; it appears as a coinfection with hep B | Hepatitis D |
| Transmitted by the oral fecal route; it spreads through the fecal contamination of water | Hepatitis E |
| Is seen frequently as a coinfection with hep C; it spreads through bloodborne exposure. Has been found in some blood donors and can be transmitted by transfusion | Hepatitis G
*Transmission occurs through contaminated injectable drugs; contaminated blood, organs, or tissues; or unsafe methods of tattooing or body piercing |
| The 5 yr survival rate for liver cancer depends on what? | Extent of cancer when diagnosed, localized liver cancer survival rate is approx 31% |
| Rarely hepatitis is caused by bacteria such as | Streptococci, Salmonellae, or Escherichia Coli |
| Involves the liver and nearby lymph nodes and organs 5 year survival rate 11% | Regional stage liver cancer |
| Metastases to distant organs or tissues, 5 yr survival rate is 3% | Distant liver cancer |
| What is the 5 yr survival rate for liver cancer detected early and patient has had a liver transplant? | 60%-70% |
| Formerly called infectious hepatitis is the most common form today and is a short incubation virus [10-14 days] | Hepatitis A |
| Formerly called serum hepatitis a long incubation virus [28-160 days] | Hepatitis B |
| Has an incubation period of 2 weeks to 6 months commonly 6-9 weeks | Hepatitis C |
| Also called delta virus only occurs in people infected with hep B and may progress to Cirrhosis and Chronic Hepatitis. Incubation is 2 to 10 weeks | Hepatitis D |
| Also called enteric non A non B hepatitis transmitted through fecal contamination of water, primarily in developing countries, it is rare in the US the incubation period is 15 to 64 days | Hepatitis E |
| A little known strain that infects only 2% to 5% of the population. It frequently coexists with other hep viruses such as hep C | Hepatitis G |
| Patient with Cirrhosis of the liver, you want to evaluate | Percentage of meals being eaten, weight loss, how patient responds to care, keeping pt as comfortable as possible is the goal |
| What does the American Cancer Society ACS estimate that primary liver cancer will be diagnose? | In more than 40,000 ppl in the year 2017 more than 29,000 men and more than 11,000 women
*Newly diagnosed cases is estimated that almost 30,000 will die from the disease |
| What is the type of primary liver cancer seen the most? | Frequently, Hepatocellular Carcinoma; the other primary tumors are Cholangiomas or Biliary duct Carcinomas |
| What are the high risk factors for primary liver cancer? | Cirrhosis of the liver and infection with either Hep C or Hep B |
| Since 1980, incidence of liver cancer has more than tripled, the increase in cases of primary liver cancer stems from the | Increased incidence of Hep B |
| More than 4 mill ppl in US are infected with Hep B or Hep C and risk factors such as | Increasing age, obesity, type 2 diabetes, male gender, Cirrhosis, and hepatotoxins are some factors tied to liver cancer |
| Most patients with Cirrhosis require what kind of diet? | Well balanced, moderate, high protein, high carb diet with adequate vitamins
*Impending liver failure, protein and fluids are restricted, sodium restriction is frequently necessary which can make providing a palatable diet more difficult; Provide frequent oral hygiene and a pleasant environment to help patient increase food intake |
| Because of pruritus, malnutrition, and edema, what are patients with Cirrhosis prone to having? | Skin lesions and pressure sores
*Initiate preventative nursing interventions to avoid impairment of skin integrity such as alternating pressure air mattress, frequent turning, and back rubs |
| What must the patient with Cirrhosis understand? | Need to get adequate rest and avoiding infections
*Turning pt q 2 hrs and providing ROM help avoid infection and Thrombophlebitis |
| What may palpation reveal? | Enlarged nodular liver |
| A type of brain damage caused by liver disease and consequent ammonia intoxication | Hepatic Encephalopathy
*Thought to result from a damaged liver being unable to metabolize substances that can be toxic to the brain such as ammonia |
| What are the S&S of a patient with Hepatic Encephalopathy? | Progress from inappropriate behavior, disorientation
Asterixis [a clinical sign that describes the inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements]
Twitching of the extremities to stupor; unresponsiveness from which a person can be aroused only by vigorous, physical stimulation and coma |
| A hand flapping tremor in which the patient stretches out an arm and hyper extends the wrist with the fingers separated, relaxed, and extended; rapid irregular flexion and extension flapping of the wrist occurs in pt who is acutely ill | Asterixis |
| What is the treatment of pt with Hepatic Encephalopathy? | Supportive care to prevent further damage to the liver |
| In the past a low protein diet often was prescribed for pts with Cirrhosis because it was thought to | Decrease amount of ammonia produced in the intestine. current belief is that protein should not be restricted because these pts often have existing malnutrition |
| Medications may be given to cleanse the bowel and help decrease the | Serum ammonia level in pts with Cirrhosis |
| What may be prescribed to decrease bowel's pH from 7 to 5? | Lactulose which may decrease production of ammonia by bacteria within the bowel |
| How can Lactulose be administered? | Orally, as retention enema, or via nasogastric tube
*Also functions as a cathartic, lactulose traps ammonia in the gut and the drug's laxative effect expels the ammonia from the colon |
| Antibiotics such as neomycin are poorly absorbed form the GI tract are given | Orally or Rectally
*Because this drug may cause renal toxicity and hearing impairment, Lactulose is preferred |
| What results in the ammonia production? | Bacterial action on protein in feces |
| A complex of longitudinal, torturous veins at the lower end of the esophagus | Esophageal Varices
*Enlarge and become edematous as the result of portal hypertension; susceptible to ulceration and hemorrhage avoiding this is a main goal treatment |
| For pts who have not bled from esophageal varices, what has been shown to reduce the risk of bleeding and bleeding related deaths? | Prophylactic treatment with nonselective beta blockers [propranolol inderal] |
| What causes Varices to rupture? | Anything that increases abdominal venous pressure, coughing, sneezing, vomiting, or the Valsalva maneuver
*Rupture may occur slowly over several days or suddenly and without pain |
| Endoscopy may be performed to identify varices or to rule out bleeding from other sources, Endoscopic therapies include | Scleropathy [ the injection of chemicals used to cause inflammation]
Fibrosis and destruction of the vessels causing the bleeding
Ligation of varices |
| What is the hormone vasopressin VP used for? | Administered intravenously or directly into the superior vena cava to decrease or stop the hemorrhaging
*VP produces vasoconstriction of the vessels dreases portal blood flow and decreases portal hypertension |
| What does NTG Nitroglycerin do? | Current drug therapy is a combination of VP and NTG, NTG reduces the detrimental effects of VP which include decreased coronary blood flow and increased BP |
| Therapeutic management of a ruptured esophageal varix is an emergency what must be maintained? | Patient's airway, bleeding varix controlled, and IV lines established for fluids and blood replacement as needed |
| Why should VP be avoided or used cautiously in older adults? | Because of risk of cardiac ischemia which is restriction in blood supply to the heart
*If VP drip does not stop or control bleeding, a Sengstaken Blakemore tube with openings at tip may be inserted
This tube is passed through nose and balloon in stomach to press against bleeding vessels and control the hemorrhage |
| When would a Gastric Lavage be performed? | To remove any swallowed blood from stomach; iced isotonic saline solutions for lavage to facilitate vasoconstriction, endoscopic sclerotherapy may be used to stop the bleeding or band ligation |
| Severity of fluid retention from ascites and edema determines treatment, initially pt is placed on Bed rest, monitoring of I & O and restrictions on amount of fluid of | 500ml to 1000ml/day and sodium of 1000 to 2000 mg a day consumed.
*Diuretic therapy may be added if diet does not control ascites and edema; Spironolactone at 100 to 400 mg a day may be used to obtained desired diuresis |
| Salt poor albumin may be administered in an attempt to restore what? | Plasma volume if the intravascular volume is decreased significantly |
| What are subjective data in early stages of Cirrhosis? | Patient's description of flu like symptoms, loss of appetite, nausea and vomiting, general weakness and fatigue, indigestion, abnormal bowel movements constipation and or diarrhea |
| What is the most commonly affected in anatomic area? | Epigastric region or right upper quadrant of the abdomen |
| Pruritus results form what? | Accumulation of bile salts under the skin, resulting in Jaundice |
| Collection of objective data in early stages of Cirrhosis includes observing | Low hemoglobin,fever, weight loss and jaundice which is yellow discoloration of skin mucous membranes and sclera of the eyes caused by greater than normal amounts of bilirubin in the serum |
| Collection of objective data in the later stages includes | Noting Epistaxis, purpura, hematuria, spider angiomas and bleeding gums |
| Late symptoms of Cirrhosis may include what? | Ascites, hematologic disorders, splenic enlargement and hemorrhage from esophageal varices or other distended GI veins |
| What can increased ammonia levels in the brain cause in patients? | Mentally disorientation, display abnormal behaviors and speech patterns |
| What can any prolonged interference with gas exchange lead to? | Hypoxia, coma and ultimately death |
| What can relieve ascites and also provide fluid for laboratory examination? | Paracentesis, a procedure in which fluid is withdrawn from the abdominal cavity |
| What are used to diagnose Cirrhosis? | Visualization through ERCP [ Endoscopic retrograde cholangiopancreatography ], to detect common bile duct obstruction, Esophagoscopy, scans and biopsy of the liver |
| What to avoid and eliminate to cause further damage to the liver such as Cirrhosis? | Alcoholm hepatotoxins or environmental exposure etc, diet therapy is aimed at correcting malnutrition, well balanced diet high in calories 2500/3000 calories/day
75 mg of protein per day, low fat low sodium 1000mg to 2000mg a day
*Additional vitamins and folic acid usually meets needs with cirrhosis and improves deficiencies |
| In most instances, portal hypertension that is caused by cirrhosis is irreversible; this increased pressure causes | Ascites which is an accumulation of fluid and albumin in the peritoneal cavity |
| When the damaged liver cannot metabolize protein in the usual manner, protein intake may result in an elevation of | Blood ammonia levels
*Protein must be present in adequate amounts to create colloidal osmotic pressure and attract the fluid to pass back into the blood vessels after it escapes in the capillaries |
| What stimulates kidneys to retain sodium and water? | Fluid leaving the blood and circulating volume decreases, receptors in brain signal the adrenal cortex to increase secretion of aldosterone |
| When the normal liver inactivates the hormone aldosterone, but the damaged liver allows its effect to continue it is called | Hyperaldosteronism |
