| Retention of fluid and sodium results in increased pressure in blood vessels and lymphatic channels, resulting in portal hypertension; Ascites is thus a result of | Portal Hypertension, hypoalbuminemia, and hyperaldosteronism
*Hepatic insufficiency gradually causes distention of veins in the upper part of the body including esophageal vein |
| In the early stages the liver is firm and therefore easier to palpate, and abdominal pain may be present because | Rapid enlargement produces tension on the organ's fibrous covering |
| In the later stages of the cirrhosis disease, it is characterized by | Dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, ecchymoses and spider telangiectases which are small dilated bood vessels with a bright red center point and spider like branches |
| Where does spider telangiectases appear on the body? | Nose, cheeks, upper trunk, neck, and shoulders
*These later manifestations are the result of scarring liver tissue that produces chronic failure of liver function and fibrotic changes that cause obstruction of the portal circulation |
| What is the cause of the GI organs and the spleen becoming congested and not functioning properly? | When enough cells of the liver become involved to interfere with its function and obstruct its circulation |
| Why does Anemia occur in Cirrhosis? | Because of the body's decreased ability to produce red blood cells RBC's
*Cirrhotic liver cannot absorb vitamin K or produce the clotting factors VII, IX, X |
| Anemia causes the patient with cirrhosis to develop | Bleeding tendencies |
| May occur with heavy alcohol consumption. Amount of alcohol that causes damage to the liver differs | Alcohol related liver disease
*Chances for developing cirrhosis alcohol related increase for women when they ingest more than two or three drinks per day and for men when they drink three or four drinks per day |
| Occurs worldwide, caused by viral hep especially hep C but also hep B and D, exposure to hepatotoxins or infection | Postnecrotic cirrhosis |
| Results from destruction of the bile ducts as a result of inflammation; resulting damage to ducts leads to bile backing up into the liver | Biliary Cirrhosis |
| The absence of or under development of biliary structures that is congenital in nature | Biliary Atresia |
| Results from longstanding, severe right sided heart failure in patients with cor pulmonale, constrictive pericarditis and tricuspid insufficiency | Cardiac Cirrhosis |
| Results from fat building up in the liver. Incidence of this condition, is increasing as a result of the growing obesity population | NAFLD "Nonalcoholic fatty liver disease"
*Also associated with diabetes, coronary artery disease and use of corticosteroids |
| Because Cirrhosis is not always known, alcoholism is by far the greatest factor leading to Cirrhosis. It is believed to result from the combination of | Alcohol's hepatotoxic effect on liver coupled with the common problem of protein malnutrition seen in alcoholics |
| Although liver cells have great potential for regeneration, repeated scarring decreases their | Ability to replace themselves |
| A chronic degenerative disease of the liver in which the lobes become covered with fibrous scar tissue. | Cirrhosis |
| What do you assess before the procedure of Endoscopic for pancreatitis? | Prothrombin time and INR, tell pot that test takes a[[rpox 1-2 hrs during which time they must lie completely motionless on hard xray table which may be uncomfortable
*Withhold food and fluids for 8 hrs before examination obtain pt's signature for consent
* After, keep pt on NPO until gag reflex returns assess for abdominal pain tenderness and guarding which are signs of perforation |
| Assess for S&S of pancreatitis which is the most common ERCP | Complication, including nausea, abdominal pain, fever, chills, vomiting and diminished or absent bowel sounds
*Signs of hypovolemic shock, including decreased BP, increased pulse and respirations, SOB, cool clammy skin and decreased urine output |
| What are organs that assist with digestion? | Liver, gallbladder, and exocrine pancreas |
| Cirrhosis is ranked as the twelfth leading cause of | Death in the US
*Approx 38,000 ppl die each yr from disease. Slightly more men are diagnosed with cirrhosis than women. More than 100,000 people have the disease |
| When can the liver not be able to regenerate its self? | When Cirrhosis is present
*Overgrowth of new and fibrous tissue restricts flow of blood to the organ contributing to its destruction |
| ERCP | Endoscopic Retrograde Cholangiopancreatography enables visualization not only of biliary system but also of the pancreatic duct.
*Test involves inserting a fiberoptic duodenoscope through oral pharynx through esophagus and then stomach into the duodenum |
| The ERCP of pancreas is a sensitive and reliable procedure for detecting what? | Significant degrees of pancreatic dysfunction
*Can also be used to evaluate obstructive jaundice, remove common bile duct stones and place biliary and pancreatic duct stents to bypass obstruction |
| What indicates the presence of a tumor? | Localized pancreatic duct narrowing |
| Five viruses designated A through E can cause this disease of an inflammation of the liver caused by viruses, bacteria and noninfectious causes such as alcohol ingestion and drugs | Hepatitis |
| Hepatitis D virus is carried by | Hepatitis B HBV |
| Which Hepatitis's are most common? | Hep A, B and C |
| Which Hep viruses are seen less frequently in the US? | Hep D and E |
| Various of types of Hepatitis virus can be detected by what? | Antigen, antibody levels, and incubation periods |
| Notify lab of any antibiotics pt is currently taking because certain broad spectrum antibiotics such as | Neomycin can cause a decreased ammonia level giving inaccurate test results |
| What is the normal serum amylase test value? | 60-120 somogyi units/dL or 30 to220 units/L SI units |
| What is the normal serum ammonia test value? | 10 to 80 mcg/dL |
| How long does levels of amylase in urine remain elevated for? | 7 to 10 days after onset of pancreatitis |
| How can the biliary tract be evaluated safely accurately and noninvasively? | By intravenous IV injection of technetium and positioning patient under camera to record distribution of tracer in the liver biliary tree, gallbladder and proximal small bowel |
| The primary use of the gallbladder scanning study is to diagnose | Acute Cholecystitis [inflammation of gallbladder]
*This procedure is superior o=to oral cholecystography, ultrasonography and computed tomography CT of abdomen for detection of acute Cholecystitis |
| What nursing interventions can you do for gallbladder scanning with patient? | Reassure pt that exposure to radioactivity is minimal because on a trace dose of the radioisotope is used. Pt is on NPO status from midnight until examination is complete |
| A safe, simple and valuable method of diagnosing pathologic liver conditions; specially designed needle is inserted through skin making it a percutaneous procedure, between the sixth and seventh or eighth and ninth intercostal space and into the liver | Needle liver Biopsy
*Pt lies supine with right arm over the head, instructed to exhale fully and not breathe while needle is inserted
*Often done using ultrasound or CT guidance |
| What is the percutaneous liver biopsy used to diagnose? | Various liver disorders such as cirrhosis, hepatitis and drug related reactions, granuloma or tumor |
| A procedure used to outline and detect structural changes of liver | A radioisotope liver scan
*Given intravenously
*Later a gamma ray detecting device "Geiger counter" is passed over the pt's abdomen. This record distribution of radioactive particles in the liver |
| When can the spleen be visualized by the detector? | When technetium-99m sulfur is used |
| Ammonia is a by product of | Protein metabolism, most ammonia is made by bacteria acting on proteins in the intestine |
| What to make sure has to be ordered for liver biopsy? | Measurements of platelets, clotting or bleeding time, prothrombin time, and INR report any abnormal values |
| The pigment that gives bile its yellow orange color, formed when old or damaged red blood cells disintegrate and release their hemoglobin which is broken down into its component parts including heme | Bilirubin
*Passes through bloodstream to the liver where it is converted into water soluble called direct. |
| 0.1 to 0.4 mg/dL | Direct bilirubin |
| 0.2 to 0.8 mg/dL | Indirect bilirubin |
| 0.3 to 1.2 mg/dL | Total bilirubin |
