1 / 74

Hepatic Disorders: Hepatitis/Cirrhosis

Hepatic Disorders: Hepatitis/Cirrhosis. Lisa Randall, RN, MSN, ACNS-BC RNSG 2432. Objectives. C ompare and contrast risk factors associated with hepatitis and cirrhosis Analyze the etiology and pathophysiology of hepatitis and cirrhosis

alijah
Download Presentation

Hepatic Disorders: Hepatitis/Cirrhosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hepatic Disorders:Hepatitis/Cirrhosis Lisa Randall, RN, MSN, ACNS-BC RNSG 2432

  2. Objectives • Compare and contrast risk factors associated with hepatitis and cirrhosis • Analyze the etiology and pathophysiology of hepatitis and cirrhosis • Integrate diagnostic tests with etiology, pathophysiology, and signs/symptoms of both disorders • Formulate relevant prioritized nursing diagnoses that address physical, pyschosocial, and learning needs and evaluate nursing interventions

  3. Anatomy & Physiology

  4. A Liver B Hepatic vein C Hepatic artery D Portal vein E Common bile duct F Stomach G Cystic duct H Gallbladder

  5. Pathophysiology • Largest organ • Metabolic functions • Bile synthesis • Hepatocytes • Bile secretion • Storage • Mononuclear phagocyte system • Kupffer cells • Phagocytic activity

  6. Metabolic functions • Metabolism of glucose • Protein • Fatty acids • Cholesterol

  7. Other Functions • Immunologic • Blood storage • Plasma protein synthesis • Clotting • Storage of vitamins and minerals • Waste products of hemoglobin • Bile formation and secretion • Steroids and hormones • Ammonia • Drugs, ETOH, toxin metabolism

  8. HEPATITIS

  9. Pathophysiology • Inflammation • Hepatic cell necrosis • Proliferation/enlargement Kupffer cells • Cholestasis • Regeneration

  10. Types • Chronic • Fulminant • Toxic • Hepatobillary

  11. Hepatitis Types (Viral) • A • B • C • D • E • G *see handout

  12. Clinical Manifestations Acute Chronic • Anorexia • N/V • RUQ pain • Bowel irregularity • Malaise • HA • Fever • Arthralgias • Uticaria • Weight loss • Jaundice • Hepatomegaly • Splenomegaly • Pruritus • Dark urine • Bilirubinuria • Light stools • Fatigue • Malaise • Easy fatigability • Hepatomegaly

  13. Phases • Preicteric • Prodromal • Icteric • Jaundice • Posticteric • Convalescent

  14. Hepatitis A • Fecal/oral • 15-50d • S/S • Light stools • Dark urine • Fatigue • Fever • Jaundice • Labs • Vaccine • IgG • Prevention

  15. Hepatitis B • Percutaneous/permucosal • Sexual contact • Perinatal • 45-180d • S/S • 30% asymptomatic • Flu • Light stools • Dark urine • Fatigue • Fever • Jaundice • Labs • Prevention • Vaccine • IgG • Safe sex • No sharing of razors, toothbrushes, needles • Chronicity • Antivirals

  16. Hepatitis C • Percutnaeous/mucosal • Sexual contact • Perinatal • 14-180d • S/S • 80% asymptomatic • HBV • http://youtu.be/y6osMO5xnag • Labs • Prevention • Safe sex • No sharing of razors, toothbrushes, needles • Chronicity • Interferon • antivirals

  17. Hepatitis D • HBV • 2-26wk • Labs • Interferon • HBV vaccine • S/S • HBV

  18. Hepatitis E • Fecal/oral • Contaminated water • Poor sanitation • 15-64d • Labs • S/S • HBV • No vaccine

  19. Diagnostics • LFT • ALP • Serum bilirubin • Liver biopsy • Antigen specific

  20. Treatment • Diet • High cal/protein, low fat • Vitamins (B, K) • ETOH/Drugs • Fluid management • Bed rest • Drug therapy • Prevention of HAV and HBV • Interferon • Lamivudine • Ribavirin • Acetaminophen

  21. Nursing Diagnoses • Risk for infection (transmission) • Imbalanced nutrition • Disturbed body image • Knowledge deficit

  22. Cirrhosis

  23. Pathophysiology • Caused by destruction of liver cells, fibrosis and nodule formation restricting blood and bile flow • Normal hepatic blood pressure is near zero. Restriction of blood flow in liver dysfunction causes hypertension, and blood will attempt to find other pathways, bypass liver • Results in significant impairment of liver function • 80% destroyed before signs and symptoms • Liver can regenerate itself if good nutrition, rest, and no alcohol

  24. Types of Cirrhosis Classified by risk factors • Post necrotic • Hepatitis • Alcoholic Cirrhosis • Laennec’s • metabolic changes in liver, particularly fat • Biliary • obstructive • Cardiac • right side heart failure • Drug induced • INH, rifampin, Tylenol

  25. Signs & Symptoms • Liver enlarged • Dull pain RUQ • Weakness • Anorexia • Skin • Sclera • Portal hypertension • Splenomegaly • Ascites • Esophageal varices • Hepatic encephalopathy • Hepatorenal Syndrome • Liver failure

  26. Signs & Symptoms

  27. Jaundice • Excess bilirubin • Heptocellular • Cirrhosis • Obstructive • Hemolytic • Excessive destruction of RBCs • Transfusion reaction • Autoimmune • Faulty hemoglobin • Sickle cell

  28. Diagnostics • LFT • CBC • Coags • Bilirubin • Albumin • Ammonia • Esophagascopy • Liver biopsy *See Table 44.15

  29. Liver Biopsy • 3 types • Needle • Laparoscopic • Transvenous • Catheter • Blood clotting problems • Excess fluid • Complications • Puncture of lung or gallbladder • Infection • Bleeding • Pain

  30. Liver Biopsy • Adequacy of clotting- PT/ INR, Platelets (Vit. K?) • Type and cross match for blood • Stop aspirin, ibuprofen, and anticoagulants 1 wk. before • Chest x-ray • Consent form & NPO 4 to 8 hr. • Vital signs & Empty bladder • Supine position, R arm above head • Hold breath after expiration when needle inserted • Be very still during procedure – 20 minutes

  31. After Needle Liver Biopsy • Pressure • Right side • minimum of 2 hrs • flat 12-14 hrs • Vital signs & check for bleeding • NPO X 2 hr after • Assess for peritonitis, shock, & pneumothorax • Rt. shoulder pain common • caused by irritation of the diaphragm muscle • usually radiates to the shoulder a few hours or days. • Soreness at the incision site • Tylenol • avoid aspirin or ibuprofen for the first week because they decrease blood clotting, which is crucial for healing. • Avoid coughing, straining, lifting x 1-2 weeks

  32. Nursing Assessment • LOC • Reflexes • Hyperreflexia • Pupils • Orientation • Sensory/motor • Asterexis • http://www.youtube.com/watch?v=pAOWjYo-sX4 • Coordination • Dysmetria • Fluid/electrolytes • Acid/base imbalances See table 44.17

  33. Nursing care • Safe environment • Sustain life

  34. Nursing Diagnoses Hepatitis Cirrhosis • Risk for infection (transmission) • Imbalanced nutrition • Disturbed body image • Knowledge deficit • Excess fluid volume • Disturbed thought process • Ineffective protection • Impaired skin integrity • Imbalanced nutrition • Knowledge deficit

  35. Treatment • Diet • Sodium restriction • High carbs • Mod fat • 75-100gm protein • 60-80gm/d (hep encephalopathy) • Fluid management • Drug therapy • Diuretics • Laxatives • Anti-infective agents • Surgical/medical interventions

  36. Major Complications of Cirrhosis Portal hypertension Variceal bleeding Ascites Spontaneous bacterial peritonitis Splenomegaly Hepatorenal syndrome Hepatic encephalopathy

  37. Portal Hypertension • Arteriovenous shunting • Marked ascites • Caput medusae • Dilated abdominal veins • Esophageal varices • Hemorrhoids • Hyperslenism • Mod anemia • Neutropenia • Thrombocytopenia

  38. Surgical/Medical Interventions • Paracentesis • Gastric lavage • Balloon tamponade • Schlerotherapy • Banding • TIPS (transjugular intrahepatic portosystemic shunt) • Liver transplant

  39. Ascites • Sodium restriction • Bedrest initially • Diuretics • Spironolactone • Lasix • HCTZ • Fluid removal • Paracentesis • Peritoneovenous Shunt

  40. Ascites Caput medusae

  41. Paracentesis • Only used if respiratory distress • Pt will loose 10-30 grams of protein • Pt in sitting position • Empty bladder first • Post--watch for hypotension, bleeding, shock & infection

  42. Esophageal varices • Collateral vessels • Complex of swollen, enlarged veins • Portal hypertension • 2/3-3/4 • Bleeding • LIFE-THREATENING

More Related