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NURS 642 (Hepatology) LIVER EXAM 2 STUDY GUIDE MARY VILLE UNIVERSITY
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NURS 642 (Hepatology) LIVER EXAM 2 STUDY GUIDE MARY VILLE UNIVERSITY
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NURS 642 (Hepatology) LIVER EXAM 2STUDY GUIDE MARY VILLE UNIVERSITY.
Esophageal varices
✔✔~screen w/ EGD annually if dx with cirrhosis.
~TX (medium or large varices): nonselective beta blockers and variceal
band ligation. Antibiotic prophylaxis (ex: fluoroquinolones). Vasoactive
meds (ex: octreotide). Vit K (with abnormal PT). Lactulose
(encephalopathy-related GI bleed).
~Acute GI Bleed: Fluids, PRBC's, FFP.
Coagulopathy:
✔✔If INR >2.0 give Vit K. If need procedure can give FFP.
Bacterial peritonitis
✔✔Anti-microbial therapy (ex: cefotaxime).
Hepato-renal syndrome
✔✔hold diuretics, give albumin.
Hypoglycemia
✔✔10% glucose infusion or 50% glucose IV push if needed
,HCC
✔✔is the most common primary malignancy of the liver and the primary
cause of death in patients with cirrhosis.
Alcoholic liver disease
✔✔~Alcohol intake usually exceeds 80 g/day in men & 30-40 g/day in
women.
~S/SX: often asymptomatic. An enlarged, tender liver
~Advanced S/SX: Dupuytren's contractures, parotid gland enlargement,
and testicular atrophy.
~AST to ALT ratio of 2:1, particularly in the setting of an elevated GGT.
~often reversible, but is the most common precursor of cirrhosis in USA.
Drug- and toxin-induced liver injury
✔✔~MED HISTORY**
~(NSAID's and Antibiotics). (Acetaminophen**)
~Features: lack of illness prior to ingesting the drug, clinical illness
developing after beginning the drug, & improvement after the drug is
withdrawn.
~Older persons may be at higher risk for hepatotoxicity from certain agents
such as: Amoxicillin-Clavulanic Acid, Isoniazid, and Nitrofurantoin
Nonalcoholic fatty liver disease (NAFLD)
✔✔~Principle causes are Obesity, DM, & Hypertriglyceridemia.
~S/SX: Often asymptomatic or mild RUQ discomfort.
, ~steatosis ("fatty change") on US.
~TX: lifestyle changes. Weight loss. Dietary fat restrictions, and moderate
exercise.
~Potentially reversible with removal of causative agent
Primary biliary Cholangitis (PBC)
✔✔~middle age women.
~Late S/SX: xanthelasma ("demarcated yellowish deposit of cholesterol
underneath the skin - around the eyelids"), xanthoma ("fatty growths
develop underneath the skin"), or steatorrhea ("Oily, smelly stools").
~Labs: Elevation alkaline phosphatase, + antimitochondrial antibodies,
Elevated IgM, & increased cholesterol. Later stages elevation in bilirubin.
~TX: Ursodeoxycholic acid 13-15 mg/kg/day in 1-2 doses per day is
preferred tx method for PBC.
Hemochromatosis
✔✔~Autosomal recessive disease.
~Characterized by increased iron as hemosiderin in liver, pancreas, heart,
adrenals, testes, and kidneys.
~Most patients are asymptomatic.
~Classic triad of cirrhosis, diabetes mellitus, and skin pigmentation
("bronze diabetes") suggests late stage hemochromatosis.
~MRI or CT may show changes consistent with iron overload of the liver.
MRI can show quantitative hepatic iron stores and help assess the degree
of hepatic fibrosis.
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