Acute and Chronic 2 Final Exam Questions and Answers 2024

Pathophysiology -- Cirrhosis - Inflammation of the liver results in necrosis and scarring. Necrosis results in alteration in function, then liver failure, then hepatic encephalopathy, then hepatic coma, and can eventually lead to death. Scarring of the liver leads to vascular obstruction which results in portal hypertension. Destruction of hepatocytes and replacement with scar tissue. Most Common Causes -- Cirrhosis - Chronic HCV, NASH, Alcohol-Induced Liver Disease Early and Late Clinical Manifestations -- Cirrhosis - Early: anorexia, N/V, flatulence, diarrhea or constipation Late: jaundice, edema, ascites, hematologic disorders, spider angiomas, splenomegaly, endocrine problems, peripheral neuropathies What are the complications of Cirrhosis and what do they entail? - Portal Hypertension: increased venous pressure in portal circulation Gastric and Esophageal Varices: complex of tortuous, enlarged veins at the lower end of the esophagus Ascites: accumulation of serous fluid in the peritoneal or abdominal cavity Hepatic Encephalopathy: build-up of ammonia level in serum Treatment -- Ascites - Sodium Restriction, Diuretics, Paracentesis Paracentesis - Removal of fluid from the peritoneal cavity with a needle that is guided by ultrasound Treatment -- Portal Hypertension - Insert a transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein percutaneously relieves portal hypertension by shunting blood to the systemic circulation. Beta-Blockers Treatment -- Esophageal Varices - Banding, Balloon Tamponade, Replace Volume Treatment -- Hepatic Encephalopathy - Lactulose (absorption of ammonia) and Decreased Protein Intake Dietary Recommendations -- Cirrhosis - High in calories (3000 calories/day) High in carbohydrates Moderate to low levels of fat Protein restriction (for some patients) Malnutrition is a serious problem Collaborative Care and Nursing Management -- Cirrhosis - Slow the progression and treat complications Jaundice - Yellowish staining of the sclera, mucous membranes, and skin due to elevated bilirubin Types -- Jaundice - Hemolytic, Hepatocellular, Obstructive Bilirubin - Product of the breakdown of RBCs Conjugated (Direct) Bilirubin - Water-soluble and excreted in bile Unconjugated (Indirect) Bilirubin - Insoluble in water and binds to albumin in the liver to become conjugated Hemolytic Jaundice - Increased hemoglobin breakdown and degradation Liver cannot keep up with hemolysis