Chapter 53- Patients with Liver Problems

Select what characterizes cirrhosis of the liver.

• Widespread fibrotic (scarred) bands of connective tissue

• Tissue becomes nodular

• Nodules block blood and lymph flow

• Liver shrinks in size and softens

• Reversible if treated in early stages

Answer explanation

Characterized by:

-widespread fibrotic (scarred) bands of connective tissue

-Tissue become nodular

-Nodules block blood and lymph flow

-Liver shrinks in size and hardens

The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself.

In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

Which are types of cirrhosis?

• postnecrotic

• Laennec's

• biliary

• cancerous

Postnecrotic cirrhosis is caused by which of the following?

• vital hepatitis

• drugs

• toxins

• alcohol

Laennec's cirrhosis is caused by what?

• alcohol

• drugs

• autoimmune disease

• liver failure

Biliary cirrhosis is caused by which?

• chronic biliary obstruction

• autoimmune disease

• HTN

• alcohol

Complications of cirrhosis?

• portal hypertension

• swelling in legs and abdomen

• enlargement in spleen

• biliary obstruction

• renal encephalopathy

Answer explanation

•High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.

•Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.

•Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.

•Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can't make enough clotting factors, this also can contribute to continued bleeding.

•Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.

•Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.

•Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.

•Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.  ICTERUS

•Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.

•Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.

•Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.

What is the priority nursing intervention in the management of a client with decompensated cirrhosis?

• Limiting protein intake

• Managing nausea and vomiting

• Monitoring fluid intake and output

• Elevating the head of bed >30 degrees

Answer explanation

Decompensated Cirrhosis – oblivious signs of liver failure (Portal HTN, Ascites, Biliary Obstruction, Hepatic Encephalopathy)

Decompensated cirrhosis has multiple complications, of which bleeding esophageal varices is one. This condition can present a life-threatening emergency.

Preventing nausea and vomiting is an important intervention in the management of esophageal varices. Monitoring protein, fluid balance, and client positioning are also important interventions in the care of the client with end-stage liver disease.

Select signs and symptoms that may be seen in a patient with cirrhosis.

• fatigue

• weight change

• GI symptoms

• alcohol withdrawl

• dilated pupils

Jaundice is caused by:

• intrahepatic obstruction

• leukopenia

• testicular atrophy

• acites

Which assessment finding requires immediate nursing intervention in a client with severe ascites?

• confusion

• temperature 38.2C

• tachycardia, 110bpm

• shallow respirations, rate 32 bpm

Answer explanation

Ascites can increase abdominal distention, which interferes with lung expansion and compromises ventilation and oxygenation. Risk for infection, fluid displacement, and confusion are also assessment variables requiring monitoring in a client with ascites.