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( can these notes/terms be written so its in complete sentences where a group of high school students can understand them) Hepatitis, Cirrhosis, & Esophageal Varices 1. Liver Physiology & Pathophysiology FIGURE 1. LIVER PATHOPHYSIOLOGY Gastrointestinal The liver is a highly vascular organ with several vital functions, including: ⮹ Detoxification: Filters toxins, drugs, and metabolic waste (bilirubin, ammonia) ⮹ Metabolism and energy: Processes carbohydrates, fats, and proteins; stores glycogen; regulates blood sugar ⮹ Synthesis: Synthesizes clotting factors and albumin Pathophysiology Liver inflammation (hepatitis virus, alcohol, hepatotoxic medications) damages liver cells, leading to necrosis, scarring (cirrhosis), and impaired function (FIGUREHepatitis Hepatitis: Inflammation of the liver due to alcohol, drugs, or viruses (hepatitis A, B, or C) (see TABLE 1) TABLE 1. TYPES OF VIRAL HEPATITIS Type Transmission Course Hepatitis A ⮹ Fecal-oral (contaminated water) ⮹ Self-limiting Hepatitis B ⮹ Blood (sharing needles) and body fluid (sex, giving birth) ⮹ Acute or chronic Hepatitis C ⮹ Blood ⮹ Chronic, curable with antivirals Hepatitis D ⮹ Blood ⮹ Chronic (only occurs with Hep B) © Bootcamp.com 6 2. Hepatitis, Continued Assessment findings ⮹ Clients may be asymptomatic. ⮹ Fever, anorexia, lethargy ⮹ Nausea, vomiting, diarrhea ⮹ î ‰bilirubin (liver is unable to process it into bile) Jaundice (yellow skin) and scleral icterus (yellow sclera) (FIGURE 2 & FIGURE 3) ⮹ Pruritus (itching) from bile buildup ⮹ Dark urine, clay-colored stools ⮹ î ‰liver enzymes (ALT, AST) 1. Prevent transmission: Fecal-oral for hepatitis A ⮹ Hepatitis A vaccine ⮹ Frequent handwashing ⮹ Use boiled/bottled water in underdeveloped countries. ⮹ Cook foods thoroughly (meat, shellfish). Blood and body fluid for hepatitis B and C ⮹ Hepatitis B vaccine ⮹ Use barrier protection (condoms). FIGURE 2. JAUNDICE Gastrointestinal FIGURE 3. SCLERAL ICTERUS ⮹ Avoid sharing needles and personal items (razor, toothbrush). 2. Encourage adequate nutrition and rest: ⮹ Encourage rest toî €metabolic demand. ⮹ Teach client how to manage pruritus (TABLE 2). Hepatitis care focuses on: 1. Preventing transmission 2. Encouraging adequate nutrition and rest 3. Preventing liver damage Prevent hepatitis: Practice frequent hand hygiene, receive hepatitis vaccines, and avoid sharing needles and personal items (razor, toothbrush). Avoid alcohol and acetaminophen: Instruct clients with hepatitis and cirrhosis to avoid hepatotoxic substances, like alcohol and acetaminophen, to prevent further liver damage. ⮹ Eat small, frequent meals to maintain adequate nutrition. ⮹ Administer antiemetics (e.g., ondansetron) for nausea. TABLE 2. PRURITUS MANAGEMENT ⮹ Use warm water and mild or no soap when cleansing the skin. Pat skin dry; avoid rubbing. Apply alcohol-free moisturizers. ⮹ Keep fingernails short; avoid scratching. ⮹ Take antihistamines (hydroxyzine) as needed. 3. Prevent liver damage: ⮹ Administer antiviral medications to prevent hepatitis B from becoming chronic and to cure hepatitis C. Avoid hepatotoxic substances (alcohol, acetaminophen) to prevent further liver damage. ⮹ Monitor for liver failure (ascites, bleeding). Manage pruritus: Instruct clients to cleanse the skin with warm water and mild soap, gently pat dry, and apply an alcohol-free moisturizer. © Bootcamp.com 2 3. Cirrhosis Cirrhosis: Chronic liver disease with inflammation, fibrosis, and scarring of liver tissue (FIGURE 4). ⮹ Causes: Chronic alcoholism, hepatitis, biliary obstruction, nonalcoholic fatty liver disease (NAFLD) ⮹ Can cause multiple life-threatening complications (TABLE 3) Assessment findings (FIGURE 5) ⮹ Jaundice, spider angiomas, palmar erythema ⮹ Edema, ascites (see FIGURE 6) ⮹ î ‰bilirubin and liver enzymes (ALT, AST) ⮹ Impaired clotting (î €platelets, prolonged PT/INR) ⮹ Hepatic encephalopathy: Confusion and asterixis (hand flapping) FIGURE 4. CIRRHOSIS PATHOPHYSIOLOGY Gastrointestinal FIGURE 5. CIRRHOSIS ASSESSMENT FINDINGS FIGURE 6. ASCITES © Bootcamp.com 3 3. Cirrhosis, Continued TABLE 3. CIRRHOSIS COMPLICATIONS & MANAGEMENT Complication Management Portal hypertension & varices: Cirrhosis î ˆî ‰portal vein pressure î ˆ Blood reroutes to smaller, fragile veins î ˆ Varices ⮹ Beta blockers to î €portal pressure ⮹ Monitor for signs of ruptured varices (blood in stool or emesis). Bleeding:î €clotting factor production +î ‰portal vein pressure (esophageal varices) =î ‰bleeding risk ⮹ Bleeding precautions ⮹ Beta blockers to î €portal pressure Ascites:î €albumin +î ‰portal pressure pushes protein-rich fluid into the peritoneal cavity ⮹ Diuretics ⮹ Anticipate paracentesis to remove fluid. ⮹ Monitor for infection (peritonitis). Hepatic encephalopathy: î ‰ammonia levels î ˆ Confusion, lethargy, and asterixis ⮹ Lactulose to î €ammonia levels ⮹ Monitor LOC. Gastrointestinal ⮹ Implement bleeding precautions (avoid invasive procedures and NSAIDs). ⮹ Administer beta blockers toî €portal pressure and bleeding risk. Monitor coagulation labs (PT, PTT, INR, platelet count). Assess for signs of bleeding (petechiae, bruising). Avoid hepatotoxic substances (alcohol, acetaminophen) toî €risk for further liver damage. 2. Manage fluid overload and support nutrition: Keep HOB elevated to prevent dyspnea. Assess daily weights, intake and output, and abdominal girth. ⮹ Monitor forî €urine output due to risk of Cirrhosis care focuses on: 1. Preventing bleeding and further liver damage 2. Managing fluid overload and supporting nutrition 3. Preventing encephalopathy 1. Prevent bleeding and further liver damage: ⮹ Anticipate liver biopsy for diagnosis. ⮹ Clients undergoing liver biopsy are at high risk for bleeding. ⮹ Pre-procedure: Assess coagulation labs and obtain type and crossmatch. ⮹ Post-procedure: Monitor for signs of bleeding (hypotension, tachycardia, blood on dressing). kidney failure caused by cirrhosis (hepatorenal syndrome). Implement a low-sodium diet toî €fluid retention. ⮹ Administer diuretics toî ‰fluid excretion and improve ascites. ⮹ For ascites: Prepare for paracentesis (needle inserted in peritoneal cavity to remove excess fluid) (FIGURE 7). ⮹ Pre-procedure: Void to prevent bladder damage. ⮹ Post-procedure: Monitor for hypovolemia (dizziness, hypotension). ⮹ Prevent skin breakdown from fluid overload (reposition frequently, pressure support mattress). ⮹ Teach client to manage pruritus (TABLE 2). ⮹ Provide thiamine and vitamin B supplements to correct vitamin deficiencies. 3. Prevent encephalopathy: ⮹ Monitor for encephalopathy (confusion, asterixis). Administer lactulose toî €ammonia levels. ⮹ Lactulose traps ammonia in the bowel and î ‰excretion throughî ‰stool output. ⮹ Monitor electrolytes: Excess stool excretion î ˆ Hypokalemia Fluid overload management: Manage fluid overload by measuring abdominal girth and daily weights, placing the client on a low-sodium diet, and administering diuretics. © Bootcamp.com 4 3. Cirrhosis, Continued FIGURE 7. PARACENTESIS Gastrointestinal Interventions ⮹ Teach client to avoid actions thatî ‰risk of rupture (straining during bowel movements, coughing). Provide immediate intervention if bleeding occurs. ⮹ Maintain airway and breathing (suction, supplemental oxygen, ventilatory support). ⮹ Administer IV fluids and blood transfusions. ⮹ Administer octreotide (î €bleeding via vasoconstriction). ⮹ Prepare for procedures to stop bleeding. ⮹ Endoscopy: Variceal ligation, sclerotherapy Balloon tamponade: Applies pressure to bleeding vein(s) using balloons in the esophagus and stomach (FIGURE 9). ⮹ Secure tube to prevent balloon shift and airway obstruction. ⮹ Monitor for signs of airway obstruction 4. Esophageal Varices Esophageal varices (EV): Fragile, dilated veins in the esophagus caused by portal hypertension (FIGURE 8). ⮹ Fragile veins easily rupture and cause life-threatening bleeding due to thrombocytopenia and clotting factor deficiency. ⮹ Rupture riskî ‰with straining, coughing. FIGURE 8. ESOPHAGEAL VARICES (dyspnea, î €oxygen saturation). ⮹ Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure: Stent placed to divert blood from the portal vein î ˆî €portal pressure î ‰infection risk post-rupture ⮹ Monitor clients for infection (fever,î ‰WBCs). ⮹ Administer antibiotics. FIGURE 9. BALLOON TAMPONADE Balloon tamponade care: For a client with balloon tamponade for esophageal varices, monitor for signs of airway obstruction, like dyspnea and decreased oxygen saturation. © Bootcamp.com 5 What methods prevent hepatitis transmission? Clients with hepatitis or cirrhosis should avoid hepatotoxic substances like _____ and _____ to prevent further liver damage. What interventions help manage pruritus? Manage fluid overload by measuring _____ and daily weights, placing the client on a _____ diet, and administering diuretics. What life-threatening emergency is a client at risk for following balloon tamponade? 5. Airway obstruction 3. Use warm water, mild soap, pat dry when cleansing skin, and apply alcohol-free moisturizer. 4. abdominal girth, low-sodium Answers: 1. Frequent hand hygiene, hepatitis vaccines, avoiding sharing needles and personal items (razor, toothbrush) 2. alcohol, acetaminophen Gastrointestinal

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