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_______ is the most common cause of cirrhosis.
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Alcohol consumption
A paracentesis is used to treat ascites for patients who...
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have impaired respiratory or severe abdominal pain
What should a patient do immediately before a paracentesis?
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Pee (to prevent bladder punctures).
An esophageal balloon should be deflated every _______ to prevent necrosis.
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8-12 hours
What are the characteristics of portal hypertension?
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Increased venous pressure, splenomegaly, large collateral veins, ascites, hypertension, and esophageal varices.
Nona-alcoholic fatty liver disease is characterized by hepatic _______ not causes by alcohol, hepatitis or autoimmune disease.
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hepatic steatosis
What prophylactic treatment is used for patients with esophageal varices?
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Non-selective beta blockers like propranolol. Decreases venous pressure by decreasing CO.
_______ cirrhosis is caused by viral, toxic, or auto-immune hepatitis. Broad bands of scar tissue form in the liver.
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Post necrotic
_______ cirrhosis can be caused by obstructions or infection. There is diffuse fibrosis of the liver and jaundice is the main feature.
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What is a major concern with using propranolol as prophylaxis for varices?
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It decreases hepatic blood flow, increasing the risk of encephalopathy.
How is mean arterial pressure calculated?
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2 (diastolic) + systolic divided by 3; Less than 60 = decreased organ perfusion (shock)
How long can the kidneys go without adequate perfusion before they are damaged?
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20 minutes
What is the difference between blood type and screen and blood type and match?
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Screen: ID's type needed; Match: reserve for specific unit for patient
_______ are small, dilated blood vessels with a bright red center and branches that form on the nose, cheeks, trunk, neck and shoulders due to cirrhosis.
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Spider angiomas/telangiectasia
_______ is a chronic inflammatory condition affecting the liver and bile ducts. It is associated with ulcerative colitis and is a form of biliary cirrhosis.
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Primary Sclerosing Cholangitis
What are early signs and symptoms of cirrhosis?
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Anorexia, dyspepsia, n/v, diarrhea, constipation, gas, RUQ dull, heavy pain, palpable liver, fever and lethargy.
What are late signs and symptoms of cirrhosis?
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Small, nodular liver, jaundice, ascites, peripheral edema, skin lesions, blood and endocrine disorders, and peripheral neuropathy.
_______ is caused by connective tissue over-growth that decreases the liver's ability to conjugate and excrete bilirubin.
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What dose of dopamine is an appropriate initial dose to increase BP?
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5 mcg/kg/min; Check in 15 minutes; Bump to 7.5/max 20mcg
What causes the skin lesions of cirrhosis to form?
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Increased estrogen coupled with the liver's inability to metabolize steroid hormones.
What hematologic problems can occur with cirrhosis?
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Thrombocytopenia, leukopenia, anemia which are caused by splenomegaly. Coagulation disorders are also included.
What should you do if an esophageal balloon slips up and obstructs the airway?
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Cut it (scissors must be kept bedside) or deflate it.
Esophageal varices are located in the _______ part of the esophagus. Gastric varices are located in the _______ part of the stomach.
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esophageal = lower; gastric = upper (cardia/fundus)
_______ is the most life threatening complication of cirrhosis.
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Esophageal varices
Why does a patient with cirrhosis develop peripheral edema?
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Liver synthesis of albumin is impaired, decreases oncotic pressure and increases pressure. Proteins moved from blood vessels into the lymph space which then leaks into the peritoneum.
_______ is a terminal complication of cirrhosis caused by ammonia build-up.
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Hepatic encephalopathy
After receiving one unit of blood, the hemoglobin should increase by _______.
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1 gram
How are varices diagnosed?
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_______ is a chronic, progressive disease of the liver caused by degeneration and destruction of parenchymal liver cells.
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_______ should be used cautiously in older adults with an active varices bleed because it increases the risk of cardiac ischemia.
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