1. Inflammation of the liver: caused by virus, drugs, chemicals, and autoimmune disease, or bacteria.
2. Cirrhosis
   1. Risk factors
      1. Alcohol
      2. hepatitis, biliary obstruction
      3. Long-term HF
      4. Drug induced (Tylenol)
   2. S&S
      1. anorexia, dyspepsia, flatuelence, N/V, weakness
      2. Juandice, peripheral edema
   3. Diagnostics
      1. Liver ultrasounds
      2. Liver biopsy
         1. Pre-Op
            1. Type and cross match
            2. No aspirin, NSAIDS, and anticoag x 1wk
            3. Empty bladder
            4. VS
         2. Post-op
            1. R side x 2hrs, flat x 12hrs
            2. VS & Check for bleeding
            3. NPO x 2hrs after
            4. Clear liquid
            5. Avoid coughing, straining, lifting x 1-2wks
      3. Angiography
      4. CBC & Electrolytes
         1. serum albumin
         2. Low RBC, Hgb, Hct
            1. anemia
         3. Low platelet
            1. Subtopic 1
      5. Liver Function Tests
      6. Coagulation
         1. PT/PTT prolonged
            1. High risk for bleeding
      7. bilirubin-increased
         1. Topic
      8. serum ammonia-elevated
   4. Complications
      1. ascities
      2. Esophageal varices
      3. hepatic encephalopathy
   5. Meds
      1. Diuretics
         1. spironolactone
      2. Laxatives
      3. Anti-infectives
      4. Lactulose
      5. beta blockers
   6. Nsg Dx
      1. Excess fluid volume
      2. Disturbed thought process
      3. Impaired skin integrity
      4. Imbalanced nutrition: less than body requirements
      5. Knowledge deficit
   7. Discharge Teaching
      1. Vit.B complex
      2. Rest
      3. diuretics
      4. Avoid alcohol, aspirin, Tylenol, and NSAIDs
      5. Diet
         1. Low sodium
         2. High Carb
         3. fluid restriction
         4. No alcohol
   8. Treatment
      1. Paracentesis
         1. Watch S&S of shock
      2. Balloon tamponade
         1. Deflate esophageal balloon if respiratory distress
      3. TIPS
      4. Liver transplant
      5. Sclerotherapy/band ligation
3. Diagnostic Tests
   1. Liver biopsy
   2. Liver Function Test: Increased AST & ALT, Increased serum bilirubin, prolonged PT
   3. Antibody tests
   4. Coagulation tests
4. Destruction of liver cells, fibrosis, and nodule formation restricting blood and bile flow
5. Meds
   1. Vaccination - best protection
      1. except Hep C
   2. Antivirals-not until chronic
      1. interfereon
6. Signs & symptoms
   1. malaise, anorexia, nausea
   2. RUQ pain, jaundice, hepatomagaly, and pruritus
   3. light stools, dark urine, fatigue
7. Nursing Diagnosis
   1. Risk for infection
   2. Imbalanced nutrition: less than body requirements
   3. Disturbed body image
8. Discharge teaching
   1. Diet
      1. High calorie/protein
      2. Low fat
      3. Vit B & K
      4. No alcohol or drugs
   2. Activity
      1. Bed rest until juandice gone
9. Viral
   1. Hep C
      1. blood
   2. Hep B
      1. sexual contact, needle
   3. Hep A
      1. transmitted by fecal-oral route