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Portal Hypertension Resistance to portal flow and increased portal venous…

- - - - Kidneys retain sodium and water (hypervolemia)
        
        Hepatic Ascites
        
        Decreased albumin
        
        Adequate protein intake
        
        Fluid in vasculature leaks into third space
        
        Swelling of lower extremities
        
        Weight gain
        
        Daily weights
        
        Increased abdominal girth
        
        Paracentesis
        -Aspirates excess fluid in abd
        -Empty bladder prior (puncture risk)
        -Maintenance not tx
        
        Spironolactone and lasix
        
        Complication
        
        Small bowel perforation
        E. Coli in ascites fluid
        -high mortality
        
        Tx: IV antibiotics
        
        Dx: Paracentesis
        
        Px: Long term oral antibiotics
        
        Dietary sodium restriction (<2,000 mg/day)
- - - - Hepatic Esophageal Varices
        Dilated tortuous veins usually found in subumucosa of lower esophagus
        
        Melena
        
        Hematemesis
        
        General deterioration in mental and/or physical status
        
        Watch for shock
        
        IV antibiotic therapy
        
        Indwelling with strict I&Os
        
        Low BP high HR
        
        IVF
        
        Vasoconstrictor (somatostatin) with endoscopic therapy
        
        MAP >65/70 mmHg
        
        Caused by hx of alcoholism
      - Blood products
        -Type and screen: Blood type, Rh, antibodies/antigens
        -Type and cross: Compatibility
        -Consent for blood admin good for entire admission
- - - - Hepatocellular jaundice
      - Obstructive jaundice
      - Hemolytic jaundice
- - - - biliary obstruction, bile stasis, inflammation, diffuse hepatic fibrosis, PBC, PSC
    - - Associated wit h right sided heart failure
- - - - Infection control
      - Bleeding prevention
      - Monitoring of protein levels and clotting factors
      - Monitoring for signs and symptoms of liver dysfunction
      - Monitoring for signs and symptoms of rejection
    - - Bleeding
      - Infection
      - Rejection
      - Delayed graft function
      - Biliary leaks and obstruction
      - Hepatic artery thrombosis
      - Portal vein thrombosis
- - - - Paracentesis