Episode Details

🟠 Cirrhosis

Patho: Hepatocyte loss → fibrotic nodules → portal HTN → varices/ascites; ↓ albumin & clotting factors; ↑ ammonia → hepatic encephalopathy (HE).

Meds: • Diuretics: spironolactone (K⁺-sparing), furosemide (K⁺-wasting) → track I&O, K⁺. • Ammonia ↓: lactulose (2–3 soft stools/day), rifaximin (↓ gut bacteria). • Varices: non-selective β-blockers (propranolol/nadolol) prevent bleed; octreotide acutely; vasopressin rescue. • Coags: vit K if PT/INR prolonged.

Watch for:

1. Variceal bleed (hematemesis/melena → shock).
2. HE grade 3–4 (confusion→coma).
3. Coagulopathy (bruising, epistaxis).
4. Ascites/edema (SBP risk).
5. Jaundice, spider angiomas, palmar erythema.

RN priorities: • HE: q2h neuro, asterixis, NH₃; give lactulose/rifaximin; remove GI blood; bowel regimen. • Ascites: daily weight, I&O, girth marks, skin checks; Na restriction; diuretics; semi-Fowler’s; void pre-paracentesis. • Varices: vitals, PT/INR, platelets; no ETOH/NSAIDs/aspirin; β-blocker adherence. Active bleed → 2 large-bore IVs, type & cross, octreotide; balloon tamponade safety (label/secure; scissors at bedside). Pearls: Prolonged PT/INR, low albumin signal decline; fetor hepaticus = HE.

🔴 Acute Pancreatitis

Patho: Premature enzyme activation → autodigestion, necrosis/hemorrhage → massive third-spacing → hypovolemia/shock; fat necrosis → hypocalcemia.

Meds: IV opioids (morphine/dilaudid), dicyclomine, PPIs/H2, antacids.

Red flags:

1. Shock (hypotension/tachy).
2. Resp: effusions/atelectasis → ARDS.
3. Severe LUQ/epigastric pain → to back, not relieved by emesis.
4. Hemorrhage signs: Cullen (umbilicus), Grey-Turner (flanks).
5. Hypocalcemia (Chvostek/Trousseau)

🟡 Viral Hepatitis (A–E)

Patho: Viral hepatocyte injury → inflammation/necrosis; ↓ bilirubin processing → jaundice; chronic HBV/HCV → fibrosis → cirrhosis/HCC.

Tx: • Acute: supportive only (rest, nutrition; antihistamines for pruritus). • Chronic HCV: DAAs (e.g., sofosbuvir/velpatasvir) → >95% cure. • Chronic HBV: tenofovir/entecavir long-term; peg-IFN (flu-like sx, depression). • Diet: well-balanced, small frequent meals; no alcohol.

Phases/Signs: • Acute/icteric: jaundice, malaise, low-grade fever, RUQ pain, anorexia; early smell aversion/food repugnance. • Convalescent: prolonged fatigue (wks–mos). • Fulminant failure: encephalopathy + coagulopathy → ICU.