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Transcript of Liver Cirrhosis
- 1. Liver Cirrhosis
- "cirrhosis" derives from Greekkirrhos , meaning "tawny" (the orange-yellow colour of the diseased liver).
- It is a chronic liver disease characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to progressive loss of liver function.
- commonly caused by alcoholism, hepatitis B and C and fatty liver disease but has many other possible causes.
- Some cases are of unknown cause, but most of these due to unrecognized fatty liver disease.
- Cirrhosis is generally irreversible once it occurs, and treatment generally focuses on preventing progression and complications.
3. Signs and Symptoms
- Yellowing of the skin (jaundice)
- Loss of appetite
- Easy bruising from decreased production of blood clotting factors by the diseased liver.
- Spider angiomata or spider nevi.
- Nail changes.
- Muehrcke's nails
- Terry's nails
- Hypertrophic osteoarthropathy.
- Dupuytren's contracture.
- AscitesCaput medusa
- Cruveilhier-Baumgarten murmur.
- Fetor hepaticus
- Others. Weakness, fatigue, anorexia, weight loss.
5. 4 major types of cirrhosis Associated with alcohol abuseSmall nodules form as a result of persistence of some aoffending agents4. Alcoholic Cirrhosis- Atriventricular valve dse - prolonged constructive peritonitis - decompensated core pulmonaleChronic liver disease associated with right sided heart failure.3. Cardiac CirrhosisPrimary: Chronic stasis of the bile in intrahepatic ducts -autoimmune process implicated Secondary: - Obstruction of bile ducts outside the liver. - bile flow decreased with concurrent cell damage to hepatocytes around the bile ductules2. Biliary Cirrhosis- post acute viral hepatitis - most common worldwide - most massive loss of liver cells, wit irregular patterns of regenerating cells1. Post Necrotic CirrhosisEtiology Definition 6. Complications
- Edema and ascites
- Spontaneous bacterial peritonitis (SBP)
- Bleeding from esophageal varices
- Hepatic encephalopathy
- Hepatorenal syndrome
- Hepatopulmonary syndrome
- Liver cancer (hepatocellular carcinoma)
- Nonalcoholic fatty liver disease (NAFLD)
- Cryptogenic cirrhosis (cirrhosis due to unidentified causes)
- Chronic viral hepatitis
- Inherited (genetic) disorders
- Primary biliary cirrhosis (PBC
- Primary sclerosing cholangitis (PSC
- Infants can be born without bile ducts ( biliary atresia )
- Less common causes of cirrhosis include unusual reactions to some drugs and prolonged exposure to toxins, as well as chronic heart failure (cardiac cirrhosis).
- Hereditary hemochromatosis.
- Wilson's disease.
- Alpha 1-antitrypsin deficiency (AAT).
- Cardiac cirrhosis
- Glycogen storage disease type IV
- Cystic fibrosis
- Drugs or toxins
- Certain parasitic infections (such as schistosomiasis)
- liver biopsy , through a percutaneous, transjugular, laparoscopic, or fine-needle approach.
- However, a biopsy is not necessary if the clinical, laboratory, and radiologic data suggests cirrhosis. Furthermore, there is a small but significant risk to liver biopsy, and cirrhosis itself predisposes for complications due to liver biopsy.
9. Lab findings
- Alkaline phosphatase .
- GGT .
- Prothrombin time
- Serum sodium
- Leukopenia and neutropenia
- Coagulation defects
- Other laboratory studies performed in newly diagnosed cirrhosis may include
- Serology for hepatitis viruses, autoantibodies (ANA, anti-smooth muscle, anti-mitochondria, anti-LKM)
- Ferritin and transferrin saturation (markers of iron overload), copper and ceruloplasmin (markers of copper overload)
- Immunoglobulin levels (IgG, IgM, IgA) - these are non-specific but may assist in distinguishing various causes
- Cholesterol and glucose
- Alpha 1-antitrypsin
10. MEDICAL MANAGEMENT
- Lactulose and neomysin.
- The beta-blocker nadolol (Corgard) may be given together with isosorbide mononitrate
- Ferrous sulfate and folic acid. Vitamin K may be ordered to reduce the risk of bleeding. When bleeding is acute, packed RBCs, fresh frozen plasma, or platelets may be administered to restore blood components and promote hemostasis.
- Oxazepam (Serax), a benzodiazepine antianxiety/ sedative drug
- A healthy diet is encouraged, as cirrhosis may be an energy-consuming process.
- Antibiotics will be prescribed for infections, and various medications can help with itching.
- Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol.
- Treatment for hepatitis-related cirrhosis involves medications used to treat the different
- types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune
- hepatitis. Cirrhosis caused by Wilson's disease, in which copper builds up in organs, is
- treated with chelation therapy (e.g. penicillamine) to remove the copper.
11. SURGICAL MANAGEMENT
- Transplantation or organ replacement
12. Nursing Management 13.
- Excess fluid volume
- Weight daily. Assess for JVD, measure abdominal girth daily, and check for peripheral edema. Monitor intake and output.
- Assess urine specific gravity.
- Provide low-sodium diet and restrict fluids as ordered.
- Disturbed thought processes
- Assess neurologic status, including level of consciousness, and mental status. Observe for signs of early encephalopathy: changes in handwriting, speech, and asterixis.
- Avoid factors that may precipitate hepatic encephalopathy. Avoid hepatotoxic medications and CNS depressant drugs.
- If possible, plan for consistent nursing care assignments.
- Provide low-protein diet as prescribed; teach the family the importance of maintaining diet restrictions.
- Administer medications or enemas as ordered to reduce nitrogenous products. Monitor bowel function and provide measures to promote regular elimination and prevent constipation.
- Orient to surroundings, person, and place; provide simple explanations and reassurance.
- Ineffective protection
- Monitor VS; report tachycardia or hypotension
- Institute bleeding precautions
- Monitor coagulation studies and platelet count. Report abnormal results.
- Carefully monitor the client who has had bleeding esophageal varices for evidence of rebleeding: hematemesis, hematochezia or tarry stools, signs and symptoms of hypovolemia or shock
- Impaired skin integrity
- Use warm water rather than hot water when bathing.
- Use measures to prevent dry skin
- If indicated, apply mittens to hands to prevent scratching.
- Institute measures to prevent skin and tissue breakdown
- Administer prescribed antihistamine cautiously.
- Imbalanced nutrition: less than body requirements
- Weight daily
- Provide small meals with between meal snacks
- Unless protein is restricted due to impending hepatic encephalopathy, promote protein and nutrient intake by providing nutritional supplements such as Ensure or instant breakfast.
- Arrange for consultation with a dietician for diet planning while hospitalized and at home.
17. Thank you