Liver Cirrhosis

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Transcript of Liver Cirrhosis

  • 1. Liver Cirrhosis

2. Definition

  • "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)
  • Fatigue
  • Weakness
  • Loss of appetite
  • Itching
  • Easy bruising from decreased production of blood clotting factors by the diseased liver.

4.

  • Spider angiomata or spider nevi.
  • Nail changes.
    • Muehrcke's nails
    • Terry's nails
    • Clubbing
  • Hypertrophic osteoarthropathy.
  • Dupuytren's contracture.
  • Gynecomastia
  • Hypogonadism
  • Splenomegaly
  • AscitesCaput medusa
  • Cruveilhier-Baumgarten murmur.
  • Fetor hepaticus
  • Jaundice
  • Asterixis
  • 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
  • Hypersplenism
  • Liver cancer (hepatocellular carcinoma)

7. Causes

  • Alcohol
  • 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
  • Autoimmune
  • 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
  • Galactosemia
  • Glycogen storage disease type IV
  • Cystic fibrosis
  • Drugs or toxins
  • Certain parasitic infections (such as schistosomiasis)

8. Diagnosis

  • 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

  • Aminotransferases
  • Alkaline phosphatase .
  • GGT .
  • Bilirubin
  • Albumin
  • Prothrombin time
  • Globulins
  • Serum sodium
  • Thrombocytopenia
  • 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
  • Imaging
  • Endoscopy

10. MEDICAL MANAGEMENT

  • Diuretics
  • 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.
  • Antacids
  • 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.

14.

  • 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

15.

  • 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.

16.

    • 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