Jaundice and Hepatic Cirrhosis

Work done by:

Marcos Ana Marcos Pires Angela Pires Sandra Marisa Martins Rui Liborio Piçarra
Anatomy of the liver
The liver is one of the most complex organ in our body, located approximately in
the 5th intercostal space; ligament falsiforme divides the liver into two lobes
, the right and left; The portal system consists of veins, venous sinusoids and
liver, the functional unit of liver is the hepatic lobe, each lobe consisting of
multiple layers of liver cells.
Liver Cirrhosis
"Chronic disease and degenerative disease of the liver, which destroys the struc
ture and liver function."
(DOUGHTY, 1995)
"Chronic disease of the liver characterized by diffuse inflammation and fibrosis
resulting drastic structural changes and a significant loss of liver function."
(Phippe, Wilma et al. 2003)
Epidemiology 40% of patients with cirrhosis are asymptomatic; Men twice more aff
ected than women, more frequent in individuals aged between 40-60 years; Some pe
ople seem more susceptible than others to this disease; Only 25% of alcoholics d
evelop liver cirrhosis, losing on average 12 years of productive life.
Etiology
Alcohol (85% of cases); Malnutrition (lack of vitamins and proteins); Prob
lems bile (primitive or secondary to an obstacle); Exposure to certain chemica
l substances (arsenic and phosphorus); autoimmune hepatitis; Congestive hear
t attack on the right.
Types of Liver Cirrhosis
1. Cirrhosis Läenec / Macronodular / Gorda
More common, is a consequence of the toxic effects of chronic consumption, exces
sive alcohol on the liver
Produces acetaldehyde, in excessive amounts Amendment anatomical liver
Alter / destroy the function of hepatocytes fibrotic tissue around the central v
ein and portal vein
2. Cirrhosis pós-necrótica/micronodular • Occurs due to acute viral hepatitis be
fore or necrosis
massive hepatic drug-induced
3. Biliary cirrhosis is the rarest of all fibrosis occurs around the bile ducts
and liver lobes. Results of biliary obstruction and chronic infection
Signs and symptoms
The onset is insidious and may take years to develop; Early
Fatigue Anorexia Edema of the ankles Epistaxis Bleeding Gums Retenti
on Net
Delayed
Constipation skin dilated veins will vote navel Ascites Splenomegaly P
ancytopenia Impotence Vascular spiders Deterioration of mental function
Jaundice
Jaundice
There are two types: Jaundice with unconjugated bilirubin, direct from the degra
dation of red blood cells; jaundice with conjugated bilirubin associated with a
deficit of bilirubin excretion by the liver
The yellow color in body tissues - sclera - the underside of the tongue. Serum b
ilirubin levels exceed 2mg/dl;
The rash may develop when the body removes bilirubin through the skin pores.
Diagnosis
More laparoscopic liver biopsy, detects the destruction and fibrosis of the live
r tissue of the liver scintigraphy shows abnormal thickening and a liver mass, C
T, which determines the size of the liver and its irregular nodular surface; Eso
phagoscopy to determine the presence of esophageal varices; Paracentesis to exam
ine the net ascíticio (cells, proteins and the number of bacteria), CTP differen
tiates obstructive jaundice extra intrahepatic; liver function tests serum are h
igh.
Treatment
Usually based on symptoms presented by patients: Antacids, decreases gastric pai
n and minimizes the possibility of gastrointestinal bleeding; Vitamins and nutri
tional supplements to promote healing of damaged liver cells and improve the gen
eral nutritional condition of the patient, administer albumin to maintain osmoti
c pressure
(Cont.)
• For treatment of ascites and imbalance hidoelectrolítico:
- Potassium-sparing diuretics - Bed rest to diuresis - Restrict the intake of so
dium and water - Paracentesis to remove fluid and relieve symptoms
Complications
Hyponatraemia and water retention, bleeding esophageal varices; Coagulopathies;
spontaneous bacterial peritonitis Hepatic encephalopathy
Nursing care
Nursing diagnoses are determined by analysis of patient data. These data can be:
Subjective:
Recent History General characteristics of the body feeding habits social history
Elimination System Changes gastrointestinal neuromuscular Sexuality
Objectives:
Vital signs and sclerotic skin changes Abdomen Breathing neuromuscular
Nursing care plan
1.€Activity intolerance related to fatigue and weight loss. Objective: Increase
energy and participation in actions of Nursing: Providing a diet rich in protein
and vitamin supplements; Encourage alternating periods of rest and exercise, st
imulate and assist in gradually increasing periods of exercise.
(Cont.)
2. Change in body temperature (hyperthermia) related
inflammatory process of cirrhosis. Objective: To maintain body temperature withi
n normal parameters. Shares of Nursing: Assess and record the temperature regula
rly; stimulate fluid intake; Apply cold compresses or ice bag on the skin; Admin
ister antipyretics prescribed; Keep patient at rest when the temperature is high
.
(Cont.)
3. Ineffective breathing pattern, associated with ascites,
immobility and stasis of secretions. Objective: To improve the respiratory condi
tion. Nursing actions: Monitor the breathing and possible respiratory sounds of
4 / 4 hours; Position in Fowler; decubitus Switch 2 / 2 hours; Encourage deep br
eathing of 2 / 2 hours; Helping the patient during paracentesis.
(Cont.)
4. Pain and discomfort associated with enlarged liver and sensitive
ascites. Objective: Increase the level of comfort. Shares of Nursing: Keep the b
ed rest when the patient has abdominal discomfort; Administer anti-spasmodic and
sedative drugs as prescribed; Watch, record and report the presence and charact
eristics of pain and discomfort, reduce fluid intake and sodium.
(Cont.)
5. Altered nutrition (eating less than the corporeal needs), related to anorexia
and gastrointestinal disorders.
Objectives: To improve nutritional status. Shares of Nursing: Offer small, frequ
ent meals; Catering attractive and aesthetically pleasing condition at mealtimes
, encourage increased fluid intake, other than alcohol; administer the prescribe
d medication for nausea and vomiting; observe evidence of gastrointestinal bleed
ing intestine.
(Cont.)
6. Excess fluid volume, related to the formation of ascites and edema. Goals: Re
store normal volume of liquids. Shares of Nursing: Restrict fluid intake and sod
ium if prescribed; Administer anti-diuretics, potassium and protein supplements
as prescribed; Register intakes and eliminations; Measure and record the daily a
bdominal circumference.
(Cont.)
7. Risk of change in skin integrity, related to immobility, poor nutrition, edem
a and jaundice. Objectives: To maintain the skin part. Shares of nursing: Assess
daily the patient's skin for possible signs of pressure zone, anti-bedsore Use
materials; Keeping the skin clean and moisturized; Keep nails short and clean; P
rovide soft clothing to rub the skin.
(Cont.)
8. Risk of infection related to immunosuppression Objective: Prevent infections.
Nursing Actions: Monitor signs of infection; Using aseptic technique in invasiv
e procedures, keep a good bronchial hygiene, avoid contact of people with infect
ions.
(Cont.)
9. Risk of bleeding associated with impaired production of clotting factors and
poor absorption of vitamin K. Objectives: To avoid bleeding. Shares of Nursing:
Assess signs of bleeding (skin, mucous, urine and feces); Watch SV 4 / 4 hours a
nd daily prothrombin time and platelets; Avoid punctures whenever possible; Admi
nister vitamin K, if required; Teach the patient to use brush soft teeth, avoid
the use of dental floss and efforts to excessive coughing.
Prevention
The programs aimed at prevention of cirrhosis have with main objective the contr
ol of intake of alcohol.