Hepatic Cirrhosis

Cirrhosis is defined as a chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis the type disrupts the structure and function of the liver.

definition

Three types of cirrhosis: Alcoholic cirrhosis it is the scar tissue characteristically surrounds the portal areas. The most frequent cause is chronic alcoholism. It is the most common type of cirrhosis.

Types

Postnecrotic cirrhosis in which there are broad bands of scar tissue. this is late result of the previous bout of viral hepatitis Billary cirrhosis - in which scaring occurs in the liver around the bile ducts. This type of cirrhosis usually results from the chronic biliary obstruction and infection ( cholangitis). Less common on the other two types.

types

Pathopysiology

Intermittent mild fever Vascular spiders Palmar erythema (reddened palm) Unexplained epistaxis Ankle edema

Vague morning indigestion Flatulent dyspepsia Abdominal pain Firm, enlarged liver splenomegaly

Compensated

ascites jaundice Muscle wasting Weight loss Continious mild fever Clubbing of fingers Pupura ( due to decrease platelet count)

Spontaneous bruising hypotenstion Sparse body hair White nails Gonodal atrophy

decompensated

Infection and peritonitis bacterial peritonitis- can be develop in patients w/ cirrhosis and ascites in the absence of intraabdominal source of infection or an abcess. This condition is called SBP ( spontaneous bacterial peritonitis). Bacteremia due to translocation of the normal intestinal flora is believed likely route of infection.

Gastrointestinal varices obstruction of tgen blood flow throgh the liver caused by fibrotic changes results in the collateral blood vessels in the GI system and shunting of blood vessels in lower pressures.

Edema the reduces plasma albumin concentration predisposes the patient to form an edema. It is generalized edema or Anasarca. It often affects the lower extremities : upper extremities and the presacral area. Facial edema is not typical. Over production of aldosterione occurs, causing sodium and water retention and potasium exretion.

Vitamin deficiency and Anemia it is the result of inadequate formation, use and storage of certain vitamins ( vit. A, C & K)

Signs of deficiency arev common , particularly in hemorrhagic phenomena associated with vitamin k deficiency. Chronic gastritis and impaired GI function, inadequate dietary intake and impaired liver function results anemia. The patient's anemia ,poor nutritional status and poor state of healthb results to fatigue, which affects the ADL or activities of daily living

Mental deterioration deterioration of mental and cognitive function w/ impending hepatic coma and hepatic encephalopathy. Neurologic assesment including patient's behavior , cognitive abilities, orientation to time and place and speedch patterns.

Laboratory test Serum albumin, serum globin level, enzyme test serum alkaline phosphate , AST, ALT, GGT, bilirubin tests are performed. Prothrombin time . MRI, CT and ultrasound Liver biopsy is the confimatory test, ABG

Assesment and diagnostic findings

Management depend on the presenting symptoms Anatcids or H2 antagonist Gastric distess Vitamins and nutritional supplements promotes healing of the damaged liver cells Potasium- sparing diuretics to decrease ascites Silybum marianum- tx jaundice Silymarin- antioxidant, anti-inflammatory SAM- e (adenosylmethione)- antioxidant function

Medical management

Assessing client's nutritional status by obtaining the clients daily weights, monitoring plasma proteins, transferrin, and creatinine levels

Nursing management

Pictures of cirrhosis

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Prepared by : Mary An C. Palcon BSN- 3B