Professional Documents
Culture Documents
INTRODUCTION
Cirrhosis
caused
by
ANATOMY AND
PHYSIOLOGY
PATHOPHYSIOLOGY
CHRONIC ALCOHOLISM
TOXINS FROM ALCOHOL:
RELEASE OF ACETYLDEHYDE
DAMAGE HEPATOCYTES
NECROSIS OF
HEPATOCYTES
FIBROSIS
DECREASE
IVER FUNCTION
LIVER CELLS
REGENERATE
IN ABNORMAL
PATTERN
AST, ALT,
ALKALINE,
PHOSPHATAS
E, GGT
OBSTRUCTION
IN BLOOD FLOW
PORTAL
HYPERTENSION
LIVER CELLS
REGENERATE
IN ABNORMAL
PATTERN
LIVER CELLS
LOADED WITH FAT
ENLARGEMENT
IRRITATES THE
GLISSON CAPSULE
PAI
N
DECREASE LIVER
FUNCTION
INCREASE GLYCOGENESIS,
DECREASE GLYCOGENOLYSIS,
GLUCOGENESIS
ALTERED GLUCOSE
METABOLISM
DECREASE ENERGY
DECREASE LIVER
FUNCTION
DECREASE PRODUCTION
OF ALBUMIN
DECREASE COLLOIDAL
OSMOTIC PRESSURE
EDEMA,
ASCITES
DECREASE LIVER
FUNCTION
DECREASE METABOLISM OF STEROID HORMONE
ESTROGEN,
PROGESTERONE,
TESTOSTERONE
MALE
ALDOSTERONE
FEMALE
ALKALOSIS
EDEMA,
ASCITES
HYPOKALEMIA
DECREASE LIVER
FUNCTION
DECREASE PROTEIN SYNTHESIS
(IN GENERAL)
SUSCEPTIBILITY
TO INFECTION
DECREASE LIVER
FUNCTION
DECREASE PRODUCTION OF
CLOTTING FACTORS
BLEEDING TENDENCIES
BLOOD LOSS
ANEMIA
DECREASE LIVER
FUNCTION
DECREASE METABOLISM OF AMMONIA
INCREASE AMMONIA LEVELS
HEPATIC ENCEPHALOPATHY
CHANGES IN COORDINATION,
MEMORY, ORIENTATION
COMA
DEATH
DECREASE LIVER
FUNCTION
DECREASE METABOLISM
DRUGS
DRUG TOXICITY
DECREASE LIVER
FUNCTION
OBSTRUCTION OF BILE FLOW
ECREASE CLOTTING
FACTORS CLAY-COLORED
BLEEDING/ANEMIA
FECES
BILE REABSORBED
IN THE BLOOD
BILE SALTS IN
JAUNDICE
SKIN
INCREASE
BILE IN
KIDNEY
PRURITUS
DARKCOLORED
URINE
DECREASE LIVER
FUNCTION
DECREASE STORES OF
VITAMINS & MINERALS
DECREASE RBC
PRODUCTION
ANEMIA
DECREASE ENERGY
PRODUCTION
ETIOLOGY
ALCOHOL
VIRAL HEPATITIS
AUTOIMMUNE HEPATITIS
STEATOHEPATITIS
DRUGS AND TOXINS
BILIARY DISEASE
METABOLIC/GENETIC CAUSES
CARDIOVASCULAR DISEASE
CLINICAL
MANIFESTATIONS
NEUROLOGIC FINDINGS
Asterixis
Paresthesias of feet
Peripheral nerve degeneration
Portal-systemic encephalopathy
Reversal of sleep-awake pattern
Sensory disturbance
GASTROINTESTINAL (GI) FINDINGS
Abdominal pain
Anorexia
Ascites
Clay-colored stools
Diarrhea
Esophageal varices
Fetor hepaticus
Gallstones
Gastritis
Gastrointestinal bleeding
Hemorrhoidal varices
Hepatomegaly
Hiatal hernia
Hyperslenism
Malnutrition
Nausea
Small nodular liver
Vomiting
RENAL FINDINGS
Hepatorenal syndrome
Increase urine bilirubin
ENDOCRINE FINDINGS
Increased aldosterone
Increased antidiuretic hormone
Increased circulating estrogens
Increased glucocorticoids
Gynecomastia
IMMUNE SYSTEM DISTURBANCES
Increased susceptibilityof infection
Leukopenia
CADIOVASCULAR FINDINGA
Cardiac dysrhythmias
Development of callateral circulation
Fatigue
Hyperkinetik circulation
Peripheral edema
Portal hypertension
Spider angiomas
PULMONARY FINDINGS
Dyspnea
Hydrothorax
Hyperventilation
Hypoxemia
HEMATOLOGIC FINDINGS
Anemia
Disseminated intravascular
coagulation
Impaired coagulation
Splenomegaly
Thrombocytopenia
DERMATOLOGIC FINDINGS
Axillary and pubric hair changes
Caput medusae
Ecchymosis
Increased skin pigmentation
Jaundice
Palmar erythema
Pruritus
Spider angiomas
FLUID AND ELECTROLYTE
DISTORBANCES
Ascites
Decreased effective blood volume
Dilutional hyponatremia or
Hypernatremia
Hypocalcemia
Hypokalemia
Peripheral edema
Water retention
ASSESSMENT OF
ABNORMAL LABORATORY
FINDINGS IN LIVER
DISEASE
SERUM ENZYMES
Elevated serum aspartate Hepatic
cell destruction
aminotransferase (AST) hepatitis (most specific indicator)
Elevated serum alanine
Hepatic cell destruction,
amino-tranferase(ALT)
hepatitis
Elevated lactate dehy- Hepatic cell destruction
drogenase(LDH)
Elevated serum alkalineObstructive jaundice, hepatic
phosphatase
metastasis
BILIRUBIN
Elevated serum total
Hepatic cell disease
Elevated serum direct Hepatitis, liver metastasis
conjugated bilirubin
Elevated serum indirect Cirrhosis
unconjugated billrubin
Elevated urine billrubin Hepatocellular obstruction, viral
or toxic liver disease
INTERVENTION
ACTIVITIES
FLUID/ELECTROLYTE MANAGEMENT
Obtain laboratory specimens for monitoring of altered fluid and
electrolyte levels(e.g. Hct, BUN, protein, sodium, and potassium
levels) as appropriate.
Keep an accurate record of intake and output.
Weigh client daily and monitor trends.
Monitor for signs and symptoms of fluid retention.
Monitor vital signs, as appropriate.
Administer prescribed supplemental electrolytes, as appropriate.
BLEEDING PRECAUTIONS
Monitor the client closely for hemorrhage
Monitor for signs and symptoms of persistent bleeding
Monitor coagulation studies, including prothrombin time (PT),
partial
thromboplastin time (PTT), fibrinogen, fibrin degradation/split
products,
and platelet counts, as appropriate.
NEUROLOGIC MONITORING
Monitor level of consciousness.
Monitor level of orientation.
Monitor recent memory, attention span, past memory,
mood, affect, and behaviors.
Monitor vital signs: temperature, blood pressure, pulse, and
respirations.
DIET THERAPY
DRUG THERAPY
ALCOHOL ABSTINENCE