Liver Cirrhosis: Causes, Symptoms, and Treatment - PDF

LIVER CIRRHOSIS -- end-stage liver disease, chronic (repeated injury to liver cell starting from scarring due to repeated inflammation leading fibrosis - hardening of the tissue manifested by fibrotic scar tissue (nodules). TWO TYPES OF CIRRHOSIS Alcoholic cirrhosis – direct injury to liv...

LIVER CIRRHOSIS -- end-stage liver disease, chronic (repeated injury to liver cell starting from scarring due to repeated inflammation leading fibrosis - hardening of the tissue manifested by fibrotic scar tissue (nodules). TWO TYPES OF CIRRHOSIS Alcoholic cirrhosis – direct injury to liver due to alcohol Nonalcoholic fatty liver disease – caused by viral Hepatitis B or C, Autoimmune disorders, hepatotoxic drugs, fat collections in the liver. OTHER CAUSES: Chronic viral Hep B Hepatitis C - If left untreated may lead to cirrhosis Alcohol consumption damaging the liver cell which will eventually lead to scarring. CLINICAL FEATURES Decrease bilirubin metabolism. Bilirubin is a by-product that occurs when we break down RBC. This needs to be excreted through GI system. When the liver does not process the bilirubin, it remains within the blood resulting to: Jaundice, intense itching, darkened urine, pale stools Decrease functionality of coagulation (high risk of bleeing): Protein synthesis - coagulation factors such as prothrombin are created within the liver including albumin and immunoglobulins, estrogen. S/S: Coagulation deficiency manifested by ecchymosis, edema on abdomen and lower extremities due to albumin deficiency, loss of sexual hair and testicular atrophy, vasodilation manifested by Palmer Erythema (red palm) Build up estrogen leading to gynecomastia on male Altered blood flow can lead to portal vein hypotension Portal veins - allows receiving of blood from the veins of the esophagus and the stomach as well as the spleen and the intestines. On portal vein hypotension , the blood begins to pool back towards other organs (stomach varices, esophageal varices, splenomegaly) leading to complications. Stomach varices and esophageal varices which can rupture. GI bleeding may happen due to esophageal and stomach varices. Keep an eye on signs of bleeding (hematemesis, black tarry stool, coffee ground vomitus). Hepatic Encephalopathy due liver cannot able to synthesize ammonia, it is not able to break down leading to ammonia build up within the body, and the  brain. Cerebral HTN and cerebral hypertension may occur. Liver cirrhosis patient should always be monitored for altered mental status. Encephalopathy leads to asterixis (flapping tremor) Ascites - enlarged abdomen which can put pressure up on the diaphragm in the lungs leading to atelectasis and pneumonia Bacterial peritonitis because liver cannot synthesis immunoglobulins and fluid within the body is present, it promotes bacterial infection.Keep an eye on abdominal rigidity and guarding and sign of infection. Higher risk of liver cancer. LABORATORY RESULT ABNORMALITY High Serum Bilirubin Prolonged clotting times due to poor coagulation High ALT - Elevated ALT levels, also known as high liver enzymes, indicate potential liver damage or inflammation. High Ammonia - Ammonia is a toxic waste product produced by the breakdown of proteins in the body. Liver is sick leading to poor detoxification of ammonia. Low WBC because spleen is trapping the white blood cells due to portal vein hypertension – high risk of infection Decrease Serum Albumin - low albumin levels can include swelling, itchiness, vomiting, nausea, and muscle cramps. Liver is primarily responsible for producing albumin that maintains fluid balance. Poor albumin leads to fluid accumulation like in the case of ascites and edema NURSING INTERVENTION HOB Elevated – distended abdomen due to ascites may cause intraabdominal pressure to diaphragm causing difficulty breathing. Administer Diuretics – to get rid of excessive fluid. Monitor Potassium level (potassium sparing diuretics) Manage ascites (paracentesis) Daily Weighing, girth measurements Sodium and fluid restrictions Monitor mental status due to ammonia build up. – altered mental status means high ammonia level Avoid sedatives to help reduce any kind of confusion may have due to ammonia build up and to increase gut motility. (opiods, benzodiazepines) Avoid hepatotoxic drugs Encourage Hep A and B vaccines Skin care is promoted with calamine lotion to relieve some itching (pruritus) caused by bilirubin build up. Paracentesis - HCP help to relieve abdominal pressure by inserting a needle into the abdomen to drain the fluid and sed off to the lab for culture. It is important to treat hypotension after paracentesis with a Colloid solution (25% albumin IV) due to large fluid being withdrawn. Always check BP during and after the procedure and anticipate administering albumin solution IV to maintain the oncotic pressure and maintain the balance of water in the circulatory system. MEDICATIONS Lower the serum ammonia in the blood Lactulose through the stool. “LactuLOOSE – LOOSENS the stools” Lesser ammonia à decrease risk of hepatic encephalophagy Acid reducers Antacid Diuretics Get rid of excessive fluid in the body Vitamins AVOID: hepatotoxic drugs like NSAIDS, Say NO to alcohol, raw or undercooked raw foods which may cause parasite meat and seafood, highly processed foods, infections foods high in sodium, unhealthy fats, sugary drinks, caffeinated beverages, and certain medications like nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen PATIENT WITH LIVER CIRRHOSIS