Cirrhosis

Question 1

Definition

Answer 1

Liver disease where liver cells become severely damaged and are replaced w/ fibrous tissue; major liver scarring

Question 2

Etiology

Answer 2

• Viral infection: Hep C or B
• ETOH consumption
• Increased fat collection in liver: obesity, high cholesterol, diabetes
• Bile duct problems
• Autoimmune system

Question 3

Role of liver

Answer 3

Metabolizes 
Detoxifies 
Digestion
Storage
Production

Question 4

Liver metabolism

Answer 4

• Glucose: excessive amount in blood synthesized + stored as glycogen to lower blood sugar… Coverts glycogen to glucose to increase blood sugar
  
  • Byproduct of lipids and protein breakdown is ammonia which the liver convers into urea to be excretes

Question 5

Liver detoxification

Answer 5

Makes drugs (sedatives etc.) less harmful to body 
Removes toxins (ETOH)
Helps remove hormones produced by gland 
   - cirrhosis = decreased metabolism of estrogen = more in the body = gynecomastia, itchy, red palms, spider angiomas

Question 6

Liver storage

Answer 6

Vitamins (B12, A, C, E, D & K) along w/ iron, glycogen

Question 7

Liver digestion

Answer 7

Digestion

• hepatocytes produce bile which is bilirubin.
• kupper cells remove old RBCs and break down hemoglobin into heme and globin
• hepatocytes metabolize heme into iron and biliribin which is put into bile and leaves the body in stool = why stool has its color

Increased bilirubin in the blood = jaudice + clay colored stools

Question 8

Liver production

Answer 8

Produce blood plasma proteins

• albumin: maintains oncotic pressure
• fibrinogen, prothrombin: clotting helpers

Question 8

Liver production

Answer 8

Produce blood plasma proteins

• albumin: maintains oncotic pressure
• fibrinogen, prothrombin: clotting helpers

Question 9

Complications

Answer 9

• Portal HTN; portal vein becomes narrowed due to scar tissue = restriction of blood to liver + increased pressure to connected organs
• Enlarged spleen (splenomegaly): spleen stores platelets and WBC which lowers their count
• Esophageal varices: increased pressure portal vein dilates vessels and weakens = rupture!. Life-threatening = lower platelets, lower vitamin K and low clotting factors!

• Fluid Volume Overload: legs + abdomen
“ascites” = risk for infection from gut bacteria = venous congestion + lower albumin

• Hepatic encephalopathy: unable to detoxify => amomonia + other toxins collect in the brain
• Renal Failure

Question 10

Clinical manifestations

Answer 10

“THE LIVER IS SCARRED”

Tremors 
Hepatic foetor
Eye + eye "yellowing"
Loss of appetite 
Increased bilirubin + ammonia 
Varices 
Edema legs 
Reduced platelets + WBCs
Itchy skin
Spider angiomas 
Splenomegaly, stool - clayed colored 
Confusion
Ascites 
Redness on palms 
Renal failure 
Enlarged breast in men  
Deficient on vit. B12, A, C, D, E, K

Question 11

Nursing interventions

Answer 11

Glucose: monitor for hyper + hypoglycemia

Bleeding risk: monitor PT - limit invasive procedures, hold pressure 5 min or more @ injection site, soft tooth brushes, stool for blood
• Varices – risk for bleeding = watch for coughing, vomiting, alcohol consumption, constipation

Toxic buildup = Monitor VS, monitor mental status, monitor ammonia level, reflexes, jaundice

Nutrition: low protein diet if confused only. Give high lean protein, low sodium diet, no alcohol or raw seafood

Fluid volume overload: Strict Intake + Output, measuring abdominal girth, daily weights, turning q 2 hr. cause of risk for skin breakdown + risk for infection
No supine = difficulty breathing, activity intolerance

Question 12

Management

Answer 12

Lung transplant, shunting surgery

Diuretics, beta blockers, nitrates

Blood products

Paracentesis - aspirate fluids off the abdomen