Cirrhosis Flashcards
What is Liver Cirrhosis
Liver cells attempt to regenerate but the process is disorganized
- abnormal blood vessel and bile duct formation
- overgrowth of new fibrous connective tissue distorts liver’s normal structure, impedes blood flow
- irregular regeneration and disorganized regeneration, poor cellular nutrition and hypoxia d/t inadequate blood flow and scar tissue result in decreased liver functioning
Cirrhosis is the final stage of chronic liver disease
Etiology of Cirrhosis
- insidious, prolonged course
- eleventh leading cause of death in Canada
- twice as common in men
- highest in ages 40-60
- Treatment focuses on trying to reduce complications and are aimed at stopping or delaying disease progression, minimizing liver cell damage and reducing complications.
Factors that can lead to cirrhosis (5)
- Chronic alcohol use disorder (excessive alcohol ingestion is the single most common cause of cirrhosis, alcohol has a direct hepatotoxic effect)
- Nonalcohol fatty liver disease (NAFLD)
- Cases of nutrition-related cirrhosis have resulted from extreme dieting, malabsorption, and obesity
- Patient with Hepatitis B and C
- Environmental factors, as well as a genetic predisposition
Biliary Cirrhosis
Associated with chronic biliary obstruction
Diffuse fibrosis of liver with jaundice
Cardiac Cirrhosis
From longstanding severe right-sided heart failure
Common Assessment Findings for Hepatic Disorder (9)
- GI issues (clay coloured stool, no bile, anorexia, NV, constipation)
- Jaundice, dark urine from bilirubin, icterus, pruritis
- Energy deficits (d/t carb, lipid, and protein metabolism being effected. absorption is impacted. Not getting nutrients or from anemia from bleeding)
- Petechiae or bruising or bleeding from decreased VK absorption
- Peripheral or pulmonary edema
- Ascites
- Altered mental state, confusion r/t liver disease and build up of toxins
- Cachectic, so much fluid in interstitial space
- Look dired, dilated abdominal veins, protruding abdomen
Common laboratory findings indicating decreased liver function (5)
Elevated liver enzymes: ALT, AST, LDH, Alk Phos, GGT
Decreased serum albumin levels (normal 3.5-5)
Prolonged prothrombin time
Increased unconjugated bilirubin (fat soluble, indirect) - too much bilirubin in the blood
Increased Conjugated bilirubin (water soluble, direct) - impaired excretion
Collaborative Care
- Rest
- Avoidance of alcohol, Aspirin, acetaminophen, and NSAIDS
- Management of ascites
- Prevention and management of esophageal variceal bleeding
- Management of encephalopathy
What causes Jaundice?
Bilirubin is formed when hemoglobin is broken down as part of the normal processes of recycling older damaged RBC. Unconjugaed bilirubin – carried in blood stream by albumin because it is insoluble, to the liver where it binds with bile and becomes conjugated. Bilirubin is then moved into the digestive tract to be eliminated from the body through the stool or urine.
If bilirubin cannot be moved through the liver it builds up in the blood and bile salts are deposited under the skin the result is jaundice and pruritis.
Many people with jaundice have dark urine and light coloured stool. Occur when a blockage or other problem prevents the bilirubin from being eliminated in the stool.
Often jaundice presents first in the scelra of the eyes
Skin Lesions (2) and what causes them?
- Spider angioma occurs on the nose, cheeks, upper trunk, neck and shoulders
- Palmar Erythema a red area that blanches with pressure appears on the palms of the hands
- Both of these are caused by low levels of circulating estrogen as a result of the liver’s inability to metabolize steroid hormones
Peripheral Neuropathy
- what is it and what causes it
Found in alcoholic cirrhosis, probably caused by a deficiency in thiamine, folic acid, and vitamin B12
- damage to nerves outside of the brain and spinal cord. weakness, numbness or pain. stabbing, burning, tingling
Endocrine Disorders: Hypogonadism
- can cause: (4)
a decrease in male sex hormones can cause:
- gynecomastia
- loss of axillary and pubic hair
- testicular atrophy
- impotence +/- loss of libido
In women - amenorrhea, in older women - vaginal bleeding
Hypoaldosteronism: Na+ an water retention and potassium loss
Hematological Problems (4)
Thrombocytopenia - decreased platelets. strongest indicator of cirrhosis
Leukopenia - presence of a reduced volume of WBC
Anemia - reduced volume of RBC
Decreased prothrombin - results from the livers inability to produce prothrombin and other clotting factors. Manifested with gingival bleeding, epistaxis, purpura, petechiae, heavy menstrual bleeding
What causes hematological problems?
- splenomegaly which results from the backup of blood from the portal vein into the spleen. Overactivity results in increased removal of blood cells especially platelets from circulation.
- Anemia can be due to inadequate blood cell production and survival and also be due to esophageal varicies or bleeding
Reasons: alcoholic bone marrow suppression, sepsis, lack of folate, platelets sequestering in the spleen, decreased thrombopoieten
Portal Hypertension
Portal hypertension is an increase in BP within the system of veins called the portal venous system. 2/3 of blood supply to the liver.
Veins coming from stomach, intestines, spleen and pancreas merge into the portal vein which then branches into smaller vessels and travels through the liver. If vessels are blocked due to liver damage, blood cannot flow properly - leads to high pressure in the portal system. May lead to development of varices in the esophagus, stomach, rectum or umbilical area
Varices can rupture and bleed resulting in potentially life-threatening complications
What are Esophageal Varices?
Result of portal hypertension. Tortuous veins. trying to offset the pressure in the portal vein through developing collateral circulation. Very fragile veins, tolerate high pressure poorly. Bleed easily
Signs and Symptoms of Esophageal Varices
Do a GI assessment. Look for risk of bleeding – easy bruising, petechiae, gingival bleeding, normal hemoglobin, anemic, RBC level. CBC.
Subjective assessment questions: if they have been vomiting – what did it look like. Blood that has been sitting in the stomach – looks like coffee grounds.
Stool – abnormal colour, does it look black (melina)
VS – any indication of alteration.
Evidence of hypovolemic shock
Diagnosis of Esophageal Varices
Endoscopy is indicated. Gastroscopy or upper gastrointestinal endoscopy. Preferred for diagnosis or screening for varices. Doctor is looking for dilated veins. Any red streaks or red spots. Treatment can be performed during exams.
