Cirrhosis By: Renee Alta
What is Cirrhosis? • Cirrhosis is a condition that causes irreversible scarring of the liver. As scar tissue replaces normal tissue, blood flow through your liver is affected. This makes it increasingly difficult for your liver to carry out essential functions, such as detoxifying harmful substances, purifying your blood and manufacturing vital nutrients.
What does the liver do? • Synthesize Bile and bile salts • Synthesize Proteins • Phagocytosis • Dextoxification • Metabolism of Carbohydrates • Metabolism of Protein • Metabolism of Fats • Excretion • Storage
The Liver Healthy Liver Cirrhotic Liver
Alcoholic Cirrhosis Postnecrotic Cirrhosis Primary Biliary Cirrhosis Secondary Biliary Cirrhosis Cardiac Cirrhosis Types of Cirrhosis
What happens to the body with liver cirrhosis? • Portal hypertension is an increased venous pressure in the portal circulation caused by compression in the portal or hepatic vascular system. • Increased pressure causes ASCITES. • If fluid leaves the adrenal cortex will increase the secretion of aldosterone. Aldosterone is the hormone that signals for the retention of sodium and water.
Spider Angiomata Palmar Erythema Nail Changes Muehtrcke’s Nails Terry’s Nails Clubbing Hypertrophic osteoarthropathy Dupuytren’s Contracture Gynecomastia Hypocomastia Liver size Splenomegaly Ascites Caput Medusa Cruveilhier_Baumgarten Feta Hepaticus Jaundice Asterixis Signs & Symptoms
Muehrcke’s Nail Terry’s Nail
Diagnostic Tests • The gold standard for diagnosis of cirrhosis is a liver biopsy, through a percutaneous, transjugular, laparoscopic, or fine-needle approach.
Lab Findings • Aminotransferases -- AST and ALT are moderately elevated, with AST > ALT. However, normal aminotransferases do not preclude cirrhosis. • Alkaline phosphatase -- Usually slightly elevated. • GGT -- Correlates with AP levels. Typically much higher in chronic liver disease from alcohol. • Bilirubin -- May elevate as cirrhosis progresses. • Albumin -- Levels fall as the synthetic function of the liver declines with worsening cirrhosis since albumin is exclusively synthesized in the liver • Prothrombin time -- Increases since the liver synthesizes clotting factors.
Lab Findings Cont’d • Globulins -- Increased due to shunting of bacterial antigens away from the liver to lymphoid tissue. • Serum sodium -- Hyponatremia due to inability to excrete free water resulting from high levels of ADH. • Thrombocytopenia -- Due to both congestive splenomegaly • Leukopenia and neutropenia -- Due to splenomegaly with splenic margination. • Coagulation defects -- The liver produces most of the coagulation factors and thus coagulopathy correlates with worsening liver disease.
Medical Management • Antiemetics such as Finergen to control nausea or vomitting • Benadryl or Dramamine may be given for the pruritis • Compazine, Vistraril and Atarax are CONTRAINDICATED in severe liver dysfunction.
Nursing Interventions • Check vital signs every 4 hours and more so if a hemorrhage is present • Monitor for GI hemorrhage as evidence by hematemesis, melena, anxiety and restlessness • Sodium Restrictions • Lotion to relieve the pruritis • Monitor I&O • Measure abdominal girth and weigh daily