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8/4/2019 HepAtic Cirrhosis.. Maan Palcon
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Hepatic CirrhosisHepatic Cirrhosis
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definition
Cirrhosis is defined as a chronic diseasecharacterized by replacement of normal livertissue with diffuse fibrosis the type disrupts the
structure and function of the liver.
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Types
Three types of cirrhosis:
Alcoholic cirrhosis it is the scar tissuecharacteristically surrounds the portal areas. The
most frequent cause is chronic alcoholism. It isthe most common type of cirrhosis.
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types
Postnecrotic cirrhosis in which there arebroad bands of scar tissue. this is late result ofthe previous bout of viral hepatitis
Billary cirrhosis - in which scaring occurs inthe liver around the bile ducts. This type of
cirrhosis usually results from the chronic biliaryobstruction and infection ( cholangitis). Lesscommon on the other two types.
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Pathopysiology
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Compensated
Intermittent mild fever Vague morning indigestion
Vascular spiders Flatulent dyspepsia
Palmar erythema(reddened palm)
Abdominal pain
Unexplained epistaxis Firm, enlarged liver
Ankle edema splenomegaly
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decompensated
ascites Spontaneous bruising
jaundice hypotenstion
Muscle wasting Sparse body hair
Weight loss White nails
Continious mild fever Gonodal atrophy
Clubbing of fingers
Pupura ( due to decreaseplatelet count)
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Infection and peritonitis
bacterial peritonitis- can be develop in patientsw/ cirrhosis and ascites in the absence of intra-abdominal source of infection or an abcess.This condition is called SBP ( spontaneous
bacterial peritonitis). Bacteremia due totranslocation of the normal intestinal flora isbelieved likely route of infection.
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Gastrointestinal varices
obstruction of tgen blood flow throgh the livercaused by fibrotic changes results in thecollateral blood vessels in the GI system andshunting of blood vessels in lower pressures.
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Edema
the reduces plasma albumin concentrationpredisposes the patient to form an edema. It isgeneralized edema or Anasarca. It often affectsthe lower extremities : upper extremities and
the presacral area. Facial edema is not typical.Over production of aldosterione occurs, causingsodium and water retention and potasiumexretion.
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Vitamin deficiency and Anemia
it is the result of inadequate formation, use andstorage of certain vitamins ( vit. A, C & K)
Signs of deficiency arev common , particularlyin hemorrhagic phenomena associated with
vitamin k deficiency. Chronic gastritis andimpaired GI function, inadequate dietary intakeand impaired liver function results anemia. Thepatient's anemia ,poor nutritional status and
poor state of healthb results to fatigue, whichaffects the ADL or activities of daily living
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Mental deterioration
deterioration of mental and cognitive function w/impending hepatic coma and hepaticencephalopathy. Neurologic assesmentincluding patient's behavior , cognitive abilities,
orientation to time and place and speedchpatterns.
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Assesment and diagnostic findings
Laboratory test
Serum albumin, serum globin level, enzymetest serum alkaline phosphate , AST, ALT,GGT, bilirubin tests are performed. Prothrombintime . MRI, CT and ultrasound
Liver biopsy is the confimatory test, ABG
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Medical management
Management depend on the presentingsymptoms
Anatcids or H2 antagonist Gastric distess Vitamins and nutritional supplements
promotes healing of the damaged liver cells
Potasium- sparing diuretics to decreaseascites
Silybum marianum- tx jaundice
Silymarin- antioxidant, anti-inflammatory SAM- e (adenosylmethione)- antioxidant
function
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Nursing management
Assessing client's nutritional status
by obtaining the clients daily weights,monitoring plasma proteins, transferrin, andcreatinine levels
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Pictures of cirrhosis
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Prepared by : Mary An C. Palcon
BSN- 3B
Thank you for listnening!