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!