Cirrhosis of the Liver...1 NURS 821 Gastrointestinal Disorders Lecture 8 Part 7 Disorders of the...
Transcript of Cirrhosis of the Liver...1 NURS 821 Gastrointestinal Disorders Lecture 8 Part 7 Disorders of the...
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NURS 821 GastrointestinalDisorders
Lecture 8
Part 7 Disorders of the Liver and Pancreas
Cirrhosis of the Liver
z Definition and pathophysiology-Hepaticscarring caused by inflammation producesischemia and altered function
z Incidence-8th leading cause of death, killing25,000 each year
Cirrhosis Types andPathophysiology
z 1. Laennec (alcoholic,portal, fatty)-alcoholinduced
z 2. Biliary-– A. Primary-? Possibly
autoimmune
– B. Secondary-obstruction-stones,tumors, etc.
z 1. After 10+ years ofheavy drinking
z Blocks normal protein, fat,carbohydrate metabolism
z Fat accumulation,inflammation
z 2.z A.. Inflammation and
lobular bile duct scarringz B. Bile duct inflammation
and scarring proximal toobstruction
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Cirrhosis types
Types
z 3. Postnecrotic-hepatitis, drug toxicity
z 4. Metabolic-metabolic and storagedefects-
z Pathophysiology
z 3. Hepatitis C ranks #1with alcohol
z Fibrous, nodular scartissue replacesnecrotic tissue
z 4. Changes depend onetiology
Cirrhosis(NIDDK, 2000)
z Causes:– Alcoholic liver disease– Chronic hepatitis B, C, and D– Autoimmune hepatitis– Inherited diseases– Nonalcoholic steatohepatitis (NASH)– Blocked bile ducts– Drugs, toxins, infections
Cirrhosis Manifestations(NIDDK, 2000)
z Early-asymptomatic
z Vague symptoms-exhaustion, fatigue,anorexia, n, weakness, wt. loss
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Cirrhosis Manifestations andComplications Relate to:
z Altered hormone and drug detoxification
z Altered protein synthesis
z Increased hydrostatic pressure
z Altered clotting factor formation
Cirrhosis Complications(NIDDK, 2000)
z Edema and ascitesz Bruising and bleedingz Jaundice, itchingz Gallstonesz Toxins in blood and CNSz Medication sensitivityz Portal hypertensionz Varicesz Other organ dysfunction (NIDDK, 2002)
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Esophageal Varices
Multisystem Effects of LiverFailure
z General-wk., AA, wt.Loss, energy loss,pathologic fractures, fetorhepaticus
z CV-BP chg.,dysrhythmias, boundingpulses
z Pulm.-pleural effusion,hypoxia, hypoventilation
z Renal-dec. RBF, brownurine, dec. output, inc.urine bilirubin andurobilinogen
z Dermatologic- spiderangiomata, palmarerythema, vascular spiders,pruritus, jaundice
z Neurologic-personalitychanges, disorientation,sensory alterations,asterixis, peripheral nervedegeneration, coma,kernicterus
Multisystem Liver FailureEffects
z Hematologic-bruising,nosebleeds, petechiae,thrombocytopenia, anemia
z Neurologic-personalitychges., disorientation,sensory alterations,asterixis, peripheral nervedegeneration, coma,kernicterus (neonates)
z Fluid/electrolytes-ascites,hypokalemia,hypocalcemia,hypomagnesemia,dilutional hyponatremia,inc. ammonia
z GI-esophageal and rectalvarices, clay coloredstools
z Endocrine-gynecomastia,testicular atrophy
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Jaundice, Melanin
Telengectia
Jaundiced Sclera
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Bilirubinuria, Proteinuria
Ascites
Caput Medusae
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Caput Medusae, Portal HTN
Pitting Edema
Pitting Edema
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Pitting Edema
Gynecomastia
Gynecomastia
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Liver Palms
Spider Nevi
Spider Nevi
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Diagram