Cirrhosis is a chronic, progressive disease of the liver caused by various factors such as alcohol abuse and viral hepatitis. It involves destruction of liver cells and their replacement with scar tissue, disrupting the liver's normal architecture. Common complications include jaundice, portal hypertension, ascites, variceal bleeding, and hepatic encephalopathy. Treatment focuses on managing complications, avoiding alcohol, and maintaining nutrition.
Cirrhosis is a chronic, progressive disease of the liver caused by various factors such as alcohol abuse and viral hepatitis. It involves destruction of liver cells and their replacement with scar tissue, disrupting the liver's normal architecture. Common complications include jaundice, portal hypertension, ascites, variceal bleeding, and hepatic encephalopathy. Treatment focuses on managing complications, avoiding alcohol, and maintaining nutrition.
Cirrhosis is a chronic, progressive disease of the liver caused by various factors such as alcohol abuse and viral hepatitis. It involves destruction of liver cells and their replacement with scar tissue, disrupting the liver's normal architecture. Common complications include jaundice, portal hypertension, ascites, variceal bleeding, and hepatic encephalopathy. Treatment focuses on managing complications, avoiding alcohol, and maintaining nutrition.
Regenerative process is disorganized, resulting in abnormal blood vessel and bile duct relationships from fibrosis Statistics > 50 of liver disease in the !S is directl" related to alcohol consumption #f the estimated $5 million alcoholics in the !SA $0%&0 have or 'ill develop cirrhosis (ro'ing number of cases related to chronic hepatitis C )th leading cause of death in people bet'een *5 and 5) "ears of age +tiolog" and ,athoph"siolog" Cell necrosis occurs -estro"ed liver cells are replaced b" scar tissue .ormal architecture becomes nodular Alcoholic /Laennec0s1 Cirrhosis 2 Associated 'ith alcohol abuse 2 ,receded b" a theoreticall" reversible fatt" infiltration of the liver cells 2 3idespread scar formation ,ostnecrotic Cirrhosis 2 Complication of to4ic or viral hepatitis 2 Accounts for &0 of the cases of cirrhosis 2 5road bands of scar tissue form 'ithin the liver 5iliar" Cirrhosis 2 Associated 'ith chronic biliar" obstruction and infection 2 Accounts for $5 of all cases of cirrhosis Cardiac Cirrhosis 2 Results from longstanding severe right%sided heart failure Clinical 6anifestations +arl" 6anifestations #nset usuall" insidious (7 disturbances8 2 Anore4ia 2 -"spepsia 2 9latulence 2 .%:, change in bo'el habits Abdominal pain 9ever Lassitude 3eight loss +nlarged liver or spleen Late 6anifestations ;'o causative mechanisms 2 <epatocellular failure 2 ,ortal h"pertension =aundice #ccurs because of insufficient con>ugation of bilirubin b" the liver cells, and local obstruction of biliar" ducts b" scarring and regenerating tissue 7ntermittent >aundice is characteristic of biliar" cirrhosis Late stages of cirrhosis the patient 'ill usuall" be >aundiced S?in Spider angiomas /telangiectasia, spider nevi1 ,almar er"thema +ndocrine -isturbances Steroid hormones of the adrenal corte4 /aldosterone1, testes, and ovaries are metabolized and inactivated b" the normal liver Alteration in hair distribution 2 -ecreased amount of pubic hair 2 A4illar" and pectoral alopecia <ematologic -isorders 5leeding tendencies as a result of decreased production of hepatic clotting factors /77, :77, 7@, and @1 Anemia, leu?openia, and thromboc"topenia are believed to be result of h"persplenism ,eripheral .europath" -ietar" deficiencies of thiamine, folic acid, and vitamin 5$& Complications ,ortal h"pertension and esophageal varices ,eripheral edema and ascites <epatic encephalopath" 9etor hepaticus ,ortal <"pertension Characterized b"8 2 7ncreased venous pressure in portal circulation 2 Splenomegal" 2 +sophageal varices 2 S"stemic h"pertension ,rimar" mechanism is the increased resistance to blood flo' through the liver Splenomegaly 5ac? pressure caused b" portal h"pertension chronic passive congestion as a result of increased pressure in the splenic vein Esophageal Varices 7ncreased blood flo' through the portal s"stem results in dilation and enlargement of the ple4us veins of the esophagus and produces varices Esophageal Varices :arices have fragile vessel 'alls 'hich bleed easil" Internal Hemorrhoids #ccurs because of the dilation of the mesenteric veins and rectal veins Caput Medusae Collateral circulation involves the superficial veins of the abdominal 'all leading to the development of dilated veins around the umbilicus ,eripheral +dema and Ascites Ascites8 % % 7ntraperitoneal accumulation of 'ater" fluid containing small amounts of protein 9actors involved in the pathogenesis of ascites8 % % <"poalbuminemia % % Levels of aldosterone % % ,ortal h"pertension <epatic +ncephalopath" Liver damage causes blood to enter s"stemic circulation 'ithout liver deto4ification 6ain pathogenic to4in is .<* although other etiological factors have been identified 9reAuentl" a terminal complication 9etor <epaticus 6ust", s'eetish odor detected on the patient0s breath 9rom accumulation of digested b"%products -iagnostic Studies Liver function tests Liver biops" Liver scan Liver ultrasound +sophagogastroduodenoscop" ,rothrombin time ;esting of stool for occult blood Collaborative Care Rest Avoidance of alcohol and anticoagulants 6anagement of ascites ,revention and management of esophageal variceal bleeding 6anagement of encephalopath" Ascites <igh carboh"drate, lo' protein, lo' .aB diet -iuretics ,aracentesis ,eritoneovenous shunt 2 ,rovides for continuous reinfusion of ascitic fluid from the abdomen to the vena cava Esophageal Varices Avoid alcohol, aspirin, and irritating foods 7f bleeding occurs, stabilize patient and manage the air'a", administer vasopressin /,itressin1 +ndoscopic sclerotherap" or ligation 5alloon tamponade Surgical shunting procedures /eCgC, portacaval shunt, ;7,S1 Hepatic Encephalopathy (oal8 reduce .<* formation 2 ,rotein restriction /0%)0gDda"1 2 Sterilization of (7 tract 'ith antibiotics /eCgC, neom"cin1 2 lactulose /Cephulac1 2 traps .<* in gut 2 levodopa -rug ;herap" ;here is no specific drug therap" for cirrhosis -rugs are used to treat s"mptoms and complications of advanced liver disease .utritional ;herap" -iet for patient 'ithout complications8 2 <igh in calories 2 C<# 2 6oderate to lo' fat 2 Amount of protein varies 'ith degree of liver damage ,atient 'ith hepatic encephalopath" 2 :er" lo' to no%protein diet Lo' sodium diet for patient 'ith ascites and edema .ursing 7mplementation Acute 7ntervention 2 Rest 2 +dema and ascites 2 ,aracentesis 2 S?in care 2 -"spnea 2 .utrition Acute 7ntervention 2 5leeding problems 2 5alloon tamponade 2 Altered bod" image 2 <epatic encephalopath" Ambulator" and <ome Care 2 S"mptoms of complications 2 3hen to see? medical attention 2 Remission maintenance 2 Abstinence from alcohol