Cirrhosis

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Cirrhosis

• By Renee Alta

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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.

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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

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The Liver
Healthy Liver
Cirrhotic Liver
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Types of Cirrhosis

• Alcoholic Cirrhosis
• Postnecrotic Cirrhosis
• Primary Biliary Cirrhosis

• Secondary Biliary Cirrhosis
• Cardiac Cirrhosis

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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.

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Signs Symptoms

• Spider Angiomata
• Palmar Erythema
• Nail Changes
• Muehtrckes Nails
• Terrys Nails
• Clubbing
• Hypertrophic osteoarthropathy
• Dupuytrens Contracture
• Gynecomastia

• Hypocomastia
• Liver size
• Splenomegaly
• Ascites
• Caput Medusa
• Cruveilhier_Baumgarten
• Feta Hepaticus
• Jaundice
• Asterixis

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Muehrckes Nail
Terrys Nail
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Diagnostic Tests

• The gold standard for diagnosis of cirrhosis is a
  liver biopsy, through a percutaneous,
  transjugular, laparoscopic, or fine-needle
  approach.

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Lab Findings

• Aminotransferases -- AST and ALT are moderately
  elevated, with AST gt 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.

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Lab Findings Contd

• 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.

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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.

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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 IO
• Measure abdominal girth and weigh daily