Cirrhosis 2

Front 1

The Bilary Tree

Back 1

Right Hepatic Duct.

Left Hepatic Duct.

Common Bile Duct.

Cystic Duct.

Pancreatic Duct.

Front 2

Compensated Cirrhosis.

Liver is scarred but can still perform essential functions

Back 2

Decompensated Cirrhosis.

Liver is impaired with obvious signs of liver

malfunction

Front 3

Types of Hepatitis

Back 3

H.A.V.: Oral, fecal, contaminated H2O, shellfish, contaminated food handlers.

H.B.V.: Blood, needles, close person to person contact.

H.C.V.: Blood illicit I V drugs, needles.

H.D.V.: Blood, needs H.B.V. to survive.

H.E.V.: Oral, Fecal, usually contaminated H2O

Front 4

Portal Hypertension

Back 4

Hypertension in the portal vein caused by an

obstruction of the flow of blood through the

liver. It is responsible for ascites, splenomegaly,

and the formation of varices.

1500mls per minute. Blood backs up. Collateral circulation, very fragile thin veins, bleeding

ulcers

Front 5

Ascites

Back 5

Collection of free fluid within the peritoneal

cavity.

Decreased plasma proteins, albumin, &

increased pressure from portal hypertension

results in a fluid shift from the vascular system.

Interventions; Paracentesis, Diuretics, Sodium

Restrictions.

Front 6

Ascites;

Protein shift from blood vessels into lymph

space. Lymph system can't handle fluid &

dumps it into the peritoneal.

Hyperaldosteronism

Back 6

Esophageal Varices; Very fragile bleed easily,

aggravated by alcohol, coarse food popcorn,

nuts, straining, coughing, sneezing.

Beta blockers (carvedilol, atenolol, metoprolol, labetalol) lopressors

Front 7

Interventions for Portal Hypertension

Back 7

Sengstaken-Blakemore tube.

Injection Scleropathy.

Endoscopic variceal ligation (EVL banding).

Transjugular Intrahepatic Portal Systemic

Shunt (TIPS)

Front 8

Portal Systemic Encephalopathy;

(Cerebral Edema)

Back 8

Reversible with early interventions.

4 stages.

1st. personality changes, sleep disturbances.

2nd. mental confusion, asterixis (muscle tremors).

3rd. marked mental confusion, stuporous.

4th. seizures, unresponsive, positive Babinski's sign. 4th stage terminal.

Front 9

Contributing Factors

Increased ammonia levels (Lactulos).

High protein diet (too much).

Infection.

Hypovolemia.

Hypokalemia.

Back 9

Constipation.

G.I. Bleeding.

Drugs (opioids, sedatives, analgesics, illicit

drugs, diuretics, hypnotics).

Toxic waste in blood.

Front 10

HEPATORENAL SYNDROME

Back 10

Signifies a poor prognosis often the cause of death.

Manifestations:

Sudden decrease in urine output < 500ml in 24 hours.

Elevated BUN. Increased Urine Osmolarity

Front 11

Drug Therapy for Complications

Back 11

Lactulose. Neomycin sulfate. Beta Blocker.

Aldactone lessens Ascities. S.E. increases K.

Vassopressin. octreotide acetate (Sandostatin)

(Esophagel varices).

Vitamin K, Diuretics,

H2 Receptor Blockers(Tagament, Protonix)

Front 12

CARE

I / O; Daily weights.

Abdominal girth measurement.

Avoid NSAIDS. Leads to bleeding.

Control coughing. Provide rest periods.

Low NA diet. Maintain rest & comfort.

Maintain fluid & electrolyte balance.

Back 12

Management Care.

Blood transfusion. Paracentesis.

Esophagogastric balloon tamponade.

Vasoconstrictive therapy. Surgical Mgt.

Transjugular intrahepatic portal systemic shunt

Educate patient on medication, mobility, the treatment plan.

Front 13

Treatment Goals.

1. Maintain liver function at its current level & prevent further deterioration of the organ.

2. Maintain electrolytes within normal limits.

3. Maintain sufficient respiratory function.

4. prevent or resolve G.I. bleeding

Back 13

5. provide adequate nutritional intake &

a positive nitrogen balance.

Front 14

Fulminant Hepatic Failure.

Syndrome of sudden & severely impaired liver function.

Prognosis is worse than chronic liver failure.

Causes: viral hepatitis, toxic meds, chemicals, metabolic disorders, structural changes.

Back 14

Liver Transplantation: Used in treatment of ESLD, primary malignant neoplasm of the liver.

Donor livers obtained primarily from trauma victims who have not had liver damage.

Donor liver cooled in saline solution that preserves the organ for up to 8 hours

Front 15

Transplant Complications:

Acute, chronic graft rejection. Infection. Hemorrhage. Hepatic artery thrombosis.

Fluid & Electrolyte imbalances.

Pulmonary atelectasis.

Psychological maladjustment.

Back 15

Excess Fluid Volume:

Interventions

Nutritional therapy, restrict fluids, sodium.

Drug Therapy, diuretics.

Paracentesis: removal of fluid