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تاريخ التسجيل : 16/08/2010
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 |  موضوع: liver cirrhosis  الأربعاء نوفمبر 03, 2010 9:17 pm | |
| Liver Cirrhosis
- DIF is a chronic hepatic disease that is characterized by destruction of the functional liver cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells. This disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.
 Classificationsof liver cirrhosis
@pathological classifications:
1, small nodular cirrhosis is characterizedby nodules are similar in size, a diameter less than 3mm, less than 1cm, fiberspacing is relatively narrow, evenly. More common in alcoholic cirrhosis; http://www.tcmwell.com
2, large nodular cirrhosis of theliver nodules the size of uneven diameter greater than 3mm, the big to up to5cm. Fiber interval thickness ranging generally wider. Post-necrotic liver cirrhosis more common;
3, mixed cirrhosis, both on thetwo types of features, strictly speaking, the vast majority of cirrhosis of theliver fall into this category;
4, incomplete separation, alsoknown as regenerative nodules of cirrhosis of the liver is not obvious nature.Multiple hepatic lobule surrounded by fibrous tissue into a largermulti-lobular nodules, regeneration is not obvious. Schistosomiasis cirrhosisof the more common.
@ according to etiology:
1, viral hepatitis, cirrhosisof the liver. 2, alcoholic cirrhosis, 3, metabolic cirrhosis 4, cholestatic cirrhosishttp://tcmwell.com 5, liver cirrhosis obstructedvenous return 6, autoimmune cirrhosis of the liver 7, poisons and drug-induced livercirrhosis 8, cryptogenic cirrhosis of
Causes ofcirrhosis
Cirrhosishas various causes. Many people with cirrhosis have more than one cause ofliver damage.
Alcohol-relatedliver disease. Mostpeople who consume alcohol do not suffer damage to the liver. But heavy alcoholuse over several years can cause chronic injury to the liver. The amount ofalcohol it takes to damage the liver varies greatly from person to person. Forwomen, consuming two to three drinks—including beer and wine—per day and formen, three to four drinks per day, can lead to liver damage and cirrhosis. Inthe past, alcohol-related cirrhosis led to more deaths than cirrhosis due toany other cause. Deaths caused by obesity-related cirrhosis are increasing.
Chronichepatitis C.Thehepatitis C virus is a liver infection that is spread by contact with aninfected person’s blood. Chronic hepatitis C causes inflammation and damage tothe liver over time that can lead to cirrhosis.
Chronichepatitis B and D. Thehepatitis B virus is a liver infection that is spread by contact with an infectedperson’s blood, semen, or other body fluid. Hepatitis B, like hepatitis C,causes liver inflammation and injury that can lead to cirrhosis. The hepatitisB vaccine is given to all infants and many adults to prevent the virus.Hepatitis D is another virus that infects the liver and can lead to cirrhosis,but it occurs only in people who already have hepatitis B.
Nonalcoholicfatty liver disease (NAFLD). In NAFLD, fat builds up in the liver andeventually causes cirrhosis. This increasingly common liver disease isassociated with obesity, diabetes, protein malnutrition, coronary arterydisease, and corticosteroid medications.
Autoimmunehepatitis. This form of hepatitis is caused by the body’s immunesystem attacking liver cells and causing inflammation, damage, and eventuallycirrhosis. Researchers believe genetic factors may make some people more proneto autoimmune diseases. About 70 percent of those with autoimmune hepatitis arefemale.
Diseasesthat damage or destroy bile ducts. Several different diseasescan damage or destroy the ducts that carry bile from the liver, causing bile toback up in the liver and leading to cirrhosis. In adults, the most commoncondition in this category is primary biliary cirrhosis, a disease in which thebile ducts become inflamed and damaged and, ultimately, disappear. Secondarybiliary cirrhosis can happen if the ducts are mistakenly tied off or injuredduring gallbladder surgery. Primary sclerosing cholangitis is another conditionthat causes damage and scarring of bile ducts. In infants, damaged bile ductsare commonly caused by Alagille syndrome or biliary atresia, conditions inwhich the ducts are absent or injured.
Inheriteddiseases.Cysticfibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogenstorage diseases are inherited diseases that interfere with how the liverproduces, processes, and stores enzymes, proteins, metals, and other substancesthe body needs to function properly. Cirrhosis can result from these conditions.
Drugs,toxins, and infections. Other causes of cirrhosis include drugreactions, prolonged exposure to toxic chemicals, parasitic infections, and repeated bouts of heart failure with liver congestion.
Symptoms of cirrhosis
Manypeople with cirrhosis have no symptoms in the early stages of the disease.However, as the disease progresses, a person may experience the followingsymptoms:
- Weakness.
- Fatigue.
- Loss of appetite.
- Nausea.
- Vomiting.
- Weight loss.
- Abdominal pain and bloating when fluid accumulates in the abdomen.
- Itching.
- Spider like blood vessels on the skin.
complications ofcirrhosis
As liverfunction deteriorates, one or more complications may develop. In some people,complications may be the first signs of the disease.
Edema andascites. Whenliver damage progresses to an advanced stage, fluid collects in the legs,called edema, and in the abdomen, called ascites. Ascites can lead to bacterialperitonitis, a serious infection.
Bruisingand bleeding. When the liver slows or stops producing theproteins needed for blood clotting, a person will bruise or bleed easily.
Portalhypertension. Normally, blood from the intestines andspleen is carried to the liver through the portal vein. But cirrhosis slows thenormal flow of blood, which increases the pressure in the portal vein. Thiscondition is called portal hypertension.
Esophagealvarices and gastropathy. When portal hypertension occurs, it may causeenlarged blood vessels in the esophagus, called varices, or in the stomach,called gastropathy, or both. Enlarged blood vessels are more likely to burstdue to thin walls and increased pressure. If they burst, serious bleeding canoccur in the esophagus or upper stomach, requiring immediate medical attention.
Splenomegaly. When portalhypertension occurs, the spleen frequently enlarges and holds white blood cellsand platelets, reducing the numbers of these cells in the blood. A low plateletcount may be the first evidence that a person has developed cirrhosis.
Jaundice. Jaundice occurs whenthe diseased liver does not remove enough bilirubin from the blood, causingyellowing of the skin and whites of the eyes and darkening of the urine.Bilirubin is the pigment that gives bile its reddish-yellow color.Gallstones. If cirrhosis preventsbile from flowing freely to and from the gallbladder, the bile hardens as gallstones.
Sensitivity to medications. Cirrhosis slows the liver’s ability to filter medications from the blood. When this occurs, medications act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side effects.
Hepaticencephalopathy . A failing liver cannot remove toxins from the blood, and they eventually accumulate in the brain. The buildup of toxins in the brain—called hepatic encephalopathy—can decrease mental function and cause coma. Signs of decreased mental function include confusion, personalitychanges, memory loss, trouble concentrating, and a change in sleep habits.Insulinresistance and type 2 diabetes . Cirrhosis causes resistance to insulin—a hormone produced by the pancreas that enables the body to use glucose as energy. With insulin resistance, the body’s muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulinby producing more, but excess glucose builds up in the bloodstream causing type2 diabetes.
liver cancer. Hepatocellularcarcinoma is a type of liver cancer that can occur in people with cirrhosis.Hepatocellular carcinoma has a high mortality rate, but several treatment options are available.
Other problems. Cirrhosiscan cause immune system dysfunction, leading to the risk of infection.Cirrhosis can also cause kidney and lung failure, known as hepatorenal and hepatopulmonary syndromes.
Diagnosis ofliver cirrhosis
Thediagnosis of cirrhosis is usually based on the presence of a risk factor forcirrhosis, such as alcohol use or obesity, and is confirmed by physicalexamination, blood tests, and imaging. The doctor will ask about the person’smedical history and symptoms and perform a thorough physical examination toobserve for clinical signs of the disease. For example, on abdominalexamination, the liver may feel hard or enlarged with signs of ascites. Thedoctor will order blood tests that may be helpful in evaluating the liver andincreasing the suspicion of cirrhosis.To viewthe liver for signs of enlargement, reduced blood flow, or ascites, the doctormay order a computerized tomography (CT) scan, ultrasound, magnetic resonanceimaging (MRI), or liver scan. The doctor may look at the liver directly byinserting a laparoscope into the abdomen. A laparoscope is an instrument with acamera that relays pictures to a computer screen.A liverbiopsy can confirm the diagnosis of cirrhosis but is not always necessary. Abiopsy is usually done if the result might have an impact on treatment. Thebiopsy is performed with a needle inserted between the ribs or into a vein inthe neck. Precautions are taken to minimize discomfort. A tiny sample of livertissue is examined with a microscope for scarring or other signs of cirrhosis.Sometimes a cause of liver damage other than cirrhosis is found during biopsy
How iscirrhosis treated?
Treatmentfor cirrhosis depends on the cause of the disease and whether complications arepresent. The goals of treatment are to slow the progression of scar tissue inthe liver and prevent or treat the complications of the disease.Hospitalization may be necessary for cirrhosis with complications.Eatinga nutritious diet. Becausemalnutrition is common in people with cirrhosis, a healthy diet is important inall stages of the disease. Health care providers recommend a meal plan that iswell balanced. If ascites develops, a sodium-restricted diet is recommended. Aperson with cirrhosis should not eat raw shellfish, which can contain abacterium that causes serious infection. To improve nutrition, the doctor mayadd a liquid supplement taken by mouth or through a nasogastric tube—a tinytube inserted through the nose and throat that reaches into the stomach.Avoidingalcohol and other substances. People with cirrhosis are encouragednot to consume any alcohol or illicit substances, as both will cause more liverdamage. Because many vitamins and medications—prescription and over-the-counter—canaffect liver function, a doctor should be consulted before taking them.Treatmentfor cirrhosis also addresses specific complications. For edema and ascites, thedoctor will recommend diuretics—medications that remove fluid from the body.Large amounts of ascitic fluid may be removed from the abdomen and checked forbacterial peritonitis. Oral antibiotics may be prescribed to prevent infection.Severe infection with ascites will require intravenous (IV) antibiotics.Thedoctor may prescribe a beta-blocker or nitrate for portal hypertension.Beta-blockers can lower the pressure in the varices and reduce the risk ofbleeding. Gastrointestinal bleeding requires an immediate upper endoscopy tolook for esophageal varices. The doctor may perform a band-ligation using aspecial device to compress the varices and stop the bleeding. People who havehad varices in the past may need to take medicine to prevent future episodes.Hepaticencephalopathy is treated by cleansing the bowel with lactulose—a laxative givenorally or in enemas. Antibiotics are added to the treatment if necessary.Patients may be asked to reduce dietary protein intake. Hepatic encephalopathymay improve as other complications of cirrhosis are controlled.Somepeople with cirrhosis who develop hepatorenal failure must undergo regularhemodialysis treatment, which uses a machine to clean wastes from the blood.Medications are also given to improve blood flow through the kidneys.Othertreatments address the specific causes of cirrhosis. Treatment for cirrhosiscaused by hepatitis depends on the specific type of hepatitis. For example,interferon and other antiviral drugs are prescribed for viral hepatitis, andautoimmune hepatitis requires corticosteroids and other drugs that suppress theimmune system.Medicationsare given to treat various symptoms of cirrhosis, such as itching and abdominalpain.
When is aliver transplant indicated for cirrhosis?
A livertransplant is considered when complications cannot be controlled by treatment.Liver transplantation is a major operation in which the diseased liver isremoved and replaced with a healthy one from an organ donor. A team of healthprofessionals determines the risks and benefits of the procedure for eachpatient. Survival rates have improved over the past several years because ofdrugs that suppress the immune system and keep it from attacking and damagingthe new liver.Thenumber of people who need a liver transplant far exceeds the number ofavailable organs. A person needing a transplant must go through a complicatedevaluation process before being added to a long transplant waiting list.Generally, organs are given to people with the best chance of living thelongest after a transplant. Survival after a transplant requires intensive follow-upand cooperation on the part of the patient and caregiver.
Nursing care Plans for Cirrhosis
The patient willà
- Perform ADL activities of daily living without excessive fatigue or exhaustion.
- Remain oriented to his environment.
- Show no signs of circulatory overload.
- Participate in decisions about care.
- Maintain adequate caloric intake.
- Patient's fluid volume will remain within normal parameters.
- Patient's skin integrity will remain intact.
- Avoid or minimize complications.
Nursing interventions for Cirrhosisà
- Monitor vital signs, intake and output, and electrolyte levels to determine fluid volume status.
- Assess fluid retention
- Weigh the patient daily and document his weight.
- Administer diuretics, potassium, and protein or vitamin supplements as ordered.
- Restrict sodium and fluid intake as ordered.
- Assist and provide oral hygiene before and after meals.
- Determine food preferences and provide them within the patient's prescribed diet limitations.
- Provide frequent, small meals.
- Observe and document the degree of sclera and skin jaundice.
- Give the patient frequent skin care.
- Observe for bleeding gums, ecchymosed, epitasis, and petechiae.
- Inspect stools for amount, color, and consistency.
- Increase the patient's exercise tolerance by decreasing fluid volumes and providing rest periods before exercise.
- Use appropriate safety measures to protect the patient from injury.
- Watch for signs of anxiety , epigastric fullness, restlessness, and weakness.
- Observe closely for signs of behavioral or personality changes.
- Observe Report increasing stupor, lethargy, hallucinations, or neuromuscular dysfunction. Arouse the patient periodically to determine level of consciousness. Watch for asterixis, a sign of developing encephalopathy.
- Allow the patient to express his feelings about having cirrhosis.
- Provide psychological support and encouragement, when appropriate.
Patient teaching nursing carePlans for Cirrhosisà
· Warn the patient against taking nonsteroidalanti-inflammatory drugs, straining to defecate, and blowing his nose orsneezing too vigorously. To minimize the risk of bleeding.
· Suggest using a soft toothbrush and aelectric razor
· Advise the patient that rest and goodnutrition conserve energy and decrease metabolic demands on the liver.
· Suggest the patient to eat frequent, smallmeals. Teach him to alternate periods of rest and activity to reduce oxygendemand and prevent fatigue.
· Tell the patient how he can conserve energywhile performing activities of daily living. For example, suggest that he siton a bench while bathing or dressing.
· Stress the need to avoid infections andabstain from alcohol. Refer the patient to alcohol abuse treatment Anonymous,if appropriate
· Alcohol abusetreatment. Emphasize to the patient with alcoholic livercirrhosis that continued alcohol use exacerbates the disease. Stressthat alcoholic liver disease in its early stages isreversible when the patient abstains from alcohol. Encourage family involvementin. Assist the patient in obtaining counseling or support for her or hisalcoholism.
· Encourage the patient to seek frequentmedical follow-up and refer the patient to an alcohol support group orliver transplant support group. | |
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