Question

Cirrhosis Systems reviewed in Cirrhosis Case Study Up Respiratory system A Cardiovascular system C Hematologic and Lymphatic system Gastrointestinal system T Urinary system Musculoskeletal system C Neurological system M Endocrine system M Integumentary system • E= Everybody A = Alli T= Tijuan .C= Cletha •M=Mackenzie Case Ben Whitehorse, a 60 year old male of Native American descent, is admitted to the hospital with hematemesis. He has a history of alcohol abuse. Ben's wife and two daughters accompany him. Ben is 5'10" tall and weighs 140 lbs. His vital signs are T 98.2, P 98 and slightly irregular, R 24. BP 152/88. He is lethargic, confused, and jaundiced. When the nurse assesses his lung sounds, she hears pulmonary crackles in all lobes. His abdominal girth measures 44 inches. His wife states he has not gone to the bathroom all morning. He has +3 edema in his feet and ankles. Ben's primary diagnosis is hematemesis with a secondary diagnosis of cirrhosis. I H . • Brainstorm other subjective and objective date that are important to include in the assessment of Ben Whitehorse. Relate the pathophysiology of cirrhosis to the assessed symptoms and other symptoms Ben may have experienced. Develop a patho-flow chart relating the symptoms to the pathological cause (examples of patho-flow diagrams may be found online). List diagnostic tests that would be appropriate for the physician to order for Ben. What abnormal laboratory results would be typical of cirrhosis? Relate the possible results of the diagnostic tests to the developed patho-flow chart. . Besides alcohol abuse, what are some other causes of cirrhosis? U List complications of cirrhosis caused by chronic alcohol abuse. Explain the pathophysiology of portal hypertension as it relates to cirrhosis. Relate these tho-flow chart previously developed. List diuretics that may be ordered for Ben to decrease the ascites. 1. How does the action of lactulose (Cephulac) lower the level of ammonia in the blood? T. What other complications result from portal hypertension? M . Explain the rationale for the complication of pleural effusion. M . Identify possible nursing diagnoses for Ben. A. What nursing interventions would be appropriate at this time? Develop a care plan for Ben Whitehorse. If Ben's condition improved and he was scheduled for discharge, what is important to include in the discharge teaching regarding: Bleeding tendencies T Exercise u Nutrition Skin care E.

Answer 1

ANSWER- PATHOPHYSIOLOGY OF CIRRHOSIS OF LIVER -

Greek word 'kirrhosis' which means yellowness (jaundice)

It is a chronic , progressive disease and irreversible destruction of hepatocytes ,

Necrosis (cell death)

scarring ( scar is a fibrous tissue formed in place of healthy liver cells )

scar obstruct blood flow and increase pressure with in portal vein

portal hypertension

Normal healthy liver cells (hepatocytes) replaced by scar tissue (fibrous tissue)

portal hypertension is caused by liver cirrhosis

liver contain Stellate cells / kuffer cell

Normal condition - stellate cells remain dormant

liver injury - stellate cell become active

stellate cell secrete TGF -BETA ( Transforming growth factor beta)

start forming collagen fibre

it forms scar

• laboratory test - 1) ALT (alanine aminotransferease / transaminase) also known as SGPT (serum glutamic pyruvic transaminase). Produce by liver . Normal level is 4-36 unit/litre

2) AST (aspartate aminotransferase / aminase) also known as SGOT (Serum glutamic oxaloacetic transaminase) . Produce by liver , pancreas, heart, skeletal muscles . Normal level is 0-35 unit/litre

3) ALP (alkaline phosphatase) produced by liver , pancreas, kidney, intestine, bones . Normal level is 35-120 unit/litre

4) GGT ( Gama glutamyl transpeptidase level) produced by liver , pancreas , kidney, intestine, prostate gland

Normal level is 9-48 unit/litre

5) Serum albumin decreased - normal level is 3.5 - 5gm/dl

6) PT/INR - increase

7) serum bilirubin - direct - normal level 0.3-1.0 mg/dl

indirect - normal level 0.2-0.8 mg/dl

8) serum urea, creatinine - increased

9) CBC (complete blood count) - decrease WBC , decrease platelet , decrease RBC

10) Liver biopsy - for scarring and necrosis

11) CT / USG

• Causes of cirrhosis of liver - a) post necrotic cirrhosis - due to hepatitis B, C, D , CMV , EBV (Ebsteinn barr virus) , also due to hepatotoxin , massive necrosis is present

b) biliary liver cirrhosis - autoimmune etiology , body own T-helper cells

c)cardiac liver cirrhosis - due to right sided heart failure - backflow of blood to liver- venous congestion-destruction of hepatocytes- liver cirrhosis