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NURS 821 GastrointestinalDisorders

Lecture 8

Part 7 Disorders of the Liver and Pancreas

Cirrhosis of the Liver

z Definition and pathophysiology-Hepaticscarring caused by inflammation producesischemia and altered function

z Incidence-8th leading cause of death, killing25,000 each year

Cirrhosis Types andPathophysiology

z 1. Laennec (alcoholic,portal, fatty)-alcoholinduced

z 2. Biliary-– A. Primary-? Possibly

autoimmune

– B. Secondary-obstruction-stones,tumors, etc.

z 1. After 10+ years ofheavy drinking

z Blocks normal protein, fat,carbohydrate metabolism

z Fat accumulation,inflammation

z 2.z A.. Inflammation and

lobular bile duct scarringz B. Bile duct inflammation

and scarring proximal toobstruction

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Cirrhosis types

Types

z 3. Postnecrotic-hepatitis, drug toxicity

z 4. Metabolic-metabolic and storagedefects-

z Pathophysiology

z 3. Hepatitis C ranks #1with alcohol

z Fibrous, nodular scartissue replacesnecrotic tissue

z 4. Changes depend onetiology

Cirrhosis(NIDDK, 2000)

z Causes:– Alcoholic liver disease– Chronic hepatitis B, C, and D– Autoimmune hepatitis– Inherited diseases– Nonalcoholic steatohepatitis (NASH)– Blocked bile ducts– Drugs, toxins, infections

Cirrhosis Manifestations(NIDDK, 2000)

z Early-asymptomatic

z Vague symptoms-exhaustion, fatigue,anorexia, n, weakness, wt. loss

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Cirrhosis Manifestations andComplications Relate to:

z Altered hormone and drug detoxification

z Altered protein synthesis

z Increased hydrostatic pressure

z Altered clotting factor formation

Cirrhosis Complications(NIDDK, 2000)

z Edema and ascitesz Bruising and bleedingz Jaundice, itchingz Gallstonesz Toxins in blood and CNSz Medication sensitivityz Portal hypertensionz Varicesz Other organ dysfunction (NIDDK, 2002)

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Esophageal Varices

Multisystem Effects of LiverFailure

z General-wk., AA, wt.Loss, energy loss,pathologic fractures, fetorhepaticus

z CV-BP chg.,dysrhythmias, boundingpulses

z Pulm.-pleural effusion,hypoxia, hypoventilation

z Renal-dec. RBF, brownurine, dec. output, inc.urine bilirubin andurobilinogen

z Dermatologic- spiderangiomata, palmarerythema, vascular spiders,pruritus, jaundice

z Neurologic-personalitychanges, disorientation,sensory alterations,asterixis, peripheral nervedegeneration, coma,kernicterus

Multisystem Liver FailureEffects

z Hematologic-bruising,nosebleeds, petechiae,thrombocytopenia, anemia

z Neurologic-personalitychges., disorientation,sensory alterations,asterixis, peripheral nervedegeneration, coma,kernicterus (neonates)

z Fluid/electrolytes-ascites,hypokalemia,hypocalcemia,hypomagnesemia,dilutional hyponatremia,inc. ammonia

z GI-esophageal and rectalvarices, clay coloredstools

z Endocrine-gynecomastia,testicular atrophy

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Jaundice, Melanin

Telengectia

Jaundiced Sclera

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Bilirubinuria, Proteinuria

Ascites

Caput Medusae

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Caput Medusae, Portal HTN

Pitting Edema

Pitting Edema

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Pitting Edema

Gynecomastia

Gynecomastia

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Liver Palms

Spider Nevi

Spider Nevi

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Diagram