Medical Surgical Nursing - I
UNIT: IV -Nursing Management of Patients With Disorder of Digestive System "Cirrhosis of liver"
the topic covers
- the stages, Pathophysiology and clinical manifestation of Cirrhosis of liver
- diagnostic evaluation and complication of Cirrhosis of liver
- medical, surgical and nursing management of patient with Cirrhosis of liver
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism
INTRODUCTION
Cancer is a general term used to refer to a condition where the body’s cells begin to grow and reproduce in an uncontrollable way. Lung cancers are the fourth most common cancer reported in the Indian males.
DEFINITION
Lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body.
CAUSES
The most common causes of fracture include,
I. Tobacco smoke
Tobacco use is responsible for more than one of every six deaths. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer.
II. Secondhand smoke
Passive smoking has been identified as a possible cause of lung cancer in nonsmokers. People who are involuntarily exposed to tobacco smoke in a closed environment (house, automobile, and building) have an increased risk of lung cancer when compared with unexposed nonsmokers.
III. Environmental and occupational exposure
Various carcinogens have been identified in the atmosphere, including motor vehicle emissions and pollutants fromrefineries and manufacturing plants. High levels of radon have been associated with the development of lung cancer, especially when combined with cigarette smoking. Chronic exposure to industrial carcinogens, such as arsenic, asbestos, mustard gas, chromates, coke oven fumes, nickel, oil, and radiation has been associated with the development of lung cancer.
IV. Genetics
Some familial predisposition to lung cancer seems apparent, because the incidence of lung cancer in close relatives of patients with lung cancer appears to be two to three times that in the general population regardless of smoking status.
TYPES OF LUNG CANCER:
1. Small cell lung carcinoma
• Accounts for 15%-25% of lung cancers
• It is most malignant form
• Tends to spread early via lymphatic and bloodstream
• Is frequently associated with endocrine disturbances
• Predominantly central and can cause bronchial obstruction and pneumonia.
2. Non-small cell lung carcinoma
Is further classified by cell type,
Adenocarcinoma
• Most common type
• Accounts for approximately 30%-40% of lung cancers
• More common in women
• Often gas no clinical manifestations until widespread metastasis is present
• Usually begins in mucous glandular tissue, is most commonly located in peripheral portions of lungs.
Squamous cell carcinoma
• Second most common type of lung cancer
• Accounts for 30%-35% of lung cancers
• Is more common in men
• Arises from the bronchial epithelium of the lungs or bronchus, slow-growing cancer that usually begins in the bronchial tubes.
Large cell carcinoma
• The least common form
• Accounts for 5%-15% of lung cancers
• Composed of large sized cells that are anaplastic and often arise in the bronchi, commonly causes cavitation
• Is highly metastatic via lymphatic and blood.
STAGING OF NON-SMALL CELL LUNG C
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism
INTRODUCTION
Cancer is a general term used to refer to a condition where the body’s cells begin to grow and reproduce in an uncontrollable way. Lung cancers are the fourth most common cancer reported in the Indian males.
DEFINITION
Lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body.
CAUSES
The most common causes of fracture include,
I. Tobacco smoke
Tobacco use is responsible for more than one of every six deaths. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer.
II. Secondhand smoke
Passive smoking has been identified as a possible cause of lung cancer in nonsmokers. People who are involuntarily exposed to tobacco smoke in a closed environment (house, automobile, and building) have an increased risk of lung cancer when compared with unexposed nonsmokers.
III. Environmental and occupational exposure
Various carcinogens have been identified in the atmosphere, including motor vehicle emissions and pollutants fromrefineries and manufacturing plants. High levels of radon have been associated with the development of lung cancer, especially when combined with cigarette smoking. Chronic exposure to industrial carcinogens, such as arsenic, asbestos, mustard gas, chromates, coke oven fumes, nickel, oil, and radiation has been associated with the development of lung cancer.
IV. Genetics
Some familial predisposition to lung cancer seems apparent, because the incidence of lung cancer in close relatives of patients with lung cancer appears to be two to three times that in the general population regardless of smoking status.
TYPES OF LUNG CANCER:
1. Small cell lung carcinoma
• Accounts for 15%-25% of lung cancers
• It is most malignant form
• Tends to spread early via lymphatic and bloodstream
• Is frequently associated with endocrine disturbances
• Predominantly central and can cause bronchial obstruction and pneumonia.
2. Non-small cell lung carcinoma
Is further classified by cell type,
Adenocarcinoma
• Most common type
• Accounts for approximately 30%-40% of lung cancers
• More common in women
• Often gas no clinical manifestations until widespread metastasis is present
• Usually begins in mucous glandular tissue, is most commonly located in peripheral portions of lungs.
Squamous cell carcinoma
• Second most common type of lung cancer
• Accounts for 30%-35% of lung cancers
• Is more common in men
• Arises from the bronchial epithelium of the lungs or bronchus, slow-growing cancer that usually begins in the bronchial tubes.
Large cell carcinoma
• The least common form
• Accounts for 5%-15% of lung cancers
• Composed of large sized cells that are anaplastic and often arise in the bronchi, commonly causes cavitation
• Is highly metastatic via lymphatic and blood.
STAGING OF NON-SMALL CELL LUNG C
Liver Cirrhosis - etiology, types, pathophysiology, management - medical and ...VarunMahajani
Liver cirrhosis is a life-threatening, end-stage hepatic disorder that needs emergency and continuous care as per the patient's presentation. this presentation discuss regarding the etiology, types, pathophysiology, clinical symptoms, and medical, surgical, and nursing management of patients with liver cirrhosis. also included the complications of liver cirrhosis and their management
CASE PRESENTATION ONCIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC EN...Akhil Joseph
A DETAIL CASE PRESENTATION ON CIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC ENCEPHALOPATHY AND GRADE II OESOPHAGEAL VARICES WITH CONGESTIVE GASTROPATHY. LIVER CIRRHOSIS AND ALL ITS COMPLICATION IN A PATIENT.
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
Chronic renal failure or chronic kidney disease management, pharmacist role, medical management objectives, goals of the therapy .
What are the risk factors of chronic renal failure, clinical manifestations of chronic renal failure, renal failure complications, pathophysiology of chronic renal failure.
Acute Kidney Failure is a sudden reduction in kidney function that results in nitrogenous wastes accumulating in the blood.
Chronic renal failure is a Progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic, fluid and electrolyte balance fails resulting in Uremia and Azotemia.
Definition, Etiology, Risk Factors, Stages, Clinical Manifestations, Management, Surgical Management, Prevention, Complications. Nursing Management
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Liver Cirrhosis - etiology, types, pathophysiology, management - medical and ...VarunMahajani
Liver cirrhosis is a life-threatening, end-stage hepatic disorder that needs emergency and continuous care as per the patient's presentation. this presentation discuss regarding the etiology, types, pathophysiology, clinical symptoms, and medical, surgical, and nursing management of patients with liver cirrhosis. also included the complications of liver cirrhosis and their management
CASE PRESENTATION ONCIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC EN...Akhil Joseph
A DETAIL CASE PRESENTATION ON CIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC ENCEPHALOPATHY AND GRADE II OESOPHAGEAL VARICES WITH CONGESTIVE GASTROPATHY. LIVER CIRRHOSIS AND ALL ITS COMPLICATION IN A PATIENT.
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
Chronic renal failure or chronic kidney disease management, pharmacist role, medical management objectives, goals of the therapy .
What are the risk factors of chronic renal failure, clinical manifestations of chronic renal failure, renal failure complications, pathophysiology of chronic renal failure.
Acute Kidney Failure is a sudden reduction in kidney function that results in nitrogenous wastes accumulating in the blood.
Chronic renal failure is a Progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic, fluid and electrolyte balance fails resulting in Uremia and Azotemia.
Definition, Etiology, Risk Factors, Stages, Clinical Manifestations, Management, Surgical Management, Prevention, Complications. Nursing Management
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Medical Surgical Nursing - I
UNIT: IV -Nursing Management of
Patients With Disorder of Digestive
System
Cirrhosis of liver
Mrs.SARANYA.R,M.Sc(N),
Associate Professor,
SRM Trichy College of Nursing,
2. OBJECTIVES
At the end of the class the students are able to,
- define Cirrhosis of liver
- List out types of Cirrhosis of liver
- describe the risk factor, etiology of Cirrhosis of liver
- Explain the stages, Pathophysiology and clinical manifestation of
Cirrhosis of liver
- Discuss the diagnostic evaluation and complication of Cirrhosis
of liver
- enumerate medical, surgical and nursing management of patient
with Cirrhosis of liver
3. ANATOMY AND PHYSIOLOGY
The liver is located in the upper right-hand portion of the abdominal
cavity, beneath the diaphragm, and on top of the stomach, right kidney,
and intestines. Shaped like a cone, the liver is a dark reddish-brown
organ that weighs about 3 pounds
4. FUNCTION OF LIVER
Metabolism –Carbohydrate, Fat & Protein
Secretory –bile, Bile acids, salts & pigments
Excretory –Bilirubin, drugs, toxins
Synthesis –Albumin, coagulation factors
Storage –Vitamins, carbohydrates etc.
Detoxification –toxins, ammonia, etc.
5. INTRODUCTION
The word "cirrhosis" is a neologism that derives from
Greek kirrhos, meaning "tawny" (the orange-yellow
colour of the diseased liver).
While the clinical entity was known before, it was
René Laennec who gave it the name "cirrhosis" in his
1819 work in which he also describes the stethoscope.
6. INTRODUCTION
Cirrhosis is a consequence of chronic liver disease
characterized by replacement of liver tissue by fibrous
scar tissue as well as regenerative nodules (lumps that
occur as a result of a process in which damaged tissue
is regenerated, leading to progressive loss of liver
function
7. TERMINOLOGY
• Necrosis. Cirrhosis is characterized by episodes of necrosis
involving the liver cells.
• Scar tissue. The destroyed liver cells are gradually replaced
with a scar tissue.
• Fibrosis. There is diffuse destruction and fibrotic regeneration
of hepatic cells.
• Alteration. As necrotic tissue yields to fibrosis, the disease
alters the liver structure and normal vasculature, impairs blood
and lymph flow, and ultimately causes hepatic insufficiency.
8. DEFINITION
A diffuse process characterized by liver necrosis and
fibrosis and conversion of normal liver architechture into
structurally abnormal nodules that lack normal lobular
organisation. WHO
9. DEFINITION
Cirrhosis of liver is a chronic, progressive disease
characterized by widespread fibrosis (scaring) & nodule
formation.
Cirrhosis occurs when the normal flow of
blood, bile, & hepatic metabolites is altered by fibrosis A
chronic disease of the liver marked by degeneration of cells,
inflammation, and fibrous thickening of tissue. It is typically a
result of alcoholism or hepatitis
10. INCIDENCES
Various types of cirrhosis may occur in different types of
individuals.
The most common, Laennec’s cirrhosis, occurs in 30% to 50%
of cirrhotic patients.
Biliary cirrhosis occurs in 15% to 20% of patients.
Postnecrotic cirrhosis occurs in 10% to 30% of patients.
Pigment cirrhosis occura in 5% to 10% of patients.
Idiopathic cirrhosis occurs in about 10% of patients
11. TYPES
1. Alcoholic cirrhosis- Most common, due to chronic
alcoholism. Scar tissue characteristically surrounds the
portal area.
2. Postnecrotic cirrhosis- There are broad bands
of scar tissue due to late results of acute viral
hepatitis, postintoxication with industrial chemicals.
12. TYPES
3. Biliary cirrhosis- Scaring occurs around bile duct in
liver, Results from chronic biliary obstruction &
infection.
4. Cardiac cirrhosis- Associated with severe right
sided long term heart failure, fairly rare.
13. CAUSES
1. Drugs and toxins
– Alcohol, methotrexate, isoniazid,
– methyldopa
2. infections
– Hepatitis B and C , Schistosoma japonicum
3. autoimmune
– PBC, autoimmune hepatitis, PSC
4. metabolic
– Wilson’s disease, haemochromatosis, alpha
1 antitrypsin, porphyria
14. CAUSES
5. Biliary obstruction
– Cystic fibrosis, atresia, strictures, gall stones
6. vascular
– Chronic right heart failure, Budd Chiari
– syndrome
7. miscellaneous
– Sarcoidosis, intestinal by- pass surgery for
– obesity
8. unknown
– cryptogenic
16. PATHOPHYSIOLOGY
Primary event is injury to hepatocellular elements
Initiates inflammatory response with cytokine
release->toxic substances
Destruction of hepatocytes, bile duct cells, vascular endothelial cells
Repair through cellular proliferation and regeneration
Formation of fibrous scar
18. SIGN AND SYMPTOMS
Hepatomegaly (although liver may also be small)
Jaundice
Ascites
Circulatory changes
Spider telangiectasia, palmar erythema, cyanosis
Endocrine changes
Loss of libido, hair loss
Men: gynaecomastia, testicular atrophy, impotence
Women: breast atrophy, irregular menses, amenorrhoea
19. SIGN AND SYMPTOMS
Haemorrhagic tendency
– Bruises, purpura, epistaxis, menorrhagia
Splenomegaly, collateral vessels, variceal bleeding, fetor
hepaticus
Hepatic (portosystemic) encephalopathy
Asterixis
Other features
– Pigmentation, digital clubbing
Hypertrophic osteoarthropathy
Dupuytren's contracture
20. SIGN AND SYMPTOMS
Nail changes.
Muehrcke's nails - paired horizontal bands separated by normal
color due to hypoalbuminemia (low production of albumin).
Terry's nails - proximal two thirds of the nail plate appears white
with distal one-third red, also due to hypoalbuminemia
Clubbing - angle between the nail plate and proximal nail fold >
180 degrees
21. DIAGNOSTIC EVALUATION
History collection
Physical Examination
Liver biopsy detects destruction and fibrosis of hepatic tissue.
Liver scan shows abnormal thickening and a liver mass.
CT scan determines the size of the liver and its irregular
nodular surface.
22. DIAGNOSTIC EVALUATION
Esophagoscopy to determine esophageal varices.
Paracentesis to examine ascitic fluid for cell, protein, and
bacterial counts.
PTC differentiates extrahepatic from intrahepatic obstructive
jaundice.
Laparoscopy and liver biopsy permit direct visualization of the
liver.
Serum liver function test results are elevated.
23. COMPLICATION
Bruising and bleeding due to decreased production of
coagulation factors.
Jaundice due to decreased processing of bilirubin.
Itching (pruritus) due to bile products deposited in the skin.
Ascites - fluid leaks through the vasculature into the abdominal
cavity.
Esophageal varices - collateral portal blood flow through
vessels in the stomach and esophagus. These blood vessels
may become enlarged and are more likely to burst.
24. COMPLICATION
Hepatic encephalopathy - the liver does not clear ammonia and
related nitrogenous substances from the blood, which are carried to
the brain, affecting cerebral functioning: neglect of personal
appearance, unresponsiveness, forgetfulness, trouble concentrating,
or changes in sleep habits.
Sensitivity to medication due to decreased metabolism of the
active compounds.
Hepatocellular carcinoma is primary liver cancer, a frequent
complication of cirrhosis. It has a high mortality rate.
25. MEDICAL MANAGEMENT
• Diuretic therapy, frequently with spironolactone (Aldactone), a
potassium-sparing diuretic that inhibits the action of aldosterone
on the kidneys. Furosemide (Lasix), a loop diuretic, may also be
used in conjunction with spironolactone to help balance
potassium depletion
• Symptomatic relief measures, such as pain medication and
antiemetics.
• Lactulose. Encephalopathy is treated with lactulose.
• Octreitide If required, octreotide may be prescribed for
esophageal varices.
26. MEDICAL MANAGEMENT
• Minimize further deterioration of liver function through the
withdrawal of toxic substances, alcohol, and drugs.
• Administration of albumin to maintain osmotic pressure.
27. NON MEDICAL MANAGEMENT
• Diet. The patient may benefit from a high-calorie and a
medium to high protein diet, as developing hepatic
encephalopathy mandates restricted protein intake.
• Sodium restriction is usually restricted to 2g/day.
• Fluid restriction. Fluids are restricted to 1 to 1.5 liters/day.
• Activity. Rest and moderate exercise is essential.
29. NON MEDICAL MANAGEMENT
Sengstaken-Blakemore or
Minnesota tube. The
Sengstaken-Blakemore or
Minnesota tube may also help
control hemorrhage by
applying pressure on the
bleeding site.
30. SURGICAL MANAGEMENT
Transjugular intrahepatic
portosystemic shunt may be
performed in patients whose
ascites prove resistant. This
percutaneous procedure
creates a shunt from the portal
to systemic cisculation to
reduce portal pressure and
relieve ascites.
32. NURSING DIAGNOSES
• Activity Intolerance related to fatigue, general debility, and
discomfort
• Imbalanced Nutrition: Less Than Body Requirements related
to anorexia and GI disturbances
• Impaired Skin Integrity related to edema, jaundice, and
compromised immunologic status
• Risk for Injury related to altered clotting mechanisms
• Disturbed Thought Processes related to deterioration of liver
function and increased serum ammonia level
33. PROMOTING ACTIVITY TOLERANCE
• Encourage alternating periods of rest and ambulation.
• Maintain some periods of bed rest with legs elevated to
mobilize edema and ascites.
• Encourage and assist with gradually increasing periods of
exercise.
34. IMPROVING NUTRITIONAL STATUS
• Encourage patient to eat high-calorie, moderate-protein meals
and to have supplementary feedings.
• Suggest small, frequent feedings and attractive meals in an
aesthetically pleasing setting at mealtime.
• Encourage oral hygiene before meals.
• Administer or teach self-administration of medication for
nausea, vomiting, diarrhea, or constipation
35. PROTECTING SKIN INTEGRITY
• Note and record degree of jaundice of skin and sclerae and
scratches on the body.
• Encourage frequent skin care, bathing without soap, and
massage with emollient lotions.
• Advise patient to keep fingernails short
36. PREVENTING INJURY THROUGH BLEEDING
• Observe stools and emesis for color, consistency, and amount;
test each one for occult blood.
• Observe for external bleeding: ecchymosis, leaking needle stick
sites, epistaxis, petechiae, and bleeding gums.
• Keep patient quiet and limit activity if signs of bleeding exhibited.
• Administer vitamin K as prescribed.
• Stay in constant attendance during episodes of bleeding.
37. • Institute and teach measures to prevent trauma:
– Maintain safe environment.
– Gentle blowing of nose.
– Use of soft toothbrush.
• Encourage intake of foods with high vitamin C content.
• Use small-gauge needles for injections, and maintain
pressure over site until bleeding stops.
PREVENTING INJURY THROUGH BLEEDING
cont..
38. PROMOTING IMPROVED THOUGHT
PROCESSES
• Restrict high-protein loads while serum ammonia is high to
prevent hepatic encephalopathy. Monitor ammonia levels.
• Protect from sepsis through good hand washing and prompt
recognition and management of infection.
• Monitor fluid intake and output and serum electrolyte levels to
prevent dehydration and hypokalemia (may occur with the use
of diuretics), which may precipitate hepatic coma.
39. PROMOTING IMPROVED THOUGHT
PROCESSES
• Keep environment warm and limit visitors.
• Pad the side rails of the bed and provide careful nursing
surveillance to ensure patient's safety.
• Assess LOC and frequently reorient as needed.
• Administer lactulose (Cephulac) or neomycin (through a
retention enema or nasogastric (NG) tube, as ordered, for
elevated ammonia levels and decreasing LOC.
40. HEALTH EDUCATION
• Stress the necessity of giving up alcohol completely.
• Urge acceptance of assistance from a substance abuse
program.
• Provide written dietary instructions.
• Encourage daily weighing for self-monitoring of fluid retention
or depletion.
• Discuss adverse effects of diuretic therapy.
41. HEALTH EDUCATION
• Emphasize the importance of rest, a sensible lifestyle, and an
adequate, well-balanced diet.
• Involve the person closest to the patient because recovery
usually is not easy and relapses are common.
• Stress the importance of continued follow-up for laboratory
tests and evaluation by a health care provider.
42. BIBLIOGRAPHY
Brunner and suddarth’s (2004) “Text book of medical surgical
nursing”, 10th edition, published by Lippincott Williams and
Wilkins page no. 2079-2087.
Lewis (2002), “Medical surgical nursing”, 6th edition, published
by Mosby page no 1635-1651.
Black .J.M. & Hawks .J.H, (2004), “Medical Surgical Nursing” 7th
edition, New Delhi: Elsevier publication,