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Pathophysiology, Signs and Symptoms of Liver Cirrhosis
Symptom
Pathophysiology
o
Development of collateral
vessels
\u2013
Esophageal varices
\u2013
Caput medusae
\u2013
Hemorrhoids
o
Portal hypertension
\u2013
Ascites
\u2013
Decreased albumin
production: Anasarca

Hepatomegaly\ue000 obstruction of the portal circulation\ue000 backflow
of blood to:
- esophageal veins\ue000 (rupture possible)
- gastric veins
- anal veins

Increase in hydrostatic pressure\ue000 escape of fluids to the
abdominal cavity
Decrease in colloidal osmotic pressure\ue000 escape of fluids all
around the body
o
Splenomegaly: Pancytopenia
o
Impaired bile synthesis
\u2013
Malabsorption of fat-
soluble vitamins
\u2013
Impaired metabolism of
sex hormones
\u2013
Female: menstrual
disorders
\u2013
Male: testicular atrophy,
gynecomastia
\u2013
Steatorrhea
Due to destruction of the liver, the spleen will compensate leading
to its enlargement\ue000 destruction of RBC, WBC, platelets
Inability of the liver to produce bile\ue000 lack of fatty acids

- inability to transport ADEK
- inability to stimulate Adrenal Cortex\ue000 lack of:
Estrogen and Progesterone\ue000 Amenorrhea
Androgen
Fats goes with the feces

o
Decreased clotting factor
synthesis: Bleeding
tendencies
o
Failure to conjugate bilirubin
\u2013
Jaundice
\u2013
Icterus
\u2013
Tea-colored urine
\u2013
Pruritus
o
Loss of liver glycogen:
Hypoglycemia
o
Loss of detoxification
properties
\u2013
Hepatorenal syndrome:
azotemia
\u2013
Hepatic encephalopathy
Lack of vitamin K for clotting factor synthesis

Inability of the liver to conjugate bilirubin\ue000 increase in total
bilirubin\ue000 ejection of unconjugate bilirubin (dark yellow) in the
blood

Bilirubin ejection can cause drying of the skin\ue000 irritable itchiness
Inability of the liver to store glycogen

Inability of the liver to detoxify ammonia\ue000 build up of ammonia
outside the blood brain barrier\ue000 cerebral dehydration\ue000
symptoms:

1. Asterixis
2.
PANCREATITIS
\u2022
Is acute / chronic inflammation of the pancreas.
Etiology and Incidence:
Cause: Unknown
Predisposing Fators
\u2022
Male
\u2022
Middle-age
\u2022
Medicine / substance
\u2022
Meat /meal intake
\u2022
Midnight attack
Pathophysiology
Manifestations:
\u2022
Abdominal tenderness and distention
\u2022
Abrupt pain
\u2013
burning, stabbing or pressing
\u2013
epigastric area
\u2013
radiates to the shoulder, substernal area, back and flank
\u2013
Relieved knee-chest position
\u2022
Cullen\u2019s sign
\u2013
Sign of hemorrhage
\u2013
Bluish discoloration of the periumbilical area
\u2022
Dyspnea
\u2022
Tachycardia
\u2022
Hypotension
\u2022
Fever
\u2022
Jaundice
\u2022
Nausea and vomitingDisruptions of pancreatic ducts
Spill of pancreatic enzymes
Hemorrhage
Hypovolemic
shock
Neurogenic
shock
Incapacitating
pain
Release of chemical
mediators
Peritoneal
Spill
Peritonitis
Respiratory
Distress
Septic
shock
Autodigestion
Hyperglycemia
Hypocalcemia
\u2022
Pain upon eating
\u2022
Steatorrhea
\u2022
Weight loss
Nursing Interventions:
\u2022
Assess:
\u2013
abdominal, cardiac, and respiratory status
\u2013
fluid balance
\u2022
Monitor and record:
\u2013
vital signs
\u2013
intake and output
\u2013
laboratory studies
\u2013
central venous pressure (CVP)
\u2013
daily weight
\u2013
urine and stool for color
\u2013
blood glucose level
\u2022
Administer the following, as ordered:
\u2022
Demerol for pain. Morphine Sulfate is contraindicated
\u2022
IVF
\u2022
Diet: NPO
\u2022
to rest the pancreas
\u2022
prevent nausea and vomiting.
\u2022
Keep the patient in Semi-Fowler\u2019s position
\u2022
Environment:
\u2022
Quiet
\u2022
Restful
Pathophysiology, Signs and Symptoms of Renal Failure
Excretory Problems:
\ue001Middle molecule accumulation or urea\ue000 trapping of:
\ue001Glucose \u2013 hyperglycemia
\ue001Keratin \ue000sallow, yellow discoloration of the hair; split ends
\ue001Lipids \ue000h y per lipidem ia \ue000a th e ro s c l e r o s i s \ue000ASHD
\u2022
Inability of lipids / fatty acids to stimulate adrenal cortex to release sex hormones\ue000
amenorrhea, infertility, impotence
\ue001Travel of urea around the body:

\ue001Surface to the skin \ue000uremic frost \ue000pr u r i tu s
\ue001Surface to GI tract \ue000PU D \ue000 gastric bleeding
\ue001Surface to pericardium \ue000 pe r c a r di ti s
\ue001Build up outside the blood brain barrier \ue000 CNS depression, psychological changes

\ue001Inability to remove uric acid\ue000 inability of the kidneys to produce HCO3\ue000 metabolic acidosis\ue000
destruction of WBC\ue000 infection tendencies
\ue001Inability to remove uric acid\ue000 GOUT

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