liver cirrhosis and peritonitis | Summaries Nursing

BACCAY, S.J.

Liver Cirrhosis Reviewer

Definition

Cirrhosis is a progressive liver disease characterized by the replacement of healthy liver tissue with scar tissue (fibrosis),

which impairs liver function. It can result from various liver diseases and conditions, ultimately leading to liver failure.

Anatomy and Physiology

●Location: The liver is situated in the upper right quadrant of the abdomen, beneath the diaphragm and above the

stomach, gallbladder, and intestines.

●Lobes:

○The liver is divided into two main lobes:

■Right Lobe: The larger lobe, covering about 60% of the liver's mass.

■Left Lobe: Smaller and extends to the left side of the body.

●Lobules:

○The functional units of the liver are called lobules, which are hexagonal structures made up of hepatocytes

(liver cells) arranged around a central vein. Each lobule contains:

■Sinusoids: Blood vessels that allow blood from the hepatic artery and portal vein to mix and flow

past the hepatocytes.

■Bile Canaliculi: Tiny ducts between hepatocytes that collect bile produced by the liver.

●Blood Supply: The liver receives blood from two main sources:

○Hepatic Artery: Supplies oxygen-rich blood from the heart.

○Portal Vein: Brings nutrient-rich blood from the gastrointestinal tract.

●Connective Tissue: The liver is encased in a fibrous capsule called Glisson's capsule, which helps protect and support

the organ.

Physiology

●Metabolism: The liver is central to metabolic processes, including:

○Carbohydrate Metabolism: Regulates blood glucose levels through glycogenesis (glucose storage) and

gluconeogenesis (glucose production).

○Lipid Metabolism: Synthesizes cholesterol and lipoproteins, and regulates fat storage and breakdown.

○Protein Metabolism: Produces vital proteins, including:

■Clotting Factors: Essential for blood coagulation (e.g., fibrinogen, prothrombin).

■Albumin: Maintains oncotic pressure and transports substances in the blood.

●Detoxification: The liver processes and detoxifies harmful substances, including drugs, alcohol, and metabolic waste

products. It converts these substances into less toxic forms that can be excreted by the kidneys or eliminated in bile.

●Bile Production: The liver synthesizes bile, which is essential for digestion and absorption of fats and fat-soluble

vitamins in the intestines. Bile is stored in the gallbladder until needed.

●Storage Functions:

○Vitamins and Minerals: Stores fat-soluble vitamins (A, D, E, K) and water-soluble vitamins (B12) as well as

minerals like iron and copper.

○Glycogen: Acts as a glucose reserve, converting glycogen back to glucose when needed.

●Immune Function: The liver contains Kupffer cells, which are specialized macrophages that help filter bacteria and

dead cells from the blood, playing a key role in the body's immune response.

Etiology

Cirrhosis can result from:

●Chronic viral hepatitis (HBV, HCV)

●Alcohol abuse

●Non-alcoholic fatty liver disease (NAFLD)

●Autoimmune liver diseases (e.g., autoimmune hepatitis)

●Biliary diseases (e.g., primary biliary cholangitis)

●Metabolic disorders (e.g., hemochromatosis, Wilson’s disease)

●Chronic drug-induced liver injury

Risk Factors

●Lifestyle: Excessive alcohol consumption, obesity, poor diet

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Liver Cirrhosis Reviewer Definition Cirrhosis is a progressive liver disease characterized by the replacement of healthy liver tissue with scar tissue (fibrosis), which impairs liver function. It can result from various liver diseases and conditions, ultimately leading to liver failure. Anatomy and Physiology ● Location: The liver is situated in the upper right quadrant of the abdomen, beneath the diaphragm and above the stomach, gallbladder, and intestines. ● Lobes: ○ The liver is divided into two main lobes: ■ Right Lobe: The larger lobe, covering about 60% of the liver's mass. ■ Left Lobe: Smaller and extends to the left side of the body. ● Lobules: ○ The functional units of the liver are called lobules , which are hexagonal structures made up of hepatocytes (liver cells) arranged around a central vein. Each lobule contains: ■ Sinusoids: Blood vessels that allow blood from the hepatic artery and portal vein to mix and flow past the hepatocytes. ■ Bile Canaliculi: Tiny ducts between hepatocytes that collect bile produced by the liver. ● Blood Supply: The liver receives blood from two main sources: ○ Hepatic Artery: Supplies oxygen-rich blood from the heart. ○ Portal Vein: Brings nutrient-rich blood from the gastrointestinal tract. ● Connective Tissue: The liver is encased in a fibrous capsule called Glisson's capsule, which helps protect and support the organ.

Physiology

● Metabolism: The liver is central to metabolic processes, including:

○ Carbohydrate Metabolism: Regulates blood glucose levels through glycogenesis (glucose storage) and gluconeogenesis (glucose production). ○ Lipid Metabolism: Synthesizes cholesterol and lipoproteins, and regulates fat storage and breakdown. ○ Protein Metabolism: Produces vital proteins, including: ■ Clotting Factors: Essential for blood coagulation (e.g., fibrinogen, prothrombin). ■ Albumin: Maintains oncotic pressure and transports substances in the blood. ● Detoxification: The liver processes and detoxifies harmful substances, including drugs, alcohol, and metabolic waste products. It converts these substances into less toxic forms that can be excreted by the kidneys or eliminated in bile. ● Bile Production: The liver synthesizes bile, which is essential for digestion and absorption of fats and fat-soluble vitamins in the intestines. Bile is stored in the gallbladder until needed. ● Storage Functions: ○ Vitamins and Minerals: Stores fat-soluble vitamins (A, D, E, K) and water-soluble vitamins (B12) as well as minerals like iron and copper. ○ Glycogen: Acts as a glucose reserve, converting glycogen back to glucose when needed. ● Immune Function: The liver contains Kupffer cells, which are specialized macrophages that help filter bacteria and dead cells from the blood, playing a key role in the body's immune response. Etiology Cirrhosis can result from: ● Chronic viral hepatitis (HBV, HCV) ● Alcohol abuse ● Non-alcoholic fatty liver disease (NAFLD) ● Autoimmune liver diseases (e.g., autoimmune hepatitis) ● Biliary diseases (e.g., primary biliary cholangitis) ● Metabolic disorders (e.g., hemochromatosis, Wilson’s disease) ● Chronic drug-induced liver injury Risk Factors ● Lifestyle: Excessive alcohol consumption, obesity, poor diet

● Medical history: Chronic viral hepatitis, family history of liver disease ● Age and gender: More common in older adults and men ● Coexisting conditions: Diabetes, hypertension, metabolic syndrome Signs and Symptoms ● Early symptoms: Fatigue, weakness, loss of appetite, weight loss ● Progressive symptoms: ○ Jaundice (yellowing of the skin and eyes) ○ Ascites (fluid accumulation in the abdomen) ○ Edema (swelling in legs and feet) ○ Easy bruising and bleeding (due to coagulopathy) ○ Confusion, altered mental status (hepatic encephalopathy) ○ Spider angiomas (small, spider-like blood vessels on the skin) ○ Palmar erythema (reddening of the palms)

1. Medical History and Physical Examination ● Medical History: Review of symptoms (e.g., fatigue, jaundice, ascites) and risk factors (e.g., alcohol use, viral hepatitis). ● Physical Examination: Assessment for signs of liver disease, such as jaundice, spider angiomas, palmar erythema, and ascites. 2. Laboratory Tests ● Liver Function Tests (LFTs): ○ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST): Elevated levels indicate liver damage. ○ Alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT): Help assess bile duct obstruction. ○ Bilirubin: Elevated levels indicate liver dysfunction. ○ Albumin: Low levels suggest impaired liver function. ○ Prothrombin time (PT) and International normalized ratio (INR): Prolonged PT indicates impaired liver function. ● Complete Blood Count (CBC): Can reveal anemia, thrombocytopenia, or leukopenia. 3. Imaging Studies ● Ultrasound: ○ First-line imaging to assess liver size, surface nodularity, and the presence of ascites or tumors. ● Computed Tomography (CT) Scan: ○ Provides detailed images of the liver and can help identify complications like tumors or portal hypertension. ● Magnetic Resonance Imaging (MRI): ○ Useful for further evaluation of liver lesions and vascular structures. ● Elastography (FibroScan): ○ A specialized ultrasound that measures liver stiffness to assess fibrosis and cirrhosis severity. 4. Liver Biopsy ● Percutaneous Biopsy: ○ Involves taking a small tissue sample from the liver to assess the degree of fibrosis and cirrhosis. It is generally reserved for cases where the diagnosis is uncertain or to assess the severity of liver disease. 5. Endoscopy ● Esophagogastroduodenoscopy (EGD): ○ Performed if portal hypertension is suspected, to check for esophageal varices. Complications ● Portal hypertension: Increased blood pressure in the portal vein can lead to varices (enlarged veins) that can bleed. ● Liver cancer (hepatocellular carcinoma) ● Hepatic encephalopathy: Accumulation of toxins in the brain leading to confusion and altered consciousness. ● Kidney failure: Hepatorenal syndrome may occur. ● Infections: Increased susceptibility to infections, especially spontaneous bacterial peritonitis (SBP). Medical Management ● Medications: ○ Diuretics for fluid retention (e.g., spironolactone) ○ Lactulose for hepatic encephalopathy ○ Beta-blockers to reduce portal hypertension ○ Antiviral therapy for viral hepatitis

○ Perforation of a hollow organ (e.g., bowel, stomach) ○ Trauma or injury to the abdomen ○ Post-surgical complications (e.g., after abdominal surgery) ○ Ascites (fluid accumulation) leading to spontaneous bacterial peritonitis (SBP) Risk Factors ● Pre-existing conditions: Liver cirrhosis, kidney disease, or inflammatory bowel disease (IBD) ● Immunocompromised state: Conditions that weaken the immune system (e.g., diabetes, cancer) ● Previous abdominal surgeries: Increased risk of adhesions and complications ● Peritoneal dialysis: Increased risk of infection Signs and Symptoms ● Abdominal pain: Often severe and diffuse ● Tenderness: Abdomen may be rigid or distended ● Fever: Elevated temperature indicates infection ● Nausea and vomiting: Common gastrointestinal symptoms ● Change in bowel habits: Diarrhea or constipation ● Altered mental status: Especially in severe cases or in the elderly Diagnostic Procedures ● Physical examination: To assess abdominal tenderness, rigidity, and distension. ● Blood tests: Complete blood count (CBC) to check for elevated white blood cell count indicating infection. ● Imaging studies: ○ Ultrasound: To identify free fluid or abscesses in the abdomen. ○ CT scan: Provides detailed images to locate the source of infection or perforation. ● Peritoneal fluid analysis: ○ Paracentesis: Fluid is withdrawn from the abdominal cavity to analyze for infection (e.g., cell count, culture). ● Laparoscopy: In some cases, a surgical procedure may be performed to directly visualize and treat the cause of peritonitis. Complications ● Sepsis: A systemic inflammatory response that can lead to multi-organ failure ● Abscess formation: Localized collections of pus may develop ● Bowel obstruction: Can occur due to adhesions or inflammation ● Shock: Can result from severe infection or fluid loss Medical Management ● Antibiotic therapy: Broad-spectrum antibiotics to combat infection ● Surgical intervention: May be necessary to remove the source of infection (e.g., appendectomy, drainage of abscess) ● Fluid resuscitation: IV fluids to maintain hemodynamic stability ● Pain management: Analgesics to manage discomfort ● Supportive care: Monitoring vital signs, laboratory values, and overall clinical status Nursing Considerations and Management ● Assessment: Regularly monitor vital signs, abdominal examination findings, and signs of shock. ● Education: Teach the patient and family about signs and symptoms of peritonitis and the importance of seeking immediate care. ● Fluid management: Monitor intake and output, and assess for signs of dehydration or fluid overload. ● Post-operative care: If surgical intervention is performed, monitor the surgical site for signs of infection and promote recovery. ● Psychosocial support: Provide emotional support and resources for coping with illness. Other Important Information ● Diagnosis: Diagnosis typically involves a physical examination, imaging studies (e.g., CT scan), and laboratory tests (e.g., blood cultures, white blood cell count). ● Prevention: Early intervention for abdominal conditions and proper technique during procedures (e.g., dialysis) can help reduce the risk of peritonitis.

liver cirrhosis and peritonitis, Summaries of Nursing

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Physiology

● Metabolism: The liver is central to metabolic processes, including: