Cirrhosis for Certified Emergency Nursing (CEN)

Cirrhosis

Definition/Etiology:

Scarring or fibrosis of the liver

• develops after a long period of inflammation
• replacement of the healthy liver parenchyma with fibrotic tissue and regenerative nodules
• Leads to portal hypertension

Causes:

• Obesity
• non-alcoholic fatty liver disease
• high alcohol consumption
• Viruses (hepatitis B/C), parasites
• drug-induced
• autoimmune diseases
• cholestatic diseases
• Genetics
  • Hemochromatosis/Wilson’s disease – iron or copper overload

Clinical Presentation:

• Fatigue, weakness, and weight loss
• Late stage – jaundice (yellowing of the skin), gastrointestinal bleeding (esophageal varices), abdominal swelling, confusion

Esophageal varices are a life-threatening complication of liver cirrhosis and portal hypertension

• Definition – Bleeding from distended blood vessels in the esophagus and stomach, usually secondary to liver disease
• Diagnostics – Coagulation panel, hepatic function studies, Upper GI endoscopy, Abdominal US or CT
• Interventions – Treat hypovolemic shock with IV fluid, blood product administration, Caution with insertion of gastric tube, Endoscopic procedures to control bleeding
  Use of Sengstaken-Blakemore tube, Minnesota tube, or Linton-Nachlas tube to tamponade bleeding

Collaborative Management:

• Liver function tests, ammonia level, coagulation profile
• Hemodynamic status
• Breath sounds and pulse oximetry
• Cardiac rate and rhythm
• Pain relief
• Gastric emesis for blood
• Check for tarry appearance and/or occult blood
• Hemoglobin and hematocrit
• Serum electrolytes
• Arterial blood gases