Formulate – Complications of Liver Cirrhosis (Nursing)

00:01 So now we're on the third F.

00:03 We did flow, we did filter, and now we're going to do formulate.

00:08 Okay, so now you have decreased synthesis of things, you have decreased synthesis of clotting factors, which leads to bleeding.

00:16 You got decreased synthesis of proteins and proteins are what help us keep fluid in the intravascular space because they attract sodium.

00:24 We've also got issues with malnutrition.

00:27 So let's break those down a little more in our following slides.

00:31 So let's start with malnutrition.

00:32 Now malnutrition in a patient with significant liver disease is pretty common.

00:37 And it gets worse as the liver disease becomes more severe.

00:41 So the more intense the liver cirrhosis is the worse the problem is going to be of malnutrition.

00:48 And it's also not a good sign that's an indication that the liver is really struggling in a patient has actually a worse prognosis for talking about mortality, risk for encephalopathy, variceal bleeding and infection.

01:03 So this is not a good sign coming up with a way that the patient can keep enough calories in, to get themselves energy, or require you working with a dietitian and the Whole Health Care team to help your patient stay as healthy as possible.

01:17 Now, we're talking about malnutrition.

01:18 I want you to think about liver cirrhosis and I'm going to talk about late stage liver disease.

01:25 So when you're thinking about cirrhosis and we're talking about malnutrition think about liver cirrhosis and then really severe late stage liver disease.

01:36 Now the reason we have a problem with cirrhosis is because it affects the protein metabolism, one of the functions of the liver.

01:43 Because you've got less liver tissue to deal with that's functional and it also can't change the amino acids the way it normally would when it's healthy.

01:52 Now when we get to late stage liver disease in addition to the problems with protein metabolism.

01:59 Now you've got this hyper metabolism and malabsorption.

02:04 So this is this vicious cycle that somebody was cirrhosis and ends up with.

02:07 In hyper metabolism, which sounds great except they can't absorb the nutrients that they need.

02:13 Remember those nutrients coming back up from the intestines.

02:16 The liver just can't process and store those things and filter them.

02:20 So in this section, we're talking about formulating, we're discussing proteins and its role in malnutrition.

02:28 So people in cirrhosis, they start initially show us signs, but late stage liver disease, they have both the risk of a hyper metabolism the body just needs that energy.

02:40 Plus they can't absorb the nutrients that they are taking in.

02:44 So they've got a malabsorption issues that got altered nutrient metabolism and they just don't feel like eating and without eating they're not going to have the energy stores that their body needs.

02:56 So when you're thinking about patients with cirrhosis, now they're going to have these big bellies, but that's not fat that is ascites.

03:06 So I want you to think about protein, its role in malnutrition and as the disease progresses, hypermetabolism, malabsorption and altered nutrient metabolism.

03:16 Now, we're still in the third F, which is Formulate.

03:19 Remember we talked about those elevated hormone levels of estrogen.

03:23 This is one of the signs.

03:25 Palmar Erythema.

03:26 Now that's a classic sign of liver damage, especially in patients lessen fifty years of age.

03:31 Now, you'll see in our picture.

03:33 The redness is most noticeable around the outer edge of the palm and it goes in a band from the wrist to the small finger.

03:42 Now other causes of palmar erythema include an overactive thyroid or rheumatoid arthritis, but we're focusing on palmar erythema that's caused from an elevated estrogen level due to cirrhosis.

03:55 Now another kind of weird-looking thing on your skin are called spider angiomas, it also goes by the name telangiectasis, now that is a mouthful.

04:06 Telangiectasis that means spider veins telangiectasis is a swollen blood vessel.

04:14 It's found slightly beneath the skin surface, which is why you can see them.

04:18 Now usually has a central red spot and kind of some reddish extensions like you see on the screen there.

04:24 Now those extensions radiate outwards like a spider's web.

04:28 So that's why we call it spider angiomas and because it's much easier to say but remember that fancy word means swollen blood vessels.

04:39 Now most of them have that red dot but there may or may not be a red dot in the center.

04:45 So other names you'll hear them called spider veins, nevus araneus, or vascular spider.

04:52 Those are kind of some funky ones, and you don't really need to write them down if you've got spider in there you'll remember.

04:58 So remember it's this group of small dilated blood vessels that are very close to the skin surface.

05:05 It likely will have a dot in the center, but it may or may not but it appears like a spider's web because the vessels radiate out from the center like you see on our screen.

05:16 Remember these happen with high estrogen levels just like the palmar erythema.

05:22 That's why we're looking at spider angiomas.

05:26 Now we talked about introducing with the certain web, but I also want you to know that they can be red, blue or purple, so if that wasn't enough, there's kind of a little rainbow throw in there if you're assessing those on your patient, if you're not sure that's what it is.

05:41 If you'll apply pressure, they'll disappear and they'll reappear when you release the pressure.

05:46 And they can happen anywhere on the body, but are most often found on the face, the neck and the leg.

05:54 So when you're assessing your patient that you know has liver disease make sure you pay close attention to their skin.

06:00 Look at the palms, look all over their body, but watch for these specifically on the face, neck and leg.

06:07 Because in liver disease, there's usually more than one angioma present.

06:13 Now this is the third problem with elevated estrogen.

06:17 We're still in that formulate talking about the high levels of estrogen but this is gynecomastia.

06:24 Now gynecomastia is an enlargement or swelling of breast tissue in males.

06:29 Take a look at our picture there.

06:31 You see normal and then what it looks like for gynecomastia.

06:35 Now most patients are very unhappy with this side effect.

06:39 And you can imagine why.

06:40 This is a body image thing it doesn't it's very difficult for people to accept.

06:45 So be very patient with your patients and understand while this might not be their biggest problem with liver disease.

06:51 This is very uncomfortable for your patients.

06:54 It's most often caused by male estrogen levels that are way too high or out of balance with their testosterone levels.

07:03 Remember always have to have a balance of estrogen and testosterone in both a male and female body.

07:09 And when estrogen gets too high, and out of balance with testosterone, that's when they'll experience gynecomastia.

07:16 Now, there's other causes of the estrogen imbalance that can cause gynecomastia.

07:21 But remember we're focused on liver cirrhosis, but it can also be caused by obesity.

07:28 So we're thinking about those three things that come from the high estrogen levels.

07:32 Palmar erythema, spider angiomas and gynecomastia.

07:38 Now this last one doesn't really fit in a category, but I wanted to make sure I put it in here again so you focused on it.

07:45 Because there's an increased risk with cirrhosis.

07:47 Now the most common type of primary liver cancer is hepatocellular carcinoma.

07:53 It most often occurs in patients who have some type of chronic liver disease like cirrhosis, Hepatitis B or Hepatitis C.

08:01 So you see there was show you some normal liver cells, then you're starting to experience serosa.

08:06 And then what it looks like it ends stage liver cancer.