Formulate – Complications of Liver Cirrhosis (Nursing)

by Rhonda Lawes

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    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 Is 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 a citis.

    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 patience.

    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.

    About the Lecture

    The lecture Formulate – Complications of Liver Cirrhosis (Nursing) by Rhonda Lawes is from the course Liver Cirrhosis (Nursing).

    Included Quiz Questions

    1. Increased breast tissue in males
    2. Edema in the peripheral extremities
    3. Yellow discoloration of the skin
    4. Redness around the outer edge of the palms
    5. Dilated blood vessels all over the body
    1. Reduced appetite
    2. Faster metabolism because of higher metabolic demands
    3. Malabsorption of nutrients
    4. Increased protein metabolism
    5. Increased bile production
    1. The client could have body-image insecurities.
    2. Gynecomastia can be very painful and uncomfortable.
    3. The client's other symptoms are more severe than gynecomastia.
    4. Gynecomastia is treated independently from liver disease.
    1. Increases the risk of bleeding
    2. Increases the client's appetite
    3. Decreases swelling
    4. Decreases the production of ammonia

    Author of lecture Formulate – Complications of Liver Cirrhosis (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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