Liver Cell Failure – Signs of Liver Cirrhosis (Nursing)

00:00 So we spent this first part introducing you to what cirrhosis is in the liver.

00:05 You know, the three main categories of causes are excessive alcohol, excessive weight which leads to non-alcoholic fatty liver disease and chronic hepatitis.

00:15 So any chronic liver disease can essentially end up in cirrhosis, but those are the three most likely causes of the disease process.

00:24 Okay, we had that big list before us and now we're kind of zeroing in on what am I most likely to see in a patient who has pretty significant cirrhosis.

00:33 So let's start at the top and work our way down.

00:37 Now we have the word there that says coma think about what you know about the liver.

00:43 Well when the liver breaks down protein, what could cause coma, well the liver breaks down protein that ends up with ammonia as a waste product which the liver then turns into urea so it can be excreted from the body if the liver is not functioning because it's cirrhotic.

01:01 I'm going to have elevated levels of ammonia which can cause neurotoxicity, seizures coma and even death.

01:10 Another type of neuro event are the asterixis.

01:13 Now, look at that, that's a sign It's kind of called a flapping reflex where the patient put their arms up and tries to lift their hands their hands will do this.

01:22 That is a classic sign of cirrhosis.

01:26 So as far as neuro, we've talked about coma and you want to make sure you've written a note out there about ammonia levels, then you've got asterixis which thoughts that flapping sign you might put that there to remind you.

01:37 Now, let's take about what the patient would look like on the outside.

01:41 Let's look at their skin.

01:42 So you've got spider angiomas on there.

01:45 These are little tiny branch like blood vessels that you can see on the skin, another one of the classic signs of cirrhosis.

01:53 You might see bruising, that's because have a bleeding tendency because your liver is responsible for helping make clotting factors and working with vitamin K.

02:03 If they have cirrhosis, they're going to bruise very easily if they just bump into something with their arm that's going to leave a bruise because they're kind of bleeders.

02:12 Okay, so we've done neuro, we've done what their skin would look like.

02:18 Now we know they're probably going to have some extra fluid around so they're going to be edematous, but also there's some other outward signs.

02:27 Gynecomastia and testicular atrophy.

02:31 Now, these are two things that you're obviously going to see with male patients as it involves the testicles but what this comes from is the liver has a really important role in hormones, and when you have cirrhosis, you end up having higher levels of estrogen and that's why you'll have the atrophy of the testicles and gynecomastia, which is a development of breast on a male body.

02:55 Okay, so we've gone In head-to-toe, what I'd recommend you do is pause the video think through the patient from head-to-toe just talked about and see how many you can remember of the manifestations of cirrhosis in your patient.