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Cirrhosis and failure (Rx (Hepatic failure (Ascites (meds (Loop diuretic…

- - - - maxolon
  - - - sandostatin (octreotide)
      - vasopressin (pitressin)
    - - inflate eso balloon 25-35 mmHg to stop bleeding
      - inflate gastric balloon with 200-250 ml air
    - - gastric aspiration of blood horuly
      - esophageal aspirate for saliva
  - - - bed rest
      - semi fowler for resp distress
      - restrict Na & fluid intake
      - monitor ab girth, body weight, dependent pitting edema
      - meds
        
        Loop diuretic
        
        Lasix
        
        K sparring diuretic
        
        Aldactone
      - monitor hypo Na, K
      - Ab paracentesis
      - albumin infusion
      - TIPS Transjugular intrahepatic portosystemic shunt
    - - RFT
      - strict I/O
      - Hemodialysis
    - - monitor for internal hemorrhage
      - Vit K injection
      - FFP fresh frozen plasma transfusion
    - - supress ammonia releasing, urease release bacteria
        
        meds
        
        osmotic catharsis
        
        lactulose
        
        aminoglycoside
        
        Neomycin
        
        enemas for gut cleansing
    - - sweating
      - hyperventilation
      - increase muscle tone
      - Glasglow coma scale
        
        decerebration, extend abnormally
        
        hypoxia to cerebellum
        
        decortication, abnormal flexion
        
        hypoxia to cortex
      - pupil dilatation
      - apnoea
      - brain herniation
      - intracranial pressure monitor
    - - altered body image
      - loss of self concept
      - loss of cognitive capacity
      - fear of bodily dysfunction
    - - Herbal medicine
      - aroatherapy
      - acupuncture
      - music therapy
- - - - HBV, HCV
    - - alcoholic cirrhosis
      - wilson's disease
      - hemochromatosis
      - drug induced arsenic methyldopa
    - - biliary cirrhosis
    - - veono-occlusive disease,
      - cardiac cirrhosis
- - - - ab pain
        
        dyspepsia
        
        anorexia
        
        weight loss
      - :arrow_down: albumin
        
        ankle edema
      - coagulopathy
        
        epistaxis
        
        bleeding gum
      - insidious onset that takes years
      - fatigue
  - - - obstructed blood flow to liver
        
        portal hypertension
        
        hemorrhoid
        
        esophageal varices
        
        spider angiomata
        
        splenomegaly
        
        pancytopenia
        
        ecchymosis, petechiae
        
        anemia
        
        Ascites
        
        altered bowel function
        
        coagulopathy
        
        GIB
        
        Hematemesis & melena
        
        black tarry stool
        
        old melena
        
        Hepatic encephalopathy
        
        delirium
        
        hepatic coma
        
        staging
        
        subclinical
        
        normal
        
        stage 1
        
        impaired attention, mood change, tremor, uncoordinate movement
        
        stage 2
        
        drowsiness, poor memory, slurred speech
        
        stage 3
        
        confuse and disorent, nystagmus, muscle rigid
        
        stage 4
        
        coma, dilated pupils, stuporous
        
        electrolyte imbalance
        
        hypoglycemia
        
        albumin deficiency
        
        generalized edema
        
        vit A,C,K deficiency
        
        hepatorenal syndrome
        
        renal insufficency
        
        oliguria
        
        ureamia