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Liver cirrhosis - scarring of the liver Types: Alcoholic Laennec's …

- - - - Tries to heal
        
        Fibriotic tissue
- - - - if ammonia level high do neuro assesment and interventions for safety
        
        1:1
        
        siderails
        
        trip/orientation
      - If high
        
        lactulose
        
        if confused low level of consciouness we give enema
        
        10g/15 ml concnetration
        
        after 7 loose stools hold medication
  - - - normal level: 3.5 - 5.5
        
        when low you give it to replace it
        
        12.g in 50 ml (or in 250 ml)
        
        spike the bottle with special tubing
        
        it's a blood product but obtained at pharmacy
        
        IV site needs to be only albumin or PB with only NS
      - low albumin leads to
        
        peripheral edema
        
        sacral edema common
        
        ascites
  - - - energy
      - ketone bodies
        
        acetone breath
  - - - high: jaundice
  - - - steatorrhea
  - - - up to 16 seconds is normal
        
        When low = give vitamin K (phytonadione)
- - - - can lead to DIC bc of lack of clotting factors
    - - pruritis because of bile crystals under skin
    - - due to ascites or pulmunary edema towards end stage
- - - - Ascites
      - Edema
      - esophageal varices
      - Meds
        
        Diuretics
        
        spironolactone (aldoctone blocking agent)
        
        furosemide
        
        Beta-blocker - reduces portal HTN
        
        Propanolol
        
        inderal
        
        Nitrates
        
        dinitrates (isosorbide) (to prevent vasoconstrition in systemic body
        
        Vasopressin
        
        constrict esophageal varices
        
        Folic acid for anemia
        
        famotidine (H2 blocker receptor to decrease chance of GI bleed)
        
        Thiamine (vit b)
      - Lifestyle
        
        low sodium
        
        bed rest
      - RAAS activated
        
        Renin, ADH, aldosteron
      - Procedures
        
        Parecentesis
        
        TIPS
        
        Peritoneal shunt (for ascites)
        
        blakemore tube
    - - Meds
        
        Lactulose
        
        Decrease ammonia level
        
        metromidazole
        
        rifaximin
        
        neomicyn