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Decompensated Hepatic Cirrhosis - Coggle Diagram
Decompensated Hepatic Cirrhosis
INTEGUMENTARY
As liver function decreases, edema begins to occur causing fluid build up in the abdomen and the extremities, mainly the lower extremities. This large accumulation of fluid can lead to a build up of bile salts which will cause massive itching on the skin.
Treatment: diuretics such as Furosemide and Spironolactone
The liver loses its ability to remove excess bilirubin from the blood causing the patient's to appear yellow in color on their skin. This can also be seen in the sclera of the eyes.
treatment: treat the underlying condition
CARDIAC
Hepatic cirrhosis can cause a decrease in the systemic vascular resistance and arterial pressure which then causes a ripple affect that causes an increase in heart rate and cardiac output
An end result of the vascular changes that cirrhosis has on the pulmonary vasculature is hepatopulmonary syndrome causing the vessels dilate
Treatment: liver transplant, Terlipressin and albumin (most important), prostaglandin/dopamine/endothelin receptor blockers
RESPIRATORY
If the disease progresses to loss of hepatic function, the liver is then unable to filter and remove toxins out of the blood which then circulate within the blood stream to other organs of the body.
Toxins in the blood can lead to complications in the pulmonary vasculature such as hepatopulmonary syndrome and portopulmonary hypertension
Hepatopulmonary Syndrome
the pulmonary vasculature becomes dilated which results in low oxygen levels in the lungs.
Symptoms: bradypnea, becoming out of breath during small tasks, and cyanosis in the feet and lip
Treatment: liver transplant
Portopulmonary Hypertension
the pulmonary vasculature becomes constricted which results in an increase in blood pressure within the lungs and can lead to leaky capillaries, pulmonary edema, and circulation issues throughout the lungs
Symptoms: bradypnea, chest pain, dizziness and lightheadedness, and edema in the feet and ankles
Treatment: medication to dilate the blood vessels in the lungs and liver transplant
NERVOUS
Hepatitis cirrhosis can lead to the livers inability to remove ammonia from the body causing it to lead to toxic levels within the circulating blood stream
Hepatic Encephalopthy
High levels of circulating levels of ammonia in the blood causes a decline in brain function
Symptoms: confusion, impaired cognition, and difficulty thinking
Treatment: Lactulose
DIGESTIVE
The ascites that appears with late stages of liver disease is a big factor in how much food a patient with liver disease eats. It can cause a lot of nausea and vomiting, resulting in poor absorption and intake of nutrients
Treatment: diuretics such as Fureosemide and Spironolactone
REPRODUCTIVE
Losing function of the liver from cirrhosis can have effects on hormone release by altering its effects in the body. Some happen to be related to the reproductive system
Hypogonadism
Gynecomastia
An increase in estrogen and androgen ratio
Decrease in testosterone
Impaired estrogen metabolism during cirrhosis and damaged hepatocytes can cause infertility in women and sometimes men.
Sexual dysfunction is very common among people with severe liver disease
Treatment: hormone therapy, liver transplant, treat the underlying condition
URINARY
With the complications of cirrhosis, liver function begins to worsen as well as creating a build up in blood pressure within the portal vein. There is then vasodilation and decreased perfusion to the kidneys resulting in vasoconstriction by the kidneys to compensate and a decreased renal blood flow. This leads to kidney injury.
Hepatorenal Syndrome (HRS)
Occurs in the latest stages of cirrhosis and is mainly caused by impaired circulation to the kidneys. It is somewhat reversible.
Symptoms: confusion, jaundice, nausea, vomiting, dark colored urine, abdominal edema.
Treatment: liver transplant, Terlipressin and albumin (most important), prostaglandin/dopamine/endothelin receptor blockers
MUSCULAR
Cirrhosis having effects on the muscular system directly currently does not have much evidence behind it
However, cirrhosis can cause a lot of gastrointestinal issue's such as anorexia and vomitting and abdominal pain
Treatment: Metoclopramide for heartburn and nausea in people with advanced liver cirrhosis, liver transplant, treat the underlying disease
This can lead to severe weight loss with a lot of abdominal edema.
ENDOCRINE
Cirrhosis has been seen to effect levels of thyroid hormones but there is not a lot of evidence behind it
Growth hormone resistance and a lack of insulin-like growth factor -1 hormone has been seen with patients with cirrhosis. This hormone stimulates growth within the body.
Symptoms: children with short stature, altered lipid levels, and less muscle mass