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Cirrhosis - Coggle Diagram

- - - - Why? = Decreased ability to conjugate & excrete bilirubin into the small intestine
    - - Spider Angiomas: Small, dilated blood vessels w/bright red center point & spiderlike branches
        
        Found on nose, cheeks, upper trunk, neck, & shoulders
      - Palmar erythema: Red area that blanches w/pressure
        
        Found on the palms of the hands
      - Why? = Increase in circulating estrogen
    - - Thrombocytopenia, Anemia, & Leukopenia
        
        Why? = Splenomegaly --> Portal hypertension
      - Coagulation Disorders
        
        Why? = No prothrombin production or clotting factors
        
        What do we see?
        
        Epistaxis
        
        Purpura
        
        Petechiae
        
        Easy bruising
        
        Gingival bleeding
        
        Heavy menstrual bleeding
    - - Female
        
        Amenorrhea (young)
        
        Vaginal bleeding (older)
      - Male
        
        Gynecomastia
        
        Why? = Increased estrogen levels
        
        Loss of axillary & pubic hair
        
        Testicular atrophy
        
        Impotence w/loss of libido
      - No metabolism of Aldosterone?
        
        Hyperaldosteronism
        
        Potassium loss
        
        Sodium & Water retention
    - - Common in alcoholic chirrosis
        
        Sensory symptoms
      - Why? = Dietary deficiency of thiamine, folic acid, & cobalamin
  - - - Compensated cirrhosis
        (No obvious complications)
- - - - Why? = Structural changes that lead to obstruction of blood flow
      - Solution = Reduce pressure
        
        Collateral circulation (alternate circulatory pathways)
        
        Anterior abdominal wall
        
        Parietal peritoneum
        
        Rectum
        
        Lower esophagus
    - - Increased venous pressure in portal circulation
      - Splenomegaly
      - Large collateral veins
      - Ascites
      - Gastric & esophageal varices
  - - - WARNING: BLEEDS EASILY!
        
        Why? = Fragile & do NOT tolerate high BP
  - - - Worsening Vasodilation
      - Decreased immune function
    - - Abdominal striae w/distended abdominal wall veins
      - Abdominal distention w/wight gain
        
        Severe: eversion of the umbilicus
      - Dehydration (dry tongue & skin, sunken eyeballs, & weakness)
      - Decrease in UO
  - - - Cerebral depressants
      - Constipation
      - Dehydration
      - GI hemorrhage
      - Hypokalemia
      - Hypovolemia
        
        These factors increase ammonia & may come first!
      - Increased metabolism
      - Infection
      - Metabolic alkalosis
      - Paracentesis
      - Uremia (RF)
    - - Change in neurologic & mental responsiveness
      - Impaired consciousness
      - Inappropriate behaviors
      - Sleep problems - trouble concentrating - deep coma
      - Sudden or gradual
      - ASTERIXIS! (Flapping Tremors)
      - Fetor Hepaticus (Musty, sweet odor of the pt's breath)
      - Apraxia (inability to construct simple figures)
  - - - Portal hypertension & liver decompensation
        
        Splanchnic & systemic vasodilation
        
        Results in renal vasoconstriction & RF
        
        Solution?
        
        Liver transplant
        
        Decreased arterial blood volume
      - Can follow...
        
        Diuretic therapy
        
        GI hemorrhage
        
        Paracentesis