Cirrhosis, Paracentesis, and Esophageal Varices

Introduction

• Presented by Cathy from Level Up RN
• Discussion on cirrhosis, paracentesis, and esophageal varices
• Includes a quiz at the end
• Recommended to use Level Up RN medical surgical nursing flashcards

Cirrhosis

• Definition: Inflammation of the liver causing destruction and replacement of hepatocytes with scar tissue.

Types and Causes

1. Postnecrotic Cirrhosis
   • Caused by viral hepatitis, toxins, or drugs.
2. Biliary Cirrhosis (Biliary Cholangitis)
   • Damage to bile ducts causing bile backup into the liver damaging hepatocytes.
3. Laennec's Cirrhosis
   • Caused by chronic alcoholism.

Early Signs

• Fatigue
• Hepatomegaly (enlargement of the liver)
• Nausea and vomiting
• Abdominal pain

Late Signs and Symptoms

• Bleeding and bruising (lack of clotting factors)
• Jaundice
• Ascites (fluid buildup in the abdomen)
• Esophageal varices
• Portal hypertension
• Peripheral edema
• Fetor Hepaticus (foul musty breath odor)
• Hepatic encephalopathy (ammonia buildup causing confusion)
• Pruritus (itching)
• Petechiae and spider angiomas
• Palmar erythema (red palms)
• Dark urine
• Clay colored stools

Lab Findings

• Elevated: ALT, AST, bilirubin, ammonia
• Decreased: Serum protein, albumin

Diagnosis

• Gold Standard: Liver biopsy
• Other tools: Ultrasound, CT, MRI

Treatment

• No cure for cirrhosis
• Medications: Vitamin and mineral supplements, diuretics, lactulose
• Procedures: Paracentesis (removing excess fluid), liver transplant

Nursing Care

• Monitor intake and output
• Restrict fluids and sodium
• Measure abdominal girth daily
• Monitor for complications (e.g., encephalopathy, portal hypertension)

Patient Teaching

• Advise low sodium diet
• Encourage small, frequent meals
• Recommend alcohol recovery program if needed

Paracentesis

• Definition: Procedure to remove fluid from the peritoneal cavity using a needle.

Indications

• Used for ascites causing respiratory distress

Nursing Care

• Before Procedure: Ensure informed consent, empty bladder, take vital signs, measure weight and abdominal girth
• After Procedure: Monitor vital signs, weight, abdominal girth, and watch for hypovolemia
• Administer albumin if prescribed

Esophageal Varices

• Definition: Swollen and fragile blood vessels in the esophagus that can hemorrhage

Risk Factor

• Portal hypertension

Symptoms of Hemorrhage

• Hypotension
• Tachycardia

Treatment

• Medications: Vasoconstrictors, non-selective beta blockers
• Procedures: Endoscopic sclera therapy, band ligation

Quiz

1. Key cause of Laennec's Cirrhosis
   • Answer: Chronic alcoholism
2. Medication that removes excess ammonia
   • Answer: Lactulose
3. Pre-procedure requirement for paracentesis
   • Answer: Empty the bladder

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