...deterioration, and showing signs of cirrhosis, F.C. is in a very dangerous position. It is concerning that he was found to have a .18 BAC because this is a potentially fatal level of alcohol in the blood (Be Responsible About Drinking, 2013). Some common manifestations of alcoholic cirrhosis that F.C. may experience include weight loss, loss of appetite/energy, edema/ascites, mood changes, and jaundice (WebMD 2012). Of these symptoms, ascites and jaundice are both secondary from hepatocellular failure, and weight loss and ascites are also secondary symptoms to portal hypertension (Copstead, pgs. 756-759). Unfortunately, with cirrhosis and portal hypertension also typically comes gastric or esophageal varices. These varices are pathways that open up when portal pressure becomes too high in order to redirect the blood flow back to the heart. When these pressures rise and these varices open up, it leaves the lining beneath the mucosa very susceptible for rupture, leading to major bleeding. Since F.C. has already had several incidents with GI bleeding, he is at an even greater risk for re-bleeding (Copstead, pg. 761). F.C’s mental deterioration is most likely caused by a disorder called hepatic encephalopathy. When cirrhosis occurs, the parts of the liver cannot function the way that they are supposed to. Since once of the major jobs of the liver is to clean out, or “detox” the blood, this function can be inhibited or even stopped if cirrhosis becomes too severe. When the blood...
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...the Disease and Pathophysiology 1. The liver is an extremely complex organ that has a particularly important role in nutrient metabolism. Identify three functions of the liver for each of the following: • Carbohydrate Metabolism Glucogensis, gluconeogensis, oxidation via TCA cycle, glycogenolysis, glycolysis • Protein Metabolism Synthesis of serum proteins, synthesis of prothrombin, globin of hemoglobin, apoferritin, nucleoproteins and serum mucoprotein, degradation of some proteins to peptides and amino acids, synthesis of urea • Lipid Metabolism Lipogensis, lipolysis, saturation/desaturation, ketogenesis, esterification of fatty acids, fatty acid oxidation, uptake/formation/breakdown/esterification/excretion of cholesterol. Formation of lipoproteins • Vitamin and Mineral Metabolism Formation of acetyl CoA from pantothenic acid, hydroxylation of vitamin D to 25‐OH D3, formation of 5‐methyl tetrahydrofolic acid, methylation of niacinamide, phosphorylation of pyridoxine, dephospsorylation of thiamin, formation of coenzyme B12 2. The CT scan and liver biopsy confirm the diagnosis of cirrhosis. What is cirrhosis? • Cirrhosis is any pathological condition where fibrous connective tissue replaces healthy tissue in an organ, usually as a consequence of inflammation or other injury. 3. The most common cause of cirrhosis is alcohol ingestion. What are additional causes of cirrhosis? What is the cause of this patient’s cirrhosis? • Other causes of cirrhosis are Hepatitis B...
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...Estimates of NAFLD occurrence vary between 20 and 30%, rising up to 90% in morbidly obese individuals (Dowman et al., 2009). Prolonged NAFLD may lead to irreversible liver damage, which is a medical emergency. Being aware of NAFLD and the complex multi-hit pathophysiology is critical to appropriately caring for these patients in the hospital setting. NAFLD patients who are at risk must be identified when hospitalized and require an individualized plan of care due to their altered hepatic metabolism. Patients that are at risk for developing NAFLD include those with a history of gastric bypass surgery, high cholesterol, elevated triglycerides and type-2 diabetes (Dowman et al., 2009). Patients identified with NAFLD need to be treated early to prevent inflammation and cirrhosis of the liver. Roughly 10%-29% of patients with NAFLD will develop some type of cirrhosis within 10 years. (Hassan, Bhalla, Ezz El Regal, & A-Kader, 2014) Review of Pathophysiology of...
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...Hepatic Encephalopathy Name________ Directions: Gender: Male Age: 47 Setting: Hospital Ethnicity: African American Preexisting Conditions: Cirrhosis secondary to alcohol hepatitis, hypertension, esophageal varices Coexisting Conditions: Disability: Unemployed (on disability) for past four years Socioeconomic: Married, father of two boys (ages 19 and 17 years old), history of drinking one quart of hard liquor each day for three years prior to diagnosis of cirrhosis Pharmacologic: Lactulose (Cephulac), neomycin sulfate (mycifradin sulfate) Client Profile: Mr. Escobar is a 47-year old male with a history of cirrhosis. He lives with his wife and teenage sons. His wife brought him to the emergency department today because she noticed that her husband had increasing confusion and lethargy and was having difficulty walking. His wife states, “ He is probably acting a little fun because he is sleep deprived. He hasn’t slept very much in the past few days.” Case Study: Mr. Escobar is afebrile. His blood pressure is 136/68, pulse 88, and respiratory rate 18. His oxygen saturation is 98% on room air. He is awake, alert, and oriented to person only. His speech is slow and he appears tired. The nurse notices a foul odor to his breath. Upon physical examination, he is found to have a slightly distended abdomen. The health care provider (HCP) does not note any asterixis. The HCP requests an abdominal ultrasound, which reveals fatty infiltration of the...
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...Case Study #1 F.C. is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 0.18. F.C.’s family reports that his mental functioning has deteriorated significantly over the past few months. 1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to hepatocellular failure? Which are secondary to portal hypertension? Some of the more common manifestations or signs and symptoms of alcoholic cirrhosis are vomiting, fever, nausea, jaundice and portal hypertension all of which can damage the body over time. Jaundice is secondary to hepatocellular failure, with the decrease and destruction of these cells the bilirubin is unable to be processed correctly. Portal hypertension is mainly caused by cirrhosis in which the vomiting and nausea are secondary due to this. These symptoms are manifested due to the tightening of the portal vein leading to the liver thus causing an increase in overall pressure and vascular resistance being key factors in the manifestations. 2. Why is F.C. at particular risk for GI bleeding? F.C is at particular risk...
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...has frequent bouts of gastrointestinal bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 0.18. F.C.’s family reports that his mental functioning has deteriorated significantly over the past few months. Discussion Questions 1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to hepatocellular failure? Which are secondary to portal hypertension? - The effects of alcohol depend on the level of alcohol consumption and how long the person has been drinking alcohol as well. Common manifestations of alcoholic cirrhosis vary however jaundice, vomiting, fever, nausea and portal hypertension are the most common symptoms. Jaundice is a symptom that is secondary to hepatocellular failure. When jaundice occurs, the bilirubin metabolic cycle is impaired due to the breakdown of cells within the liver tissue. The destruction of these cells enables bilirubin to decrease and not be inherited correctly. Portal hypertension is caused cirrhosis. Vascular resistance and blood flow play an essential role in the development. The complication arises as a massive upper gastrointestinal hemorrhage. Vomiting and nausea are secondary to portal hypertension...
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...Hepatic Encephalopathy Raven Dunn, SRN Augusta Technical College Adult Nursing II RNSG 2210 Ms. Kandace Chariff, BSN, MSN July 23, 2012 Table of Contents Abstract Page 3 Case Study Etiology and Pathophysiology Page 4 Clinical Manifestations Page 5 Diagnostic Findings Page 7 Treatment and Nursing Interventions Page 7 Patient Presentation Page 8 Conclusion Page 9 References Page 10 Appendix I Page 11 Appendix II Page 11 Appendix III Page 12 Appendix IV Page 13 Appendix V Page 13 Appendix VI Page 16 Abstract This paper will focus on the clinical manifestations of hepatic encephalopathy and its effects on Mrs. X. She is a 64 year old female who has been an alcoholic for more than 40 years. The constant abuse of alcohol has left her with cirrhosis of the liver. One problem of cirrhosis is the inability of the liver to filter ammonia. When the levels of ammonia build up in the body, it affects various organs and systems. In Mrs. X’s case, it affected her brain. She manifested impaired cognitive abilities as well as physical limitations. This case study will expand on these processes as well as her prognosis and nursing implications. Hepatic Encephalopathy Mrs. X is a 64 year old white female and was a functional alcoholic and smoker for more...
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...Pathophysiology II Digestion/Hepatic Case Study Worth 15 pts; July 15, 2014. Name: ___________________________ Directions: Please read the following scenarios and answer the questions that accompany each. Use complete sentences when answering your questions. You will likely need to use your textbook, the class BB site, additional web sites, and your own analytical skills to answers these questions in full. No two people should turn in word for word answers even if you are in the same group. Likewise, information found in resources other than your brain, should also not be copied word for word, but should be rephrased in your own word. Word for word copying in either case will count as plagiarism and no points will then be given for the assignment. Please TYPE out your answers on a separate sheet of paper. Case 1 (7.5 pts) S.M., a young woman in her twenties arrives at your clinic complaining of feelings of pyrosis in her neck, shoulders and jaw. She has had difficulty swallowing her food lately. She self-reports as a smoker. She also reports that she has a low alcohol intake but does drink two or more cups of coffee a day. She is six months along in her first pregnancy. She has a BMI of 22, her BP is 145/90 and her temperature is 37.7oC. Her only reported medications are vitamin C and prenatal tablet supplements daily. Her reported occupation is as a waitress. 1. Give a possible diagnosis for S.M.’s clinical presentations, explaining which symptoms...
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...1. The common manifestation of alcoholic cirrhosis is the final stage of liver failure. For the liver to get to this last stage, a constant and prolonged consumption of alcohol intake is necessary. The chemical reaction that is involved with the breakdown of alcohol causes the liver to metabolize fat or glucose in a different way. Allowing the liver to build up glucose (fat) in a way that leads the liver cells to be scarred over an extended time frame. As the liver continues to replace healthy cells with scarred cells, the blood supply within the liver is decreased. Which is a symptom that causes portal hypertension. 2. The bleeding can be a result of constant vomiting from the overly high blood alcohol content. Which will cause tears through out the stomach and the esophagus and produce bleeding in the gastrointestinal tract. Another cause of the bleeding could be from gastritis, which is the stomachs inability to keep its lining. Which left unprotected can cause the acid in the stomach to eat away over the years. 3. Alcohol has a huge effect on mental impairment, causing blurred vision, slurred speech, difficulty walking, and slow reaction speed. The constant day to day drinking, along with blackouts and memory loss could be the cause of his mental deterioration. Medical management of the patient would include checking the patient into a rehab center. This will cause the patient to go through withdrawals of the substance to help him get back to a normal healthy state...
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...Unit 5: Hepatic/Pancreatic Dysfunction * Functions of the liver * Metabolism of carbohydrates * Glucose energy * Dysfunction = fatigue * Metabolism of proteins * Proteins muscle * Dysfunction: weak, tired, fatigue, lethargic * Metabolism of fats * Dysfunction: atherosclerosis/ N&V * Production of bile: helps metabolize fats * Synthesis of blood clotting factors * Dysfunction: increased risk for bleeding * Blood storage: holds 400 ml – loss of blood and will put into system * Filters blood: decrease infections – remove bacteria from system * Metabolism of medications * Dysfunction: can’t metabolize and get hepatotoxicity * Hepatitis A * Transmission: Fecal-oral route * Wash veggies b/c migrant workers use fields as bathrooms * Occurrence * Poor hygiene * Improper handling of food * Poor sanitation * Foods or water in third world country * Risk Factors * Close personal contact/ handling feces contaminated waste * Animal workers/handlers from endemic areas * Handling food * Day care center workers * Seafood – clams & muscles * Natural Course * Does not progress to chronic state * Symptoms resolve...
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...potentially cause death. Hepatitis B has infected over 200 billion people worldwide and killed over one million individuals per year (Centers for Disease Control and Prevention [CDC], 2013). The hepatitis B virus (HBV) can be prevented through education, spreading awareness and getting vaccinated which provides a lifetime of protection. Description of Hepatitis B Hepatitis B is a viral infection that is caused by the hepatitis B virus (HBV). It attacks the liver and can cause both acute and chronic disease. Acute HBV lasts less than six months and ones immune system is able to fight and clear the infection. Chronic HBV lasts longer than six months and the immune system is unable to fight the infection leading to liver failure, cancer or cirrhosis. Occasionally chronic HBV can go undetected for years due to a person being asymptomatic (Mayo Clinic, 2011). Mode of Transmission In highly infected areas of the world, HBV is most commonly spread from mother to her baby at birth or from person to person in early childhood (World Health Organization [WHO], 2013). The HBV is also spread via parenteral contact with infected blood or blood products, sharing of or accidental needle sticks and having unprotected sex with someone who’s blood, saliva, semen or vaginal secretions are infected and enter your body (Copstead and Banasik, 2010). Signs and Symptoms Signs and symptoms of HBV may never appear or appear over a two to six month period. Signs and symptoms include abdominal pain...
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...contact with semen, vaginal secretions or blood of the infected person. It is of very high occurrence in drug users as they share needles and syringes contaminated with infected blood and do not think about how risky this behavior can be towards their health. Mothers can also pass this virus to their babies at childbirth but the newborns can be vaccinated to avoid getting infected in almost all cases. There are many symptoms of this disease like mild or severe abdominal pain, itching, fever, dark colored urine, high fever, nausea, feeling weak and tired, vomiting, skin turns yellow, fluid in abdomen and web of swollen blood vessels in the skin. Hepatitis B can cause many complications that can sometime lead to death too. Most common is the cirrhosis of the liver, which is the scarring of the liver and because of this liver cannot function properly. People infected with this virus can also have high incidence of liver cancer, primary hepatocellular carcinoma. It can also lead to other impairments in the body like kidney failure and anemia. Medical advancements have come up with many cures to help someone infected with this disease. There...
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...injury Hepatitis Most common cause for liver inflammation is viral infection Acute Infection: * Inflammation causes damage liver cell and may develop into hepatic cell necrosis. * If there are no complications, the liver cells can regenerate and regain its normal appearance and function. Chronic Infection: * Last longer than 6 months * May persist for years * Continuous inflammation and damage done to the liver will slowly develop into liver cirrhosis, then liver failure, and then liver cancer. Clinical Manifestations: Acute Phase: 1-4 Months: Icteric Phase * Jaundice begins * Clay Color stools Convalescence Phase: Post-Icteric phase (healing phase) * Jaundice starts to disappear * Last about 2-4 months. * Major complaint is easy fatigue and malaise. Priority Nursing Diagnosis: * Activity Intolerance r/t decrease physical energy and strength. Recovery Phase: Most patients recover completely Chronic Infection/Condition: * Develops into: Chronic hepatitis, Cirrhosis, Hepatic Failure, Heptocellular cancer Assessment: Health History: * Medications: Some medications that can be toxic to the liver Physical Assessment: * Normal liver cannot be palpated * Percussion is used to determine if the liver is normal size. (8 to 10cm) Diagnosis: Liver Enzyme: * Elevated ALT and GTT * Alk Phos will be elevated. * Damaged liver cells release alk....
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...Culture & Disease Paper Dipali Patel HCS 235 July 09, 2012 Culture & Disease Paper Hepatitis is a viral disease that affects people of all ethnic groups, races and various religious backgrounds. However, compared to the other racial or ethnic groups’ Asian population are more likely to be a higher risk to inheriting the disease than any other racial or ethnic group. The subject of discussion in this paper is how Hepatitis propagates making the Asian population in particular at risk to this disease (U.S. National Library of Medicine, 2012). What is Hepatitis? Hepatitis is the swelling of the liver that makes it to stop working well. There are five main types of known Hepatitis, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D and Hepatitis E (U.S. National Library of Medicine, 2012). Liver is organ of the body that is responsible for the variety of functions such as Detoxifications, store vitamins, maintain production of the biochemical needed by one’s body for digestion, and maintain the proper glucose levels in the body. The liver is also responsible in production of certain hormones required by the human body, and production of urea the main substance present in the urine. Hepatitis is a viral infection caused by a virus that attacks the liver leading to inflammation and demising its ability to perform the...
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...“HEPITITIS B VIRUS” Daniella Braude CAUSE The Hepatitis B virus is the most common liver infection in the world and is caused by the hepatitis B virus. The hepatitis B virus enters the body and travels to the liver via the bloodstream. In the liver, the virus attaches to healthy liver cells and multiplies. This replication of the virus then triggers a response from the body’s immune system. People are often unaware they have been infected with the hepatitis B at this stage. The liver is the main site of hepatitis B viral multiplication. Hepatitis B infection can lead to cirrhosis, liver cancer or liver failure if it is not diagnosed and managed. [1] TRANSMISSION Hepatitis B is found in blood and body fluids including saliva, semen, vaginal secretions and breast milk. The most common ways hepatitis B is spread include sexual contact, sharing of injecting equipment, needlestick injuries in the health care setting, reuse of unsterilised or inadequately sterilised needles, child-to-child transmission through household contact such as biting, sharing personal items such as razors, toothbrushes or nail clippers and Mother passing on to child. [2] HOST RESPONSE When a person is first infected with the hepatitis B virus, this is called an “acute infection.” Most adults will fight off the virus, and recover without any problems. If the virus remains in the blood for more than six months, a person is then...
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