Gastroenterology in Critical Care



I. Cirrhosis.
A. A chronic liver disease.
B. Liver cells are destroyed.
C. The cells regenerated but they are fibroid and can't function.

II. Affects.
A. Endocrine.
B. Respiratory (Acites causes shortness of breath.)
C. Liver Cancer incidence increases.
D. G.I

1.Esophageal vericies.
2. Nausea.
3. Ulcers.
4. Hemorrhoids,
5. Peritonitis.
E. Neuro.
1. Hepatic encopholophy.
2. Sensory disturbances from increased amenia and nitrogen.
F. Cardiovascular.
1. Portal Hypertension.
a. Increased blood pressure within the portal vein.
b. Increased resistance causes blood to be rerouted to other vessels which become enlarged and dilated.
c. Can affect the rectal vessels (hemorrhoids)
d. Esophagus vessels (esophageal vericies)
e. Abdominal Vesicles.
f. Vessels can rupture causing bleeding.
2. Acites - caused by portal hypertension.
a. Accumulation of plasma rich fluid in the abdominal cavity.
2. Clotting Factors.
G. Reproductive.
H. Dermatological - itching from bile salts.
I. Spleenomeglia (enlarged spleen)
1. Shunting of blood to the splenic vein.
2. Causes anemia, thrombocytopenia and leukopenia.

III. Four types of Cirrhosis.

A. Lameck Cirrhosis.
1. Associated with alcohol abuse.
2. Most common type.
3. History of high alcohol consumption.
4. Early (Pew symptoms)
a. Fatty Liver - Accumulation of fat which develops.
b. Liver becomes enlarged and tender.
c. Liver can recover if alcohol stopped.
5. Alcohol Hepatitis. (Late Symptoms.)
a. Liver becomes necrosed and fibrosed with bile stasis.
b. Anorexia, Weight loss, jaundice.
c. Acites leading to bleeding.

B. Post necrotic cirrhosis.
1. follows Hepatitis B or C.
2. Predisposition for liver cancer.
3. Cause - use of medications.
a. INH.
b. Methatrerate.

C. Biliary Cirrhosis.
1. Obstruction of the biliary duct system from stones or tumors.
D. Cardiac Cirrhosis.
1. Chronic right sided congestive heart failure causing prolonged elevation of venous pressure and liver congestion.
2. Must treat CHF.
E. Meds are used to regulate protein metabolism.

IV. Diagnosis of cirrhosis.
A. Laboratory
1. Electrolytes.
a. Decreased sodium due to overload of body water and hemodilution.
b. Decreased potassium due to poor intake and/or use of diuretics.
c. Decreased Magnesium and phosphorus.
e. Decreased hemoglobin and hemocrit, anemia.
f. Decreased platelets.
g. Bilirubin is elevated.
h. Albumin is decreased.
i. Ammonia levels are increased - liver can't metabolize.
j. Bleeding time increased.
k. Glucose may be elevated - liver can't perform glucogenisis.
1. Liver enzymes elevated.
B. Ultrasound of liver, liver biopsy, EGD, UGI, may evaluate the extent of liver damage.
C. Liver Biopsy.
1. Review patients platelet count.

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This page last updated 07/25/10