Question

Mrs. Glutton, a 58 year-old female (weight:120 kg),   smoking history: 25 years (two packs per day). She has been drinking alcohol every day since she was 20. She had hepatitis- B  when she was 50 years old. She has a sedentary life because she is obese. Mrs. Glutton; was brought to the hospital with, jaundice, itching, nausea, weakness and indigestion. After physical examination and laboratory examinations (blood and urine), she was admitted to hospital for surgery. Her operation is planned under general anesthesia.

a) What can be the preliminary diagnosis of the patient?

b) What is your reason for making this pre-diagnosis?

c)What might be the significant changes in the laboratory findings of this patient? 

) What are the risks factors in your patient for general anestahesia? Explain how do effect of these risk factors on patient.

e) What can be mojor problems during surgery for this patient?

f) For Mrs. Glutton, in postoperative care, which complications can be occured in respiratory system? What should be your nursing interventions to prevent this complications?

) For which nursing diagnoses or collaborative problems common in postoperative patients has ambulation been found to be an appropriate intervention? (select and explain one by one)

• Impaired skin integrity related to incision
• Impaired mobility related to decreased muscle strength
• Risk for aspiration related to decreased muscle strength
• Ineffective airway clearance related to decreased respiratory excursion
• Constipation related to decreased physical activity and impaired gastrointenstinal (GI) motility
• Venous thromboembolism related to dehydration, immobility, vascular manipulation, or injury

h) Plan the postoperative care and discharge training of Mrs. Glutton

i) Is organ transplantation possible for this patient? Explain the reason of your answer.

Answer 1

Preliminary diagnosis of Mrs. Glutton is Cirrhosis of the liver

Cirrhosis is a difficulty of liver sickness that includes loss of liver cells and irreversible scarring of the liver. Liquor and viral hepatitis B and C are regular reasons for cirrhosis, in spite of the fact that there are numerous different causes. Cirrhosis can cause shortcoming, loss of hunger, simple wounding, yellowing of the skin (jaundice), tingling, and weariness. Determination of cirrhosis can be recommended by history, physical assessment and blood tests, and can be affirmed by liver biopsy.

Cirrhosis is a late phase of scarring (fibrosis) of the liver brought about by numerous types of liver illnesses and conditions, for example, hepatitis and constant liquor abuse.

Each time your liver is harmed — regardless of whether by ailment, over the top liquor utilization or another reason — it attempts to fix itself. All the while, scar tissue structures. As cirrhosis advances, increasingly more scar tissue structures, making it hard for the liver to work (decompensated cirrhosis). Propelled cirrhosis is hazardous.

The liver harm done by cirrhosis by and large can't be fixed. Be that as it may, if liver cirrhosis is analyzed early and the reason is dealt with, further harm can be constrained and, once in a while, switched.

Symptoms

Cirrhosis frequently has no signs or manifestations until liver harm is broad. At the point when signs and side effects do happen, they may include:

• Weariness
• Effectively draining or wounding
• Loss of hunger
• Sickness
• Expanding in your legs, feet or lower legs (edema)
• Weight reduction
• Bothersome skin
• Yellow staining in the skin and eyes (jaundice)
• Liquid collection in your midsection (ascites)
• Spiderlike veins on your skin
• Redness in the palms of the hands
• For ladies, missing or loss of periods not identified with menopause
• For men, loss of sex drive, bosom augmentation (gynecomastia) or testicular decay
• Disarray, sluggishness and slurred discourse (hepatic encephalopathy)

Causes

A wide scope of maladies and conditions can harm the liver and lead to cirrhosis.

A portion of the causes include:

• Interminable liquor misuse
• Interminable viral (hepatitis B, C and D)
• Fat amassing in the liver (nonalcoholic greasy liver infection)
• Iron development in the body (hemochromatosis)
• Cystic fibrosis
• Copper amassed in the liver (Wilson's infection)
• Ineffectively framed bile conduits (biliary atresia)
• Alpha-1 antitrypsin insufficiency
• Acquired clutters of sugar digestion (galactosemia or glycogen stockpiling infection)
• Hereditary stomach related confusion (Alagille disorder)
• Liver ailment brought about by your body's invulnerable framework (immune system hepatitis)
• Annihilation of the bile conduits (essential biliary cirrhosis)
• Solidifying and scarring of the bile conduits (essential sclerosing cholangitis
• Contamination, for example, syphilis or brucellosis
• Drugs, including methotrexate or isoniazid

Risk factors

Drinking a lot of liquor. Over the top liquor utilization is a hazard factor for cirrhosis.

Being overweight. Being fat expands your danger of conditions that may prompt cirrhosis, for example, nonalcoholic greasy liver illness and nonalcoholic steatohepatitis.

Having viral hepatitis. Not every person with incessant hepatitis will create cirrhosis, however it's one of the world's driving reasons for liver ailment.

Complications

Complications of cirrhosis can include:

Hypertension in the veins that flexibly the liver (gateway hypertension). Cirrhosis eases back the typical progression of blood through the liver, hence expanding pressure in the vein that carries blood to the liver from the digestion tracts and spleen.

Growing in the legs and mid-region. The expanded weight in the entry vein can make liquid aggregate in the legs (edema) and in the midsection (ascites). Edema and ascites additionally may result from the failure of the liver to make enough of certain blood proteins, for example, egg whites.

Extension of the spleen (splenomegaly). Entry hypertension can likewise make changes and expanding of the spleen, and catching of white platelets and platelets. Diminished white platelets and platelets in your blood can be the main indication of cirrhosis.

Dying. Entry hypertension can make blood be diverted to littler veins. Stressed by the additional weight, these littler veins can blast, causing genuine dying. Gateway hypertension may cause amplified veins (varices) in the throat (esophageal varices) or the stomach (gastric varices) and lead to perilous dying. In the event that the liver can't make enough coagulating factors, this additionally can add to kept dying.

Contaminations. In the event that you have cirrhosis, your body may experience issues battling contaminations. Ascites can prompt bacterial peritonitis, a genuine contamination.

Ailing health. Cirrhosis may make it progressively hard for your body to process supplements, prompting shortcoming and weight reduction.

Development of poisons in the cerebrum (hepatic encephalopathy). A liver harmed by cirrhosis can't clear poisons from the blood just as a solid liver can. These poisons would then be able to develop in the mind and create mental turmoil and trouble concentrating. With time, hepatic encephalopathy can advance to lethargy or trance like state.

Jaundice. Jaundice happens when the ailing liver doesn't evacuate enough bilirubin, a blood squander item, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and obscuring of pee.

Bone infection. A few people with cirrhosis lose bone quality and are at more serious danger of breaks.

Expanded danger of liver disease. An enormous extent of individuals who create liver malignant growth have prior cirrhosis.

Intense on-constant cirrhosis. A few people wind up encountering multiorgan disappointment. Analysts currently accept this is a particular confusion in certain individuals who have cirrhosis, yet they don't completely comprehend its causes.

Prevention

Lessen your danger of cirrhosis by finding a way to think about your liver:

Try not to drink liquor on the off chance that you have cirrhosis. In the event that you have liver ailment, you ought to keep away from liquor.

Eat a solid eating regimen. Pick a plant-based eating routine that is brimming with products of the soil. Select entire grains and lean wellsprings of protein. Diminish the measure of greasy and singed nourishments you eat.

Keep up a solid weight. An abundance measure of muscle versus fat can harm your liver. Converse with your PCP about a weight reduction plan on the off chance that you are hefty or overweight.

Decrease your danger of hepatitis. Sharing needles and having unprotected sex can build your danger of hepatitis B and C. Get some information about hepatitis inoculations.

Diagnosis

Individuals with beginning period cirrhosis of the liver as a rule don't have side effects. Frequently, cirrhosis is first identified through a normal blood test or exam. To help affirm a determination, a mix of research center and imaging tests is typically done.

Tests

Your PCP may arrange at least one tests that may propose an issue with your liver, including:

Research facility tests. Your primary care physician may arrange blood tests to check for indications of liver glitch, for example, overabundance bilirubin, just as for specific chemicals that may demonstrate liver harm. To survey kidney work, your blood is checked for creatinine. You'll be screened for the hepatitis infections. Your universal standardized proportion (INR) is additionally checked for your blood's capacity to cluster.

In light of the blood test results, your PCP might have the option to analyze the basic reason for cirrhosis. The person can likewise utilize blood tests to help distinguish how genuine your cirrhosis is.

Imaging tests. Attractive reverberation elastography (MRE) might be suggested. This noninvasive propelled imaging test recognizes solidifying or hardening of the liver. Other imaging tests, for example, MRI, CT and ultrasound, may likewise be finished.

Biopsy. A tissue test (biopsy) isn't really required for analysis. Be that as it may, your PCP may utilize it to recognize the seriousness, degree and reason for liver harm.

In the event that you have cirrhosis, your PCP is probably going to prescribe normal indicative tests to screen for indications of malady movement or intricacies, particularly esophageal varices and liver malignancy. Noninvasive tests are getting all the more generally accessible for observing.

Treatment

Treatment for cirrhosis relies upon the reason and degree of your liver harm. The objectives of treatment are to slow the movement of scar tissue in the liver and to forestall or treat side effects and difficulties of cirrhosis. You may should be hospitalized in the event that you have serious liver harm.

Treatment for the hidden reason for cirrhosis

In early cirrhosis, it might be conceivable to limit harm to the liver by rewarding the hidden reason. The choices include:

Treatment for liquor reliance. Individuals with cirrhosis brought about by over the top liquor use should attempt to quit drinking. On the off chance that halting liquor use is troublesome, your primary care physician may suggest a treatment program for liquor fixation. On the off chance that you have cirrhosis, it is basic to quit drinking since any measure of liquor is poisonous to the liver.

Weight reduction. Individuals with cirrhosis brought about by nonalcoholic greasy liver illness may get more advantageous on the off chance that they get more fit and control their glucose levels.

Drugs to control hepatitis. Meds may confine further harm to liver cells brought about by hepatitis B or C through explicit treatment of these infections.

Drugs to control different causes and manifestations of cirrhosis. Drugs may slow the movement of specific kinds of liver cirrhosis. For instance, for individuals with essential biliary cirrhosis that is analyzed early, prescription may fundamentally postpone movement to cirrhosis.

Different prescriptions can soothe certain indications, for example, tingling, weakness and agony. Healthful enhancements might be recommended to counter lack of healthy sustenance related with cirrhosis and to forestall frail bones (osteoporosis).

Treatment for difficulties of cirrhosis

Your primary care physician will work to treat any complexities of cirrhosis, including:

Abundance liquid in your body. A low-sodium diet and medicine to forestall liquid development in the body may help control ascites and expanding. Progressively serious liquid development may expect methods to deplete the liquid or medical procedure to alleviate pressure.

Entryway hypertension. Certain circulatory strain meds may control expanded weight in the veins that flexibly the liver (entryway hypertension) and forestall extreme dying. Your primary care physician will play out an upper endoscopy at normal stretches to search for amplified veins in the throat or stomach (varices) that may drain.

On the off chance that you create varices, you likely will require medicine to lessen the danger of dying. On the off chance that you have signs that the varices are draining or are probably going to drain, you may require a system (band ligation) to stop the draining or decrease the danger of further dying. In extreme cases, you may require a little cylinder — a transjugular intrahepatic portosystemic shunt — put in your vein to diminish circulatory strain in your liver.

Diseases. You may get anti-microbials or different medicines for diseases. Your primary care physician likewise is probably going to suggest inoculations for flu, pneumonia and hepatitis.

Expanded liver malignant growth chance. Your primary care physician will probably suggest occasional blood tests and ultrasound tests to search for indications of liver malignant growth.

Hepatic encephalopathy. You might be recommended meds to help decrease the development of poisons in your blood because of poor liver capacity.

Liver transplant medical procedure

In cutting edge instances of cirrhosis, when the liver stops to work, a liver transplant might be the main treatment choice. A liver transplant is a system to supplant your liver with a solid liver from a perished giver or with part of a liver from a living benefactor. Cirrhosis is one of the most widely recognized purposes behind a liver transplant. Contender for liver transplant have broad testing to decide if they are sufficiently solid to have a decent result following medical procedure.

Generally, those with alcoholic cirrhosis have not been liver transplant applicants as a result of the hazard that they will come back to destructive drinking after transplant. Late examinations, in any case, propose that deliberately chosen individuals with extreme alcoholic cirrhosis have post-transplant endurance rates like those of liver transplant beneficiaries with different sorts of liver sickness.

For transplant to be a choice on the off chance that you have alcoholic cirrhosis, you would require:

To discover a program that works with individuals who have alcoholic cirrhosis

To meet the necessities of the program, which would incorporate long lasting responsibility to liquor restraint just as different prerequisites of the particular transplant community