Filtration – Complications of Liver Cirrhosis (Nursing)

00:00 Now we're ready for the second F word in talking about cirrhosis.

00:04 Filter.

00:06 A liver that suffered from cirrhosis doesn't filter as efficiently as a liver that's normal and healthy.

00:12 So we talked about filtering mean the breaking down of things.

00:16 For example as blood passes through the liver, it should filter out medications and things like alcohol and caffeine and toxins made by our body.

00:26 When you can't filter well, you end up jaundice and even have things like hepatic encelopathy.

00:31 So don't worry, we're going to break those down in detail, but I just want you to keep the framework, the first F word when it comes to cirrhosis is Flow.

00:40 The second F word is Filter.

00:44 Now, I want to talk about hepatic encephalopathy because I think medical terminology is so important.

00:50 Encephalopathy were talking about your brain hepatic means the liver has caused it.

00:57 So this is a problem with your brain, encephalo, to the central nervous system, pathy meaning disease, and hepatic caused by the liver.

01:07 So the cause of hepatic encephalopathy is elevated ammonia levels.

01:13 That means that the liver is unable to metabolize, ammonia and turn it into urea that the excreted from the body.

01:21 So you end up with high ammonia levels in the blood.

01:26 The problem with high ammonia levels in the blood is that ammonia is neuro toxics.

01:32 So ammonia is a toxin that's normally cleared from the liver.

01:36 Take a look at your brain right there.

01:38 The reason we have that there is because we want to focus you on the impact of the liver on your brain.

01:45 If the liver is unable to filter, that second F word, that ammonia by turning it into urea to get it out of your body.

01:54 You're going to end up with some serious neuro changes.

01:57 Now it can be a pretty wide rate of changes and decline in brain function.

02:02 So I want to give you kind of a list there and we've put it up there for you on your screen.

02:07 It can range from the person just not acting themselves, we call those personality changes, to not being able to think clearly, that's intellectual impairment.

02:17 Now, they can't remember things. I can't pull up words.

02:20 They can't remember where they put something or where they need to be.

02:25 Those are kind of the beginning signs, but it can progress up to seizures, loss of consciousness, coma and death.

02:34 So when the liver can't filter out the ammonia by turning it into urea you can end up with incredible risk of neurotoxicity.

02:43 Now, let's look at a really unusual sign of asterixis.

02:46 Now I want first of all, let's talk about what it is when a patient's hand is extended and the hands kind of tremor.

02:52 It's also called a flapping trimmer.

02:54 Now, there's other things that can cause this sign but it always leads to toxicity, okay? This one in relation to those high levels of ammonia is caused by an abnormal function and the diencephalic motor center of the brain.

03:09 That's not as important as you remember when the patient has elevated ammonia.

03:14 We know they can have those slight neurochanges to severe coma and death, but this would be a very noticeable sign for a patient we know has liver damage.

03:25 Remember you have to look at the whole picture of the patient because there's lots of other toxicities that can cause this very unusual response this flapping tremor, but in this case if we know the patient's liver is not functioning well, this would be another way to support the liver damage.

03:45 So we see this with liver disease and it's usually considered to be caused by the inability of the liver to metabolize ammonia to urea.

03:54 So hey, here's what I recommend.

03:56 This might seem weird to you, but try that with yourself.

04:00 Teach your brain, repeat that word asterixis and so you've got that in your mind you remember what that is.

04:08 Now again, we're still in filter.

04:10 We're talking about jaundice.

04:12 Now bilirubin is a yellow pigment that's formed when old red blood cells are breaking down.

04:17 If the liver can't metabolize bilirubin efficiently, they'll be an excess of bilirubin and that gives the eyes and the skin a yellowish tint.

04:26 Now, I know you've kind of been looking at that picture.

04:29 Look on the right side is kind of a pink color, but look on the left side more of a yellowish orange hue.

04:36 Now we can range in patients from really really yellow to almost looking like a pumpkin in the fall festival and look at the eyes, even if the patient has a beautiful skin tone.

04:47 So you can't notice the jaundice as much.

04:50 If you look in their eye, you will see yellow no matter what color their skin is.

04:56 So be on the lookout for jaundice.

04:58 Know that it's a sign that the liver cannot break down those old red blood cells and that's why we have that excess level of bilirubin.

05:07 We also us in our newborn babies, that's because their livers are immature and they have hyperbilirubinemia, but in adults it's a sign of liver that is damaged by cirrhosis.