NCM 30 Study Guide On The Child
NCM 30 Study Guide On The Child
NCM 30 Study Guide On The Child
CAUSES
• Infection
• Autoimmune (0.6% to 2%)
• Toxic factors (Prolonged exposure to certain types of chemicals and
medications like arsenic, methotrexate, toxic doses of vitamin A)
• Chronic diseases such as hemophilia and cystic fibrosis
• Bile duct disorders such as primary biliary cirrhosis and primary sclerosing
cholangitis.
RISK FACTORS
• Obesity
• Genetic factors
PATHOPHYSIOLOGY:
COMPLICATIONS:
Others:
• Kidney Failure
• Osteoporosis
• Insulin Resistance and Type 2 Diabetes.
• Heart Problems.
CLINICAL MANIFESTATION
• Compensated cirrhosis means that the body still functions fairly well
despite scarring of the liver. Many people with compensated cirrhosis
experience few or no symptoms.
• Decompensated cirrhosis means that the severe scarring of the liver has
damaged and disrupted essential body functions. Patients with
decompensated cirrhosis develop many serious and life-threatening
symptoms and complications.
• Fluid buildup in the legs and feet (edema) and in the abdomen
(ascites). (Ascites is associated with portal hypertension, which is
described in the Complications section of this report.)
• Jaundice. This yellowish cast to the skin and eyes occurs because the
liver cannot process bilirubin for elimination from the body.
Other Manifestations:
• Poor growth
• Muscle weakness
• Lethargy
• Ascites
• Edema
• GI bleeding
• Anemia
• Abdominal pain
DIAGNOSTIC EXAMINATION
• Past health history
• Laboratory evaluation
o Bilirubin
o Aminotransferase
o Ammonia
o Albumin
o Cholesterol
o Prothrombin time
Imaging Tests
o Magnetic resonance imaging (MRI)
***liver biopsy can cause internal bleeding that’s why monitoring vital signs
and laboratory values, especially hematocrit, is very important to check for
any signs of hemorrhage or shock.
Therapeutic Management
• Monitor liver function and manage specific complications such as esophageal
varices and malnutrition
• Nutritional support
• IV fluids
• Blood products
• Vasopressin
• Gastric lavage
• Endoscopic sclerotherapy
Chronic Hepatitis. Many types of antiviral drugs are used to treat chronic hepatitis
B, including pegylated interferon, nucleoside analogs, and nucleotide analogs.
Patients with chronic hepatitis C are treated with combination therapy with
pegylated interferon and ribavarin. [For more information, see In-Depth
MEDICAL MANAGEMENT:
LIVER TRANSPLANT
• Alcohol is restricted.
• To minimize the risk of bleeding, warn the patient against taking non-
steroidal anti-inflammatory drugs, straining to defecate, and blowing his nose
or sneezing too vigorously. Suggest using an electric razor and a soft
toothbrush.
• Advise the patient to take adequate rest because it decreases the metabolic
demands of the liver.
• Teach the patient to have small frequent meals. Teach him to alternate
periods of rest and activity to reduce the oxygen demand and prevent
fatigue.
• Emotional support for the family of the child (to reduce anxiety in
preparation for liver transplantation or unexpected death)