Nclex 준비 - Liver Cirrhosis

간경변증(Liver cirrhosis)은 간세포의 손상과 염증, 사망으로 인해 간 내부조직이 변성하고 간대혈관이 손상되는 질환입니다. 지속적인 간 세포 손상이 발생할 경우 간세포에 염증이 생기고, 간내부의 섬유화가 진행되면서 간세포가 소멸되고 대체조직인 결절이 생깁니다. 결국, 이러한 조직 변화로 인해 간 기능이 저하되고, 심각하게는 간부전이 발생할 수 있습니다. 간경변증은 전 세계적으로 많이 발생하고 있으며, 간암 발생 위험도가 증가할 수 있습니다. 

간경변증의 주요 원인은 알코올성 간경변증, 바이러스성 간염, 비알코올성 지방간병증, 자가면역성 간질환 등이 있습니다. 또한, 간세포암종, 알파1-안티트립신 결핍증, 유전성 대사 이상 등의 질환에 의해서도 발생할 수 있습니다. 간경변증의 증상은 일반적으로 무증상이거나 가벼운 증상으로 시작하여, 진행되면서 피로, 복통, 체중감소, 가려움증, 발열, 빈혈, 천명감, 간경변증에서는 황달, 혈관 확장 등이 발생할 수 있습니다. 

간경변증의 진단은 혈액검사, 자기공명영상(MRI), 초음파, 전산화 단층촬영(CT) 등을 이용하여 진단할 수 있습니다. 이러한 검사를 통해 간의 형태, 크기, 충전상태, 혈류, 대사작용 등을 파악할 수 있습니다. 또한, 간경변증의 진단은 병력조사, 신체검사, 혈액검사, 자기공명영상(MRI), 초음파, 전산화 단층촬영(CT) 등을 통해 진행됩니다. 

1. Low albumin
- 3rd spacing
- edema
- GI: ascites

• Low Na+ diet

 

2. Low Ca+
- Hypocalcemia
- Osteoporosis or fracture

3. Low plateltes
- Bleeding

• Bruising

- low coagulation factor production

• High PT, PTT, INR

4. Low RBC volume
- Anemia
- High Bilirubin (dead RBC)

• Jaudice (yellow skin)

5. Low WBC
- infection

6. Hyerlipidemia or HTN
- Portal HTN
- Esophageal Varices

• No NG tube

- No bile: increased cholesterol

7. Glucose
- elevated glucose level

8. Increased Ammonia
- Hepatic Encephalopathy
- Mental status change: Fatigue, confusion or sleepiness
- muscle twiching or tremor

• Assessment: “extend arms”
• Limit protein diet

9. Drug toxicity
- avoid Acetaminophen (Tylenol)
- elevated ALT & AST

10. Pruritus

https://youtu.be/gq14q3gDpfQ