Jasmin O.

Dingle BSN-4y1-3C

Etiology of Renal Calculi

The exact cause of kidney stones is unknown, but predisposing factors include the following: (1) Dehydration. Production of smaller amounts of urine promotes kidney stones. Less liquid concentrates calculus-forming substances. (2) Infection. Clumps of bacteria, particularly when stasis or obstruction accompanies infection, can serve as a nucleus for calculus formation. Additionally, infected and damaged tissue serves as a site for calculus development. (3) Obstruction. Components of calculus can collect and adhere, forming calculi (stones) in a patient with urinary stasis; for example, an immobile person with a spinal cord injury. An obstruction also promotes infection with an even greater chance of calculus formation. (4) Metabolic factors. Certain metabolic factors may predispose the formation of calculi. Included are hyperparathyroidism, renal tubular acidosis, elevated uric acid (usually with gout), defective metabolism of oxalate, genetic defect in the metabolism of cystine, and excessive intake of vitamin D or dietary calcium. Excessive intake of milk and cheese products can result in too much dietary calcium.

LIVER CIRRHOSIS
-Cirrhosis of the liver is a serious disease that causes permanent damage to the liver. The liver is a vital organ located in the right upper area of your abdomen under the ribs. Normal liver function is crucial to your overall health and life. Cirrhosis of the liver is caused by an underlying disease or condition that leads to the formation of scar tissue in the liver. * Scar tissue reduces the liver's ability to carry out vital functions including: Blood clotting Clearing the blood of toxins Digesting food and beverages to create nutrients and energy Fighting infection Metabolizing medications and other substances Producing proteins, enzymes, and healthy blood Removing waste Storing vitamins, minerals and energy PATHOPHYSIOLOGY:

Cirrhosis is known in three major forms. In Laennecs(alcohol-induced) cirrhosis, fibrosis occurs mainly around central veins and portal areas. This is the most common form of cirrhosis and results from chronic alcoholism and malnutrition. Postnecrotic (micronodular) cirrhosis consist of broad bands of scar tissue and results from previous acute viral hepatitis or drug-induced massive hepatic necrosis. Biliary cirrhosis consists of scarring of bile ducts and lobes of the liver and results from chronic biliary obstruction and infection (cholangitis), and is much rarer than the preceding forms.

DIAGNOSTIC PROCEDURES:

PHYSICAL EXAMINATION Most patients with cirrhosis severe enough to lead to ascites have additional stigmata of cirrhosis on physical examination. Accurately diagnosing ascites depends upon the amount of f luid present in the abdomen, the technique used to examine the patient, and the patients habitus. The most useful physical finding in confirming the presence of ascites is flank dullness to percussion. When this is detected, it is helpful to determine whether it shifts with rotation of the patient (shifting dullness) or whether it can be percussed anteriorly. One study found absence of f lank dullness to be the most accurate predictor against the presence of ascites; the probability of ascites without f lank dullness was less than 10 percent. Approximately 1,500 mL of fluid must be present before dullness is detected on physical examination, whereas routine ultrasonography can detect as little as 50 mL of f luid in the abdomen. Laboratory Evaluation No serologic test can diagnose cirrhosis accurately.The term liver function tests is a misnomer because the assays in most standard liver panels do not reflect the function of the liver correctly.Although liver function tests may not correlate exactly with hepatic function, interpreting abnormal biochemical patterns in conjunction with the clinical picture may suggest certain liver diseases. When a liver abnormality is suspected or identified, a liver panel, a complete blood count (CBC) with platelets, and a prothrombin time test should be performed. Common tests in standard liver panels include the serum enzymes aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, and glutamyltransferase; total, direct, and indirect serum bilirubin; and serum albumin. The ALT is thought to be the most cost-effective screening test for identifying metabolic or drug-induced hepatic injury, but like other liver function tests, it is of limited use in predicting degree of inflammation and of no use in 3 estimating severity of fibrosis. One study found that a platelet count of less than 160 K per mm has a sensitivity of 80 percent for detecting cirrhosis in patients with chronic hepatitis C. Radiographic Studies Although various radiographic studies may suggest the presence of cirrhosis, no test is considered a diagnostic standard. The major use of radiographic studies is to detect ascites, hepatosplenomegaly, hepatic or portal vein thromboses, and hepatocellular carcinoma, all of which strongly suggest cirrhosis. ULTRASONOGRAPHY Abdominal ultrasonography with Doppler is a noninvasive, widely available modality that provides valuable information regarding the gross appearance of the liver and blood flow in the portal and hepatic veins in patients suspected to have cirrhosis. Ultrasonography should be the first radiographic study performed in the evaluation of cirrhosis because it is the least expensive and does not pose a radiation exposure risk or involve intravenous contrast with the potential for nephrotoxicity as does computed tomography (CT). Nodularity, irregularity, increased echogenicity, and atrophy are ultrasonographic hallmarks of cirrhosis. In advanced disease, the gross liver appears small and multinodular, ascites may be detected, and Doppler flow can be significantly decreased in the portal circulation. The discovery of hepatic nodules via ultrasonography warrants further evaluation because benign and malignant nodules can have similar ultrasonographic appearances. A study using high-resolution ultrasonography in patients with cirrhosis confirmed with biopsy or laparoscopy found a sensitivity and specificity for cirrhosis of 91.1 and 93.5 percent, respectively, and positive and negative predictive values of 93.2 and 91.5 percent, respectively.

CT AND MRI CT and magnetic resonance imaging (MRI) generally are poor at detecting morphologic changes associated with early cirrhosis, but they can accurately demonstrate nodularity and lobar atrophic and hypertrophic changes, as well as ascites and varices in advanced disease. Although MRI sometimes differentiates among regenerating or dysplastic nodules and hepatocellular carcinoma, it is best used as a follow-up study to determine whether lesions have changed in appearance and size. CT portal phase imaging can be used to assess portal vein patency, although flow volume and direction cannot be determined accurately. Although used rarely, magnetic resonance angiography (MRA) can assess portal hypertensive changes including flow volume and direction, as well as portal vein thrombosis. One study reported that MRI can accurately diagnose cirrhosis and provide correlation with its severity. Despite the potential of MRI and MRA in the diagnosis and evaluation of patients with cirrhosis, their widespread use is limited by their expense and by the ability of routine ultrasonography with Doppler to obtain adequate information for the diagnosis of cirrhosis and presence of complications. Liver Biopsy Referral for liver biopsy should be considered after a thorough, noninvasive serologic and radiographic evaluation has failed to confirm a diagnosis of cirrhosis; the benefit of biopsy outweighs the risk; and it is postulated that biopsy will have a favorable impact on the treatment of chronic liver disease. The sensitivity and specificity for an accurate diagnosis of cirrhosis and its etiology range from 80 to 100 24 percent, depending on the number and size of the histologic samples and on the sampling method. Liver biopsy is performed via percutaneous, transjugular, laparoscopic, open operative, or ultrasonography- or CT-guided fine-needle approaches. Before the procedure, a CBC with platelets and prothrombin time measurement should be obtained. Patients should be advised to refrain from consumption of aspirin and nonsteroidal anti-inflammatory drugs for seven to 10 days before the biopsy to minimize the risk of bleeding.

SYMPTOMS OF LIVER CIRRHOSIS: Most people with cirrhosis of the liver experience no symptoms in the early stages of the disease, because small amounts of liver scarring do not significantly affect liver function. When symptoms of cirrhosis develop, they may include: Fatigue Poor appetite Weakness Weight loss If the underlying cause of cirrhosis of the liver, such as alcoholism, is not addressed, the disease can advance and cause more severe damage to the liver tissue. This can result in symptoms such as: Easy bruising Itching Nosebleeds Small red, spider-like blood vessels under the skin

Serious symptoms that might indicate a life-threatening condition: Cirrhosis of the liver is a serious disease that can lead to life-threatening complications, such as liver failure, esophageal varices, and hemorrhage. Seek immediate medical care (call 911) if you have any of these symptoms: Ascites (a buildup of fluid and swelling in the abdomen) Bleeding, such as vomiting blood or heavy rectal bleeding Change in level of consciousness or alertness, such as passing out or unresponsiveness Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions Edema (swelling) in the legs Jaundice (yellowing of the skin and whites of the eyes) Muscle tremors or shakiness Poor cognitive functioning, due to the livers inability to filter toxins and a buildup of waste products in the blood and brain Severe shortness of breath or difficulty breathing

Causes of liver cirrhosis:

Cirrhosis of the liver is caused by an underlying disease or condition that results in inflammation and the formation of scar tissue in the liver. Some types of cirrhosis are preceded by a condition called steatohepatitis, commonly referred to as a fatty liver, which is a buildup of fat cells and enlargement of the liver. If the cause of fatty liver is not addressed, it can eventually lead to permanent scarring (fibrosis) of liver tissue. Left untreated, scarring progresses and replaces healthy tissue. Scarred liver tissue cannot function normally and can eventually lead to liver failure. The most common cause of steatohepatitis is long-term alcohol abuse. Other chronic conditions, such as obesity, coronary artery disease, and diabetes are also associated with steatohepatitis. Common causes of cirrhosis of the liver There are a variety of diseases and conditions that can cause scarring of the liver. The most common causes include: Alcohol dependence and alcoholism Chronic hepatitis B or C Other causes of cirrhosis of the liver Less common causes of cirrhosis of the liver include: Autoimmune hepatitis (a form of hepatitis in which the immune system attacks the liver) Congestive heart failure (inability of the heart to effectively pump blood) Cystic fibrosis (an inherited disease that causes a buildup of mucus in the liver, lungs and other organs) Glycogen storage diseases Hemochromatosis (excessive levels of iron in the body that cause liver damage) Secondary biliary cirrhosis Wilsons disease (an inherited disease that causes excessive retention of copper) What are the risk factors for cirrhosis of the liver? A number of factors increase the risk of developing cirrhosis of the liver. Risk factors include: Alcohol dependence and alcoholism Chronic hepatitis B, C or D

Coronary artery disease (due to atherosclerosis or hardening of the arteries, or other causes) Diabetes (chronic disease that affects your bodys ability to use sugar for energy) Exposure to certain toxins such as arsenic High triglyceride blood levels Intestinal bypass surgery Long-term treatment with corticosteroids Obesity Reducing your risk of cirrhosis of the liver Not all people who are at risk of cirrhosis of the liver will develop the condition. However, you can significantly lower your risk of developing cirrhosis of the liver by: Avoiding risk factors for hepatitis, such as having unprotected sex with more than one partner, or sharing needles for tattooing or drug use Not drinking alcohol, or limiting alcohol intake to one drink per day for a woman and two drinks per day for a man Seeking regular medical care and following your treatment plan for chronic diseases and conditions, such as diabetes, obesity, high cholesterol, and coronary artery disease How is cirrhosis of the liver treated? The scar tissue that forms in the liver due to cirrhosis of the liver is permanent. The goal of treatment is to stop or slow the progression of damage to the liver and minimize and quickly treat any complications, such as portal hypertension, liver failure, and hemorrhage. Treatment plans include a multifaceted, individualized approach that varies depending on the underlying cause of the disease. For example: Alcoholism treatment includes abstaining from alcohol, which often requires participation in an alcohol treatment program. Hepatitis treatment may include corticosteroid drugs for autoimmune hepatitis or the medication, interferon, to treat a hepatitis infection. Complications of cirrhosis of the liver are also treated as appropriate. In some cases, treatment of liver failure may include liver transplant. This major surgical procedure involves using a healthy donor liver to replace a severely diseased liver. What are the possible complications of cirrhosis of the liver? Complications of cirrhosis of the liver are serious and life threatening. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of cirrhosis of the liver include: Ascites, which is a buildup of fluid and swelling in the abdomen Esophageal varices, which are swollen veins in the esophagus due to portal hypertension. These bulging veins can burst, leading to life-threatening hemorrhage. Hepatic encephalopathy, which involves changes in the brain due to an inability of the liver to filter toxins, such as ammonia. Hepatic encephalopathy can lead to coma and death. Higher risk of liver cancer Kidney failure Liver failure Permanent liver damage and loss of normal liver function Portal hypertension, which is high blood pressure in a large abdominal vein that can lead to esophageal varices and other problems