EMS World

OCT 2015

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EMSWORLD.com | OCTOBER 2015 35 Early cirrhosis is a disease that can progress undetected, causing little to no pain until decompensation occurs. Decompensated cirrhosis and liver failure are characterized by the occurrence of life- threatening complications such as ascites, spontaneous bacterial peritonitis, variceal hemorrhage and hepatic encephalopathy. Signs and Symptoms Table 2 lists the signs and symptoms associ - ated with compensated and decompensated cirrhosis. It is worth understanding how and why these manifestations occur so you can put together the entire clinical picture when assessing a patient. • Pain in the upper right quadrant of the abdomen can occur secondary to liver swelling and subsequent stretching of its protective capsule. This pain is sometimes referred to the right shoulder. • Weakness, fatigue and weight loss can occur in the patient with chronic liver fail- ure secondary to chronic malnutrition that results from insufficient nutrient, vitamin and mineral synthesis and absorption. • Pale-colored feces occur when ster- cobilin, a bile pigment, is absent from the stool. Normally bilirubin is absorbed in the liver and eventually secreted into the small intestine as bile. In the small intestine, some bilirubin is broken down and converted to stercobilin, which is then excreted in the feces and is responsible for its brown color. In chronic liver failure, bilirubin is not absorbed by the liver, and so less bile is produced and secreted into the small intestine, leading to less creation of ster- cobilin and ultimately gray or white stool. In addition, the lack of bile secretion in to the small intestine leads to a decrease in fat absorption, producing feces that contains excess fat, a condition known as steatorrhea. Such feces may float, due to excess gas, and have an oily or greasy appearance. • Dark urine occurs when bilirubin is present in the urine. If unabsorbed by the liver (as described above), bilirubin remains in the bloodstream and is excreted by the kidneys, turning the urine a dark amber, cola or even brown color. • Jaundice, also known as icterus, is a yel- lowish discoloration of the skin, conjunctival membranes of the sclera and other mucus membranes. As bilirubin levels increase in the blood, it results in an increase of biliru- bin in tissues such as the skin and mucus membranes. A serum bilirubin of greater than 2–3 mg/dL is usually required to pro- duce jaundice. The conjunctiva of the eyes are one of the first tissues to become jaun- diced as bilirubin levels rise. Patients may also develop pruritis, or itchy skin. • Ascites occurs secondary to the third- spacing of fluid from the cardiovascular sys- tem into the abdominal cavity. In chronic EMS1510S For More Information Circle 27 on Reader Service Card

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