Good Research Paper About Cirrhosis And Renal Failure
According to the American Liver Foundation, Cirrhosis can be defined as replacement of normal liver tissue with non-living scar tissue (Liverfoundation.org). The disease basically refers to liver only. The death of the natural tissues of the liver will lead to their replacement by fibrous tissue and hence scarring.
1.1 Causes of cirrhosis
Alcoholism: The commonest cause of cirrhosis of liver is chronic alcoholism. The disease process starts with swelling initially gradually leading to fibrous formation and hence cirrhosis (Das).
Other significant causes are:
Non alcoholic steatohepatitis: This is basically swelling and cirrhosis of liver not because of alcohol, but due to other conditions like obesity, diabetes, poor dietary habits, high level of body cholesterol and coronary artery disease.
Bile duct disease
Certain genetic diseases
STAGES OF LIVER CIRRHOSIS (Liver cirrhosis)
Signs and symptoms
Gastrointestinal System: Nausea, vomiting, loss of appetite
Justification: These symptoms arise as a result of failure on the part of the
gastrointestinal tract to function properly.
Integumentary System: Yellowish discoloration of the skin and itching.
Justification: Failure of bile metabolism leads to accumulation of bilirubiin. Bilirubin has a high affinity of binding with the tissues of the skin. Thus giving rise to yellowish coloration of the skin. Itching appears as a result of increased conjugated bilirubin in the main blood stream.
Cardiovascular System: Easy bruising of the skin
Justification: The reason for easy bruising of the skin is defective formation of clotting factors. As the liver is responsible for producing clotting factors of the blood, when it is diseased then there is decreased formation of these factors leading to easy bruising of the skin and internal capillary damages.
Nervous System: Confusion, dizziness etc.
Justification: The liver is responsible for detoxifying the body. It removes the toxic substances from our body. In case of cirrhosis the liver is unable to perform its normal functions; hence the toxics are not removed. These toxic substances have a tendency to reach the brain and give rise to symptoms. In very advanced cases it may lead to hepatic encephalopathy also.
SYMPTOMS OF CIRRHOSIS (Slideshare.net)
Physical examination: On physical examination, a cirrhotic liver is palpable.
Blood test: Liver function tests will demonstrate higher levels of liver enzymes.
3) Ultrasonography, MRI and CT scan may be required in difficult to diagnose cases. They may be needed to be performed in cases where the diagnosis seems to be cirrhotic liver, but the preliminary tests refute the diagnosis.
The most important step towards the treatment of the disease is treating the cause of the disease. If the disease occurred as a result of chronic alcoholism, then the first step should be to quit drinking. Orthotopic liver transplantation can be the only way out in certain cases.
Prognosis can be said to be poor in these patients. The overall survival rate for them after 5 years of diagnosis is only 25%. The prognosis becomes more and more favorable in the cases where a proper control over the cause of the disease has been achieved. For example, if the cause of the disease is alcohol, then it becomes quite easy to obtain a good control over the progress of the disease and hence the prognosis also becomes better.
Renal failure, as the name suggests is failure of the renal system to perform its function adequately. It can be classified as acute, established and chronic renal failure.
2.1 ACUTE RENAL FAILURE
Acute renal failure can be defined as reversible renal failure, occurring suddenly within a period of few days or weeks, manifested by oliguria.
Causes of Acute Renal Failure
Pre renal causes
Systemic causes: Heart failure, blood or fluid loss.
Local causes: Renal artery occlusion or stenosis, diseases affecting the arterioles.
Intrinsic Renal Disease
Acute tubular necrosis/ toxic/ septic renal failure
Glomerular disease: both primary and as a component of systemic disease
Post renal causes
Obstruction due to stone, tumor or enlargement of the prostate.
2.1.2 Signs and symptoms
Urinary System: Decreased urinary output
Justification: The cause for decreased urinary output is decreased perfusion of the kidneys. As the blood reaching the kidneys is low, the amount of urine that will be formed by the kidney is also low. Although this symptom won’t be evident in case of pre renal causes of acute renal failure.
Circulatory system: Hypotension, blood pressure may drop up to 20/10 mm of Hg.
Justification: Decreased blood volume or hypovolemia will lead to a drop in the blood pressure.
Complete blood count
Urine routine and microscopic examination
Renal ultrasound etc.
Treatment of the cause has to be considered. In case of hypovolemia adequate blood volume has to be restored, proper fluid administration may be needed. In case of metabolic acidosis, isotonic sodium bicarbonate may be used. Although used earlier, but recent trials show that the use of low dose of dopamine is not of much use in patients who are severely ill and at risk of acute renal failure.
If treated properly and in a timely manner, the changes can be reversed very easily and the condition can be managed easily. But if the treatment is ineffective, then the condition may progress further leading to established renal failure.
2.2 ESTABLISHED RENAL FAILURE
Established acute renal failure develops when there is prolonged hypoperfusion of the kidneys.
2.2.1 Signs and symptoms
Features are mostly similar to that of acute renal failure.
Circulatory system: Features of uraemia, like anoxia, nausea, vomiting, hiccoughs etc.
Justification: Circulation of urea in the blood due to failure of proper filtration by the kidneys.
Respiratory system: Increased respiratory rate.
Justification: Metabolic acidosis or pulmonary edema may lead to increase in respiratory rate. The cause for metabolic acidosis is accumulation of acidic contents in the blood and pulmonary edema may occur due to infusion of excessive amount of electrolytes in relation to urinary output.
Circulatory system: Anemia may occur due to excessive amount of blood loss or decreased erythropoiesis. Blood loss may be a result of decreased platelet function and disturbance of the coagulation mechanism.
Similar to that of Acute Renal Failure
Treatment of the cause is of prime importance. Along with that, the symptoms should be treated properly. Treatment of hyperkalemia, hypovolemia and acidosis should be undertaken.
Prognosis is usually good in cases where there are not much complications associated. It worsens with the severity of the infection and the intensity of the complications.
2.3 CHRONIC RENAL FAILURE
Chronic renal failure can be defined as an irreversible damage to the kidney functions which developed over a period of years.
2.3.1 Causes of Chronic renal failure
Congenital and inherited diseases
Renal artery stenosis
2.3.2 Signs and symptoms
Circulatory system: Uremic manifestations like tiredness, nausea, pruritis
Justification: Due to increased levels of urea in the blood.
Urinary system: Proteinuria
Justification: Due to increased loss of albumin in the urine.
Respiratory system: Deep breathing.
Justification: Due to metabolic acidosis. Also called as Kussmaul’s respiration.
Same as Acute Renal Failure
Controlling Blood pressure
Retardation of the progression of the disease by treating the cause
Dietary measures: Restricting intake of protein in daily diet is very important. But calorie intake should be kept adequate.
Maintaining fluid electrolyte balance
Controlling further bleeding.
Prognosis is not good usually. The kidneys have already undergone irreversible changes by this stage. Only resort that can be availed is kidney transplantation. With a timely transplantation done, the survival rate of the patient can increase greatly. The patient may even enjoy an almost normal life again. The condition where it is impossible to survive without kidney transplantation is called End stage renal failure.
Das, Somen. A Concise Textbook Of Surgery. Calcutta: Dr S. Das, 2008. Print.
Davidson, Stanley, and J. Alastair Innes. Davidson's Essentials Of Medicine. Edinburgh: Elsevier/Churchill Livingstone, 2009. Print.
Liver Cirrhosis. 2015. Web. 16 Mar. 2015.
Liverfoundation.org,. 'American Liver Foundation - Cirrhosis'. N.p., 2015. Web. 15 Mar. 2015.
Slideshare.net,. Symptoms Of Cirrhosis. 2015. Web. 16 Mar. 2015.
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