Case Study – Cirrhosis of the Liver

Murray Brown is a 55 year old man who manages the local hardware store in Urbenville. He lives with his wife Sharon and their three children aged, 16, 13 and 10 years. He smokes a pack of cigarettes a week which he has done since he was 16 years of age. Twelve years ago he was diagnosed with cirrhosis of the liver and has been sober for the last two years despite drinking heavily prior to this for twenty years.

Murray is admitted to hospital as an inpatient after he presented to his GP complaining of vomiting for two days and he had noticed blood in the toilet when he vomits.

Subjective data

  • He has cirrhosis for twelve years
  • Acknowledges he has been drinking heavily for twenty years but has been sober for the last two years
  • Complains of nausea, anorexia and abdominal discomfort

Objective data – physical examination

  • Thin, malnourished with moderate ascites
  • Has jaundice of sclera and skin
  • Has 4+ pitting oedema of the lower extremities
  • Liver and spleen palpable

Laboratory values

  • Total bilirubin: 257 mmol/L
  • AST: 190u/L
  • ALT: 201 U/L


Task 

Address the following questions.

  1. Outline the pathophysiology for cirrhosis of the liver to explain each of Murray symptoms and what further assessment would you do?
  2. What follow-up care and interventions would the community nurse provide to Murray?
  3. Identify the risk factors of liver cirrhosis and discuss what lifestyle modifications would be included in providing education to Murray and his family?
  4. Based on the long term complications of liver cirrhosis what medications do you anticipate Murray would be prescribed and discuss the pharmokinetics & pharmodynamics, of those you identified?
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