Rh Disease and Cirrhosis

Rh Disease

Rh disease, also known as Ray's disease, occurs when an Rh-negative mother is exposed to an Rh-positive fetus.
The mother's body recognizes the Rh-positive fetus as foreign and develops antibodies against it.
These antibodies can cross the placenta and attack the red blood cells (RBCs) of the fetus, leading to fetal anemia.
Rh incompatibility can lead to fetal death in subsequent pregnancies.
Even a miscarriage with an Rh-positive fetus can expose the mother and cause problems in future pregnancies.

During the first pregnancy, fetal blood may not mix with the mother's blood due to the placental barrier.
The mother's body may not produce antibodies against the Rh factor during the first pregnancy. The blood can mix during delivery, exposing the mother to the Rh-positive blood.
This exposure during delivery can cause problems in subsequent pregnancies.

If both parents are Rh-positive, they can have either an Rh-positive or Rh-negative baby.
If the mother is Rh-negative and the baby is Rh-positive, there is a potential problem due to incompatibility.
In such cases, the mother needs to receive a RhoGAM shot.
If the baby is Rh-negative, there is no problem.
If the baby is positive, the mom after delivery has to get a shot right away.

Hemolytic anemia: Destruction of red blood cells.
Jaundice: Yellowing of the skin and eyes due to the buildup of bilirubin.
Hydrops fetalis: Accumulation of fluid in the baby's body.
Kernicterus: Buildup of proteins in the blood, which is commonly seen when there's a fetal demise

RhoGAM (Rh immunoglobulin) is administered at 28 weeks of gestation to prevent the mother from developing antibodies against the Rh-positive fetus.
If RhoGAM is not given, there can be problems in subsequent pregnancies.
Intrauterine blood transfusions can be performed in some cases.
The mother is monitored closely throughout the pregnancy.
C-sections reduce the risk of exposure compared to vaginal delivery.

Cirrhosis: Severe liver scarring that disrupts the liver's ability to function properly.
It can lead to fluid and electrolyte imbalances.

Peripheral dilation triggers the renin-angiotensin-aldosterone system (RAAS).
This leads to the secretion of antidiuretic hormone (ADH), causing fluid retention because it is the opposite of a diuretic.
Kidney function decreases. Ascites forms due to:
- Albumin level increase.
- Lymphatic dysfunction, causing fluid to leak from blood vessels into the peritoneal cavity.
Hepatorenal failure: Kidney failure due to liver failure.
Hyponatremia: Low sodium levels due to the kidneys' inability to balance sodium levels, leading to excess fluid buildup.

Cirrhosis increases pressure in the portal vein, which carries blood from the digestive organs to the liver, resulting in fluid retention.

Patients with ascites can accumulate a large amount of fluid in their abdomen (ex: 8 liters).
Draining the fluid (paracentesis) must be done carefully to avoid complications.

Patients appear thin in the upper body with a distended abdomen and edema in the lower extremities.

Liver function tests (LFTs): Elevated.
Ammonia levels: High.
Alkaline phosphatase (Alk Phos).
Albumin.
Prothrombin time (PT) / International Normalized Ratio (INR): Coagulation studies to check for bleeding and clotting issues.
Blood pressure: May be abnormal.
Bilirubin: Elevated.
Complete metabolic panel (CMP): Monitor electrolytes, especially sodium and potassium.
Complete blood count (CBC): Watch for anemia.

Sodium restriction: Monitor sodium intake through IV fluids and food.
Diuretics: Use carefully to avoid pulling off too much fluid too quickly.
Paracentesis: Removing fluid from the abdomen.
Without treatment of the fluid in the abdomen, organs, such as the heart and lungs, can be affected.
Albumin infusion: Needed after paracentesis to replace lost albumin.
Vasopressin: Vasopressin receptor agonist used after paracentesis.
Liver transplant: For eligible patients.

Supportive care focused on symptom management.
Monitoring and assessment.
Nutritional support: Patients often lack appetite, so nutritional support is crucial.
Emotional and spiritual support: Addressing end-of-life issues.
Collaboration with the healthcare team.

Nursing judgment is crucial to assessing the patient.
If edema is present, do not raise the legs above the heart to avoid flooding the organs.
Elevating the legs depends on the patient's overall condition; it is okay to do it if there are no heart or kidney conditions.
Prioritize patient comfort in end-stage cases while being cautious.
Overall, we need to understand what's happening with the body.