Seminar on Cirrhosis of Liver

7/31/2019 Seminar on Cirrhosis of Liver

1/9

Introduction

The liver is an important organ in the body. It performs many critical functions, two of

which are producing substances required by the body. Cirrhosis is a complication of many liver

diseases that is characterized by abnormal structure and function of the liver. The diseases that lead

to cirrhosis do so because they injure and kill liver cells, and the inflammation

Definition

Cirrhosis is a chronic disease characterized by replacement of normal liver tissue

with diffuse fibrosis that disrupts the structure and function of the liver.

types

Cirrhosis of the liver, is divided into three types: alcoholic, post necrotic ,biliary cirrhosis

Aicoholic cirrhosis

In this type the scar tissue characteristically surround the portal areas .This is most

commonly caused by chronic alcoholism and is the most common type of cirrhosis

post necrotic cirrhosis

In this type there are broad band of scar tissue .This is late result of previous bout of acute

viral hepatitis

Biliary cirrhosis

In this type scarring occurs in the liver around the bile duct. This type of cirrhosis usually

results from chronic biliary obstruction and infection

Causes

- Alcohol- Chronic viral hepatitis ( hepatitis B or hepatitis C )- Inherited (genetic) disorders

* abnormal accumulation of iron (hemochromatosis)

* abnormal accumulation of copper (Wilson's disease)

* psychiatric disturbances and other neurological

- Autoimmune hepatitis

The abnormal immune activity in autoimmune hepatitis causes progressive

inflammation and destruction of liver cells (hepatocytes), leading ultimately to cirrhosis. more

commonly seen in women.


2/9

- Less common causes of cirrhosis include unusual reactions to some drugs and prolonged

exposure to toxins.

-exposure to chemicals ( carbon tetrachloride,chlorinated naphthalene,arsenic,phosphorus )

Pathophysiology

Due to causes

Tissue necrosis in the liver cells

Destroyed liver cells gradually replaced by scar tissues

Residual normal tissue and regenerating liver tissue may

Project from the constricted areas and giving like hobnail appearance

Cirrhosis of liver

Clinical manifestaions

The severity of manifestation helps to catagorize the disorder as two 1) compensated

cirrhosis, 2)decompensated cirrhosis

For compensated liver cirrhosis

- Intermittent mild fever- Palmar erythema( reddened palms )- Unexplained epistaxis- Ankle edema- Vague morning indigestion- Abdominal pain- Spleno megaly

For decompensated liver cirrhosis

- Ascites


3/9

PORTAL HYPERTENSION (RESISTANCE TO BLOOD FLOW

se leakage of leakage of plasma vasocongestion development of

Plasma in liver out of vasculature within intestinal collateral venous

Lymphatic and in to liver tissue vasculature vessels

production of persistence of

Liver lymph leakage of plasma transudation of amine neuro-

(high protein) from liver tissue into plasma in to transmitters

Abdominal cavity Abdominal cavity

Dilation of lymph redistribution

Channels draining of blood fow

liver (reduced renal perfusion)

leakage of lymph in to production of

abdominal cavity ASCITES

aldosterone

leakage of

osmotic gradient between plasma out sodium and water retetion

lymph and extracellular of vascular space

fluidfluid leakage

in to abdominal cavity intravascular oncotic pressure

albumin production

Hepatocyte dysfunction metabolism of aldosterone


4/9

- Jaundice

- Weakness- Weight loss- Continuous mild fever- Clubbing of fingers- Purpura (due to decreased platelet count)- epistaxis- hypotension- white nails

other signs and symptoms

- liver enlargement- portal obstruction

( All blood from digestive organs is collected in portal veins and carried to

liver .Because a cirrhotic liver does not allow free blood passage , blood backs up in

to spleen and GI tract .)

- infection and peritonitis- gastro intestinal varices or haemorrhoids- mental detoriation and cognitive function

Assessment and Diagnostic Methods

* Liver function tests

- Serum alkaline phosphatase,

Aspartate aminotransferase [AST]

Serum glutamic oxaloacetic transaminase (SGOT),

Alanine aminotransferase [ALT] [serum glutamic pyruvic transaminase (SGPT)],

Serum cholinesterase,

Bilirubin,

*prolonged Prothrombin time,

*Ultrasound scanning-(to messure density of parenchymalcells and scar tissue )

*CT scan


5/9

*MRI

*Radioisotopic liver scans

* ABGs, biopsy

Management

The management of the patient with cirrhosis of liver is usually based on the

presenting symptoms.

Medical management

* Antacid or h2antagonist are used to decrease gastric distress and minimize the

possibility of GI bleeding.

* vitamins and nutritional supplements promote healing of damaged liver cells and

improvethe patients general nutritional status

* Potassium sparing diuretics such as spironolactone( aldactone) or triamterene

(dyrenium) are used to decrease ascites

* An adequate diet and avoidance of alcohol are essential

*colchicine ,an anti-inflammatory agent used to treat the symptoms of gout for

moderate cirrhosis

Nursing Management

* Promoting Rest

Position bed for maximal respiratory efficiency; provide oxygen if needed.

Initiate efforts to prevent respiratory, circulatory, and vascular disturbances.


6/9

Encourage patient to increase activity gradually and plan rest with activity and mild

exercise.

* Improving Nutritional Status

Provide a nutritious, high-protein diet supplemented by B-complex vitamins and

others, including A, C, and K.

Encourage patient to eat: Provide small, frequent meals, consider patient preferences,

and provide protein supplements, if indicated.

Provide nutrients by feeding tube or total PN if needed.

Provide patients who have fatty stools (steatorrhea) with water-soluble forms of fat-

soluble vitamins A, D, and E, and give folic acid and iron to prevent anemia.

Provide a low-protein diet temporarily if patient shows signs of impending or

advancing coma; restrict sodium if needed.

* Providing Skin Care

Change patients position frequently.

Avoid using irritating soaps and adhesive tape.

Provide lotion to soothe irritated skin; take measures to prevent patient from

scratching the skin.

* Reducing Risk of Injury


7/9

Use padded side rails if patient becomes agitated or restless.

Orient to time, place, and procedures to minimize agitation.

Instruct patient to ask for assistance to get out of bed.

Carefully evaluate any injury because of the possibility of internal bleeding.

Provide safety measures to prevent injury or cuts (electric razor, soft toothbrush).

Apply pressure to venipuncture sites to minimize bleeding.

* Monitoring and Managing Complications

Monitor for bleeding and hemorrhage.

Monitor the patients mental status closely and report changes so that treatment of

encephalopathy can be initiated promptly.

Carefully monitor serum electrolyte levels are and correct if abnormal.

Administer oxygen if oxygen desaturation occurs; monitor for fever or abdominal pain,

which may signal the onset of bacterial peritonitis or other infection.

Assess cardiovascular and respiratory status; administer diuretics, implementfluid

restrictions, and enhance patient positioning, if needed.

Monitor intake and output, daily weight changes, changes in abdominal girth, and

edema formation.

Monitor for nocturia and, later, for oliguria, because these states indicate increasing

severity of liver dysfunction.


8/9

* follow up care

Prepare for discharge by providing dietary instruction, including exclusion of alcohol.

Refer to Alcoholics Anonymous, psychiatric care, counseling, or spiritual advisor if

indicated.

Continue sodium restriction; stress avoidance of raw shellfish.

Provide written instructions, teaching, support, and reinforcement to patient and

family.

Encourage rest and probably a change in lifestyle (adequate,well-balanced diet and

elimination of alcohol).

Instruct family about symptoms of impending encephalopathy and possibility of

bleeding tendencies and infection.

Offer support and encouragement to the patient and provide positive feedback when

the patient experiences successes.

Refer patient to home care nurse, and assist in transition from hospital to home.

Nursing Diagnosis

imbalanced nutrition less than body requirements related toAnorexia,nausea/vomiting, indigestion, ascites/Abnormal bowel function

impaired skin integrity related toPoor skin turgor, skeletal prominence,presence of edema, ascites

ineffective Breathing Pattern related to Intra-abdominal fluid collection(ascites)or Decreased lung expansion, accumulated secretions


9/9

High risk for Injury related toaltered clotting factors (decreased production of prothrombin, fibrinogen,

and factors VIII, IX, and X; impaired vitamin K absorption; and release of

thromboplastin)

or

Portal hypertension

Knowledge Deficit related to disease condition

Documents

Seminar on Cirrhosis of Liver