YASHODHARA GHOSHMSC NURSING STUDENT

DEFINITION- CIRRHOSIS IS A CONDITION IN WHICH THE LIVER SLOWLY DETERIORATES AND MALFUNCTIONS DUE TO CHRONIC INJURY. SCAR TISSUE REPLACES HEALTHY LIVER TISSUE, PARTIALLY BLOCKING THE FLOW OF BLOOD THROUGH THE LIVER

ANATOMY-

PHYSIOLOGY- Metabolism / Detoxification

• Metabolizes products of digestion

• Glucose regulation

• Vitamin storage

• Metabolizes drugs

• Breaks down bilirubin

Synthesis and Secretion

• Components of clotting factors

• Cholesterol, triglyceride synthesis

• Bile production

• Other proteins and hormones

Storage and Filtration of Blood

• Acts as a blood reservoir

• Contains phagocytic cells

• Part of the reticuloendothelial system.

CAUSES-

MORE COMMON- Hepatitis B or C

infection Alcohol abuse Intrahepatic

cholestasis or obstruction of bile ducts

Hepatic congestion

LESS COMMON- Autoimmune

hepatitis Bile duct disorders Some medicines Hereditary diseases Non-alcoholic fatty

liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)

PATHOPHYSIOLOGY-

CONT…

INCREASED AMMONIA

HEPATIC ENCEPHALOPATHY

OSMOTIC SHIFTS

ASCITIS

INCREASED PRESSURE RESSISTANCE

ENLARGEMENT OF ESOPHAGEAL, UMBILICAL,

RECTAL VEINS

BLEEDING VARICES

PORTAL HYPERTENSION

CLINICAL MANIFESTATIONS-

CLINICAL MANIFESTATIONS-

-Anorexia -Dyspepsia -Flatulence -Fatty stools -Nausea and

vomiting -Diarrhea or

constipation -Jaundice -Peripheral edema -Spider angioma -Spleenimegaly -Ascitis

EARLY SIGNS

LATE SIGNS

DIAGNOSTIC STUDIES-

1) History and physical examination 2) Liver function studies In cirrhosis there are abnormalities in most of the liver

function studies. As a result of release of enzyme from damaged liver cells initially enzymes are elevated.

Alkp (alkaline phosphatage) AST ALT GGT (gamma glutamyl transpeptidase) Total protein Albumin Serum bilirubin Globulin Cholesterol level

3) Complete blood count 4) Prothrombin time is prolonged. 5) Liver biopsy (percutaneous needle) to

identify liver cell changes and alteration in lobular structure.

6) Liver ultrasound 7) CT scan 8) Esophagogastroduodenoscopy 9) Angiography 10) Serum electrolytes 11) Testing of stool for occult blood 12) Upper GI barium swallows.

COLLABORATIVE CARE-Management of Ascitis:

Paracentesis Peritoneovenous shunt

COLLABORATIVE CARE- Management of Esophageal & Gastric Varices-

DRUG THERAPY- Vasopressin ( Pitressin) Propranolol (Inderal )  Lactulose (Cephulac )  Neomycin sulfate  Magnesium sulfate

 Vitamin K  H2 receptor blockers

(Ranitidine)  Proton pump inhibitors

(Pantoprazole)  Diuretics(Spironolactone) Chlorothizide (Diuril)  Frusemide (Lasix )

SURGICAL MANAGEMENT-

NUTRITIONAL MANAGEMENT-

LOWPROTEI

N

LOWSODIUM

HIGH CALORI

E

NURSING MANAGEMENT-

1.Imbalanced Nutrition, less than body requirements related to insufficient intake to meet metabolic demands secondary to anorexia, nausea, vomiting as evidenced by abdominal pain/cramping, loss of weight; poor muscle tone.

2. Fluid Volume deficient related to excessive losses through vomiting and diarrhoea as evidenced by decreased skin turgor, sunken eyes and weak peripheral pulse.

3. Excess fluid volume related to retention of fluids secondary to decreased serum albumin, increased sodium and water and portal hypertension as evidenced by dependent edema, weight gain and ascites.

CONT…

4. Low Self-Esteem, related to confinement/isolation, secondary to length of illness/recovery period as evidenced by verbalization of change in lifestyle, feelings of helplessness.

5. Risk for infection related to immunosuppression & malnutrition.

6. Fatigue related to decreased metabolic energy production as evidenced by reports of lack of energy/inability to maintain activity of daily living.

CON……

7.Risk for impaired Skin/Tissue Integrity, related to chemical substance: bile salt accumulation in the tissues.

8.Knowledge, deficient regarding condition, prognosis, treatment, self-care, and discharge needs related to lack of information as evidenced by frequent questioning.

PATIENT & FAMILY TEACHING GUIDE-

CONTINUE HEALTH CARE

AVOID ALCOHOL

AVOID ASPIRIN

AVOID FATTY SPICY FOOD

SEEKMEDICAL

ATTENTION