LIVER CIRRHOSIS Brief Anatomy of Liver The blood from the digestive system (stomach, intestines) passes through

the liv er on its way back to the heart. The liver is the largest internal organ and is involved in many complex metabolic functions essential to life. The liver extrac ts nutrients from the blood and processes them for later use. The liver makes bi le, which is used by the digestive system to help absorb fat and certain vitamin s. The liver also removes medications and toxic waste-products from the blood an d excretes them into bile. The liver is the bodys main factory for blood proteins , including the proteins involved in normal blood clotting function. Your doctor may check blood clotting tests (prothrombin time or INR) as a measure of your l iver function. Liver Cirrhosis Cirrhosis is a chronic disease characterized by replacement of normal liver tiss ue with diffuse fibrosis that disrupts the structure and function of the liver. Causes of liver cirrhosis Viral hepatitis: B and C Alcohol Biliary diseases: primary or secondary Autoimmune hepatitis Vascular causes: CHF, Budd-Chiari syndrome (thrombosis in the hepatic vein conges tion and cirrhosis),Veno-occlusive disease Drugs and toxins (mainly those used in chemotherapy and immuno-suppression) Hereditary and metabolic Non-alcoholic liver disease (NASH) Cryptogenic liver cirrhosis (no cause is identified) Sign and Symptoms Compensated Intermittent mild fever Vascular spiders Palmar erythema (reddened palms) Unexplained epistaxis Ankle edema Vague morning indigestion Flatulent dyspepsia Abdominal pain Firm, enlarged liver Splenomegaly

Decompensated Ascites Jaundice Weakness Muscle wasting Weight loss Continuous mild fever Clubbing of fingers Purpura (due to decreased platelet count) Spontaneous bruising Epistaxis Hypotension Sparse body hair White nails

 Gonadal atrophy

Complications Ascites Varices Hepatic Encephalopathy Liver Cancer (Hepatocellular Carcinoma) Pathophysiology

Diagnostic Test Ultrasound scanning- used to measure the difference in density of parenchymal ce lls and scar tissue CT, MRI, and radioisotope liver scans give information about liver size and hepa tic blood flow and obstruction. Diagnosis is confirmed by liver biopsy. Arterial blood gas analysis may reveal a ventilationperfusion imbalance and hypox ia. Medical Treatment: Drugs Antacids or histamine-2 (H2) antagonists are prescribed to decrease gastric dist ress and minimize the possibility of GI bleeding. Vitamins and nutritional supplements promote healing of damaged liver cells and improve the patients general nutritional status. Potassium-sparing diuretics such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred bec ause they minimize the fluid and electrolyte changes commonly seen with other ag ents. An adequate diet and avoidance of alcohol are essential. Colchicine, an anti-inflammatory agent used to treat the symptoms of gout, may i ncrease survival time in patients with mild to moderate cirrhosis. Angiotensin system inhibitors, statins, diuretics, immunosuppressants, and glita zones have reasonable safety profiles, but their long-term safety and efficacy i

n patients with cirrhosis has yet to be demonstrated Surgical Management A TIPS shunt is a metal tube (also called a stent) placed within the liver under x-ray guidance through an incision in the jugular vein in the neck. A TIPS shun t works by decreasing the pressure against which blood must flow within the live r (that is to reduce portal hypertension). Liver transplantation may be considered as a treatment option. During liver tran splantation surgery the diseased liver is removed and a new healthy liver from a deceased-donor or a part of a liver from a living-donor is put in its place. Li ver transplantation surgery is a major undertaking and requires life-long anti-r ejection medications afterwards. Nursing Diagnosis 1. High risk for injury related to altered clotting mechanisms and altered level of consciousness 2. Impaired skin integrity related to pruritus from jaundice and edema 3. Activity intolerance related to fatigue, lethargy, and malaise Nursing Intervention Independent: 1. Provide safe environment (pad side rails, remove obstacles in room, prevent f alls). 2. Observe each stool for color, consistency, and amount. 3. Record vital signs at frequent intervals, depending on patient acuity (every 14 h). 4. Keep patient quiet and limit activity. Rationale Minimizes falls and injury if falls occur. Permits detection of bleeding in gastrointestinal tract. Provides baseline and evidence of hypovolemia, and hemorrhagic shock. Minimizes risk of bleeding and straining. Dependent: 1. Administer vitamin K as prescribed. 2. Assist physician in passage of tube for esophageal balloon tamponade, if its insertion is indicated. 3. Offer cold liquids by mouth when bleeding stops (if prescribed).

Rationale Promotes clotting by providing fatsoluble vitamin necessary for clotting. Promotes nontraumatic insertion of tube in anxious and combative patient for immediate treatment of bleeding. Minimizes risk of further bleeding by

promoting vasoconstriction of esophageal and gastric blood vessels.