CIRRHOSIS OF LIVER

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. Scarring also impairs
the liver’s ability to -

• control infections

• remove bacteria and toxins from the blood

• process nutrients, hormones, and drugs

• make proteins that regulate blood clotting

•

produce bile to help absorb fats—including cholesterol—and

fat-soluble vitamins
TYPES:
a) Cirrhosis of known aetiology
b) Cirrhosis of unknown aetiology
-Laennec’s cirrhosis or portal cirrhosis. It is due to
alcoholism.
CAUSES:
1. Chronic viral hepatitis

2.Biliarycirrhosis
3.Bacterial infection
4.Congenital intrahepatic obstruction of the biliary tree
5.Prolonged exposure to unknown toxic agents e.g., some herbal

medicines.
PATHOPHYSIOLOGY
Hepatocyte injury with necrosis, fibrosis, regeneration and
eventual degeneration
↓
e diminished parenchymal cell mass causes regeneration of
tissue with nodular areas of proliferating
hepatocytes

↓
Hepatocytes respond to injury with deposition of collagen that
forms fibrous connective tissue
↓
This scar tissue and nodular areas of regeneration impair the
intrahepatic
blood flow
↓
Ongoing necrosis
↓
Failure of hepatocellular function and portal
hypertension occur
↓
Ascites, severe cholestasis, encephalopathy (hepatic coma)
and GI bleeding
CLINICAL MANIFESTATIONS:

1. Jaundice
2. Anorexia
3. Muscle weakness

4.Poor growth

5. Fatigue
6. Nausea
7. Vomiting

8.Weight loss
9.Abdominal pain

10.Ascites and oedema

11.Gastrointestinal bleeding
12.Anaemia.
13.Dyspnoea and cyanosis may occur especially on exertion.
14.Itching
15.Spiderlike blood vessels on the skin

DIAGNOSTIC EVALUATION
The diagnosis of cirrhosis is based on-
1. The history, especially in regard to prior liver disease,
such as hepatitis
 2.On physical examination, hepatosplenomegaly will be
revealed or a sudden decrease in liver size.

3. Laboratory evaluation, especially liver function tests, such

as bilirubin and aminotransferases, ammonia, albumin,
cholesterol and prothombin time

4. Liver biopsy for characteristic changes.

Doppler ultrasonography of the liver and spleen is

useful to confirm ascites, to evaluate the blood flow
through the liver and spleen, and to determine the
patency and size of the portal vein if liver transplantation
is considered.

THERAPEUTIC MANAGEMENT:
– Liver transplantation has improved the prognosis
substantially for many children with cirrhosis.
– Nutritional support is an important therapy for children

with cirrhosis and malnutrition. Supplements of fat-soluble vitamins are often required,
and mineral supplements may be indicated. In some instances nutritional in the form of
continuous tube feedings or parenteral nutrition may be necessary.

– Acute haemorrhage is managed with intravenous fluids,

and vasopressin
– Ascites can be managed by sodium restriction and
diuretics.

– Administering drugs like neomycin and lactulose to limit

the formation and absorption of ammonia which is an
endogenous toxin.

NURSING PROCESS:
Assessment:

Obtain complete history about the patient. In addition evaluate

the patient’s condition by performing a physical examination.
Pay special attention to the patient’s ventilation, abdominal
size, weight, the presence or absence of jaundice and other