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(p.

1431 of WONG)
 a liver disease characterized by permanent
scarring of the liver that interferes with its
normal functions

 Occurs as an end stage of many chronic liver


diseases, including biliary atresia and chronic
hepatitis.

 This condition is irreversibly damaged.

 It affects about three million Americans a year.


 Infection
 Autoimmune (0.6% to 2%)
 Toxic factors (Prolonged exposure to certain types
of chemicals and medications like arsenic,
methotrexate, toxic doses of vitamin A)
 Chronic diseases such as hemophilia and cystic
fibrosis
 Hepatitis B and C (African Americans)
 Bile duct disorders such as primary biliary cirrhosis
and primary sclerosing cholangitis.
 Metabolic disorders such as hemachromatosis,
Wilsons disease, and alpha-1 antitrypsin deficiency
 Others like Schistosomiasis,
 Obesity
 Genetic factors
 Moderate to heavy alcohol users.
 Co-infection with hepatitis B.
 Co-infection with HIV.
 Having large iron stores in the liver.
 nonalcoholic steatohepatitis (NASH)
 nonalcoholic fatty liver disease
(NAFLD)
pple type) is more dangerous than weight gained around the hips and flank area (pear type). Fat cells in the upper body have diffe
 Ascites (fluid buildup in the abdomen)
 Variceal hemorrhage, severe bleeding from varices
(enlarged veins in the esophagus and upper stomach)
 Spontaneous bacterial peritonitis, a severe infection of
the abdominal fluid
 Hepatic encephalopathy, damage to the brain caused
by buildup in the body of toxins such as ammonia
 Hepatocellular carcinoma, a type of liver cancer
 Hepatorenal syndrome, when kidney failure occurs
along with severe cirrhosis
 Kidney Failure

 Osteoporosis

 Insulin Resistance and Type 2 Diabetes.

 Heart Problems.
Cirrhosis is divided into two stages: Compensated
and Decompensated.

 Compensated cirrhosis means that the body


still functions fairly well despite scarring of the
liver. Many people with compensated cirrhosis
experience few or no symptoms.

 Fatigue and loss of energy


 Loss of appetite and weight loss
 Nausea or abdominal pain
 Spider angiomas may develop on the skin. These are
pinhead-sized red spots from which tiny blood vessels
radiate. (upper torso)
 Decompensated cirrhosis means that
the severe scarring of the liver has
damaged and disrupted essential body
functions. Patients with decompensated
cirrhosis develop many serious and life-
threatening symptoms and complications.

 Fluid buildup in the legs and feet (edema) and in


the abdomen (ascites). (Ascites is associated with
portal hypertension, which is described in the
Complications section of this report.)
 Jaundice. This yellowish cast to the skin and eyes
occurs because the liver cannot process bilirubin
for elimination from the body.
 Poor growth

 Muscle weakness

 Lethargy

 Impaired pulmonary function ( dyspnea and


cyanosis during exertion)

 Intrapulmonary shunts (hypoxemia)


 Ascites

 Edema

 GI bleeding

 Anemia

 Abdominal pain
 Past health history
 Physical examination (firm, often enlarged and rock-hard)
 Laboratory evaluation
 Liver function tests:
 Bilirubin
 Aminotransferase
 Ammonia
 Albumin
 Cholesterol
 Prothrombin time
 Imaging Tests
 Magnetic resonance imaging (MRI)
 computed tomography (CT) scan
 Liver biopsy (Transjugular Liver Biopsy, Percutaneous Liver
Biopsy and laparoscopy)
 ***liver biopsy can cause internal bleeding that’s why
monitoring vital signs and laboratory values, especially
hematocrit, is very important to check for any signs of
hemorrhage or shock.
 Doopler ultrasonography of the liver and spleen ( to check
for ascites)
 Monitor liver function and manage specific
complications such as esophageal varices and
malnutrition
 Nutritional support
 IV fluids
 Blood products
 Vasopressin
 Gastric lavage
 Balloon tamponade with a Sengstaken-Blakemore tube
( to control bleeding )
 Endoscopic sclerotherapy
 Endoscopic banding ligation
 Diuretics ( potassium –sparring)
 Albumin administration or paracentesis ( for ascites )
 Limit the ammonia formation and absorption by
administering neomycin and lactulose.
Treatment for cirrhosis depends on the cause of cirrhosis.

 Chronic Hepatitis. Many types of antiviral drugs are used to treat chronic hepatitis B,
including pegylated interferon, nucleoside analogs, and nucleotide analogs. Patients
with chronic hepatitis C are treated with combination therapy with pegylated interferon
and ribavarin. [For more information, see In-Depth

 Autoimmune Hepatitis. Autoimmune hepatitis is treated with the corticosteroid


prednisone and also sometimes immunosuppressants, such as azathioprine (Imuran).

 Bile Duct Disorders. Ursodeoxycholic acid (Actigall), also known as ursodiol or UDCA,
is used for treating primary biliary cirrhosis but does not slow the progression. Itching is
usually controlled with cholesterol drugs such as cholestyramine (Questran) and
colestipol (Colestid). Antibiotics for infections in the bile ducts and drugs that quiet the
immune system (prednisone, azathioprine, cyclosporine, methotrexate) may also be
used. Several surgical procedures may also be tried to open up the bile ducts.

 Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis


(NASH). Weight reduction through diet and exercise, and diabetes and cholesterol
management are the primary approaches to treating these diseases. Investigators are
also studying whether various drugs used to treat type 2 diabetes may help treat
NAFLD and NASH.

 Hemochromatosis. Hemachromatosis is treated with phlebotomy, a procedure that


involves removing about a pint of blood once or twice a week until iron levels are
normal.
The goal of cirrhosis therapy is to remove or alleviate the
underlying cause of cirrhosis, prevent further liver
damage, and prevent or treat complications:

 Vitamins and nutritional supplements promote healing of damaged


hepatic cells and improve the patient’s nutritional status.

 Na⁺ consumption is usually restricted, and liquid intake is limited to


or reduces to help manage ascites and edema.

 Drug therapy requires special caution detoxify harmful substances


efficiently.

 Antacids may be prescribed to reduce gastric distress and decrease


the potential for GI Bleeding.

 Alcohol is restricted.
 Sedatives should b avoided. Acetaminophen is
especially hapatotoxic, particularly when combined
with alcohol.
 To minimize the the risk of bleeding, warn the patient
against taking non-steroidal anti-inflammatory drugs,
straining to defecate, and blowing his nose or
sneezing too vigorously. Suggest using an electric
razor and a soft toothbrush.
 Advise the patient tot ake adequate rest because it
decreases the metabolic demands of the liver.
 Teach the patient to have small frequent meals.
Teach him to alternate periods of rest and activity to
reduce the oxygen demand and prevent fatigue.
 Tell the patient to avoid stress and to avoid exposure
to infection.
 Emotional support for the family of the child (to
reduce anxiety in preparation for liver transplantation
or unexpected death)

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