CIRRHOSIS OF LIVER

KINJAL TANDEL
FY MSC NURSING
 DEFINITION

I. Cirrhosis is a complication of liver disease that involves loss of

liver cells and irreversible caring of the liver
II. Cirrhosis is a chronic disease characterized by replacement of
normal liver tissue with diffuse fibrosis that disrupts the
structure and function of the liver. The fibrosis alters liver
structure and vasculature, impairing blood and lymph flow
and resulting in hepatic insufficiency and hypertension in the
portal vein
 classifications of Cirrhosis

 1.Alcoholic cirrhosis -scar tissue chacteristically surrounds the

portal areas.This is the most prevalent type that caused by long
history of chronic alcoholis
 Postnecrotic cirrhosis

consist broad bands of scar tissue and results from previous acute viral
hepatitis or drug-induced massive hepatic necrosis.
 .Biliary cirrhosis

consist of scarring of liver around the bile ducts. This type of cirrhosis
usually results from chronic biliary obstruction and
infection(cholangitis) it is much less common than the other two
classifications of cirrhosis
pathophysiology
causes

 Choronic alcoholism-
 Viral or Autoimmune hepatitis
 .Inherited or Genetic disorder-
 .Inherited or Genetic disorder-
 Drugs and toxin
 Alcoholism
 Hepatitis B and C
 causes

 8. Chemical intoxication / extra hepatic

9 Malnutrition
 10 Chronic cholestasis intra / extra hepatic
 11Hepatic venous outflow obstruction
 12 Immunological disorders
 13 Metabolic abnormalities
 14 Hepatotoxic substances
 15. Haemochromatosis
Sign and symptoms
 DIAGNOSTIC TEST

 laboratory BLOOD TEST

 Cbc, – bilirubin, albumin, alanine transaminase (ALT), aspartate
transaminase (AST),prothrombin time, and serum ammonia LFT,SGPT
SGOT- to check for elevated values, which indicate hepatic cell destruction
 CT scan or Ultrasound– show shrinkage or abnormal appearance of the
liver.
 •Laparoscopy and liver biopsy-direct visualization of the liver
 •Paracentesis-to examine ascetic fluid for cell,protein and bacterial counts.
 •Esophagoscopy– to determine the presence of esophageal varices.
 MEDICAL MANAGEMENT

 Pharmacological
 In sever cases inj Lasix 20 mg bd or od prescribe (diuretics)
 Inj ceftriaxone/ inj taxim 1gm 12 hourly (antibiotic)
 Inj.pantop 40 mg bd (antacid)
 Inj.vit k 1 (10mg) ampule im od for 5 days, to prevent bleeding disorder
 Inj.neurobion,or inj vitcofal 2cc im od for 5 days
 Potassium sparing diuretic spironolactone (Aldactone)- 50 MG BD use to decreased ascites and
pleural effusion.
 Tab.Lasilactone 25/50 mg bd or od
 Lactulose (Cholac)-used to eliminate the ammonia from the blood into the bowel. Tap water enemas
may also be ordered to help the body eliminate the ammonia
 SURGICAL MANAGEMENT

1 )Paracentesis– may perform to remove

the fluid from the abdomen and relive
pressure on the diaphragm and lungs.A
paracentesis is done by making a small
incision and inserting a trochar into the
abdomen to drain the fluid. Albumin may be
infused at the same time to pull excess fluid
back into vascular system.
 Esophagogastric intubation

 Esophagogastric intubation (balloon placed into the

esophagus and inflated to put pressure on bleeding
sites) or endoscopic sclerotherapy (placing a flexible
tube into the esophagus and using an agent that causes
sclerosing of the bleeding area) for bleeding
esophageal varices. If sclerotherapy is unsuccessful,
endoscopic banding may be performed. This technique
involves banding of the varices causing strangulation
and eventually fibrosis of the area
 CIRRHOSIS NURSING MANAGEMENT

1. Monitor vital signs, intake and output and electrolyte

levels to determine fluid volume status.Maintain some
periods of rest wtih legs elevated to mobilize edema and
ascites.Alternate rest periods with ambulation.
2. To assess fluid retention, measure and record abdominal
girth every shift. Weight the patient daily and document his
weight.Administer diuretics,potasium and protein or
vitamin supplements as ordered. Restrict sodium and fluid
intake as ordered.
NURSING MANAGEMENT

 Observe and document for bleeding gums,ecchymoses,epistaxis,

 1Monitor complications
 Acites, bleeding esophageal varices and hepatic encephalopathy is a
very feared complic
 ation in patients with liver cirrhosis
 2. Maximize the function of the liver
 3. Treatment based on the cause
 4. Prevention of infection
 5. Diuretics that retain potassium
 PATIENT TEACHING

 To minimize the risk for bleeding, warn the patient against taking
nonsteroidal anti-inflammatory drugs , straining to defecate and blowing
his nose or sneezing to vigorously.Suggest using an electric razor and a
soft toothbrush.
 Advise the patient that rest and good nutrition conserve energy and
decrease metabolic demands on the liver. Urge him to eat frequent,small
meals. Teach him to alternate periods of rest and activity to reduce
oxygen demand and prevent fatigue.
 NURSING DIAGNOSIS

1. 1. Acute Pain : abdominal - upper right quadrant related to the inflammatory

process
2. . Imbalanced Nutrition: less than body requirements related to anorexia
3. Exeess fluid volume related to portal hypertension as evidenced edema and
acitis
4. Impaired skin integrity related to peripheral edema as evidenced by shiny skin
over edematous areas
5. Dysfunctional family process alcoholism
6. Ineffective breathing pattern
 Nursing diagnosis

1. Dysfunctional family process alcoholism

2. Ineffective breathing pattern
3. Compromised family coping
4. Potential complication hemorrhage,hepatic encephalopathy
 SUMMARY

 Describe the define the cirrhosis of liver

 describe about etiology and incidence
 describe about the type of cirrhosis of liver
 describe the sign & symptoms of cirrhosis of liver
 describe about pathophysiology of cirrhosis of liver
 describe the diagnostic evaluation done for cirrhosis of liver
 describe about medical management of cirrhosis of liver
 describe about the surgical management of cirrhosis of liver
 describe about the nursing management & prevention , diet
,rest , health education
CONCLUSION

 Inthis lacture we learnt about cirrhosis

definition causes,etiology ,types ,diagnostic test,
medical and surgical management,nursing
responsibility and patient teaching and nursing
diagnosis.so its very easy to get idea about
cirrhosis of liver
Assignment

 What is the cirrhosis of liver

 Causes of
 Sign and symptoms
 Nursing management of cirrhosis of liver
THANK YOU