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LIVERLIVERCIRRHOSISCIRRHOSIS

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characterized by

scarringIt is a chronic

disease in which

there has beendiffuse destruction

and fibrotic

regeneration ofhepatic cells.

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CLINICAL MANIFESTATIONS

Onset is insidious

Early complaints includey fatigue

y anorexia

y edema of the ankles in the evening

y epistaxis

y bleeding gums

y weight loss

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LLATERATER COMPLAINTSCOMPLAINTS AREARE DUEDUE TOTO

CHRONICCHRONIC FAILUREFAILURE OFOF THETHE LIVERLIVER ANDAND

OBSTRUCTIONOBSTRUCTION OFOF PORTALPORTAL

CIRCULATIONCIRCULATION.. Chronic dyspepsia, constipation or diarrhea.

Esophageal varices, dilated cutaneous veins around theumbilicus (caput medusa), internal hemorrhoids, ascites,splenomegaly, and pancytopenia.

Plasma albumin is reducedAnemia and poor nutrition lead to fatigue and weakness,

wasting, and depression.

Deterioration of mental function from lethargy to delirium tocoma and eventual death.

Estrogenandrogen imbalance cause spider angiomata andpalmar erythema; menstrual irregularities in females;testicular and prostatic atrophy, gynecomastia, loss of libido,and impotence in males.

Bleeding tendencies, such as nosebleeds, easy bruising,hematemesis, or profuse hemorrhage from stomach and

esophageal varices.

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DDIAGNOSTICIAGNOSTIC EEVALUATIONVALUATION

Liver biopsyLiver scan

Computed tomography (CT)

scan

Esophagoscopy

PTC - Percutaneous

Transhepatic Cholangiogram

Laparoscopy, along with liverbiopsy

Serum liver function tests

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Paracentesis

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MMANAGEMENTANAGEMENTMinimize further deterioration of liver function

Correction of nutritional deficiencies

Treatment of ascites and fluid and electrolyte

imbalances. Restrict sodium and water intake, depending on

amount of fluid retention.

Bed rest to aid in diuresis.

Diuretic therapy

Abdominal paracentesis

Administration of albumin

Peritoneovenous shunt

Symptomatic relief measures

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NNURSINGURSINGIINTERVENTIONSNTERVENTIONS

Maintain some periods of bed rest with legs

elevated to mobilize edema and ascites.

Suggest small, frequent feedings and

attractive meals in an aesthetically pleasingsetting at mealtime.

Note and record degree of jaundice of skin

and sclerae along with scratches on the body.

Observe stools and emesis for color,consistency, and amount, and test each one

for occult blood.

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.CONT Be alert for symptoms of anxiety, epigastric

fullness, weakness, and restlessness, which may

indicate GI bleeding.

Restrict high-protein loads while serum ammonia

is high to prevent hepatic encephalopathy.

Monitor ammonia levels. Protect from sepsis through good hand washing

and prompt recognition and management of

infection.

Monitor fluid intake and output and serumelectrolyte levels to prevent dehydration and

hypokalemia (may occur with the use of

diuretics), which may precipitate hepatic coma.

Assess level of consciousness and frequently

reorient as needed.

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CCOMPLICATIONSOMPLICATIONS

1. Hyponatremia and water retention

2. Bleeding esophageal varices

3. Coagulopathies

4. Spontaneous bacterial peritonitis

5. Hepatic encephalopathy, which may be

precipitated by the use of sedatives, high-

protein diet, sepsis, or electrolyteimbalance

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