4. Description
• Normal lobular structure distorted by
fibrotic connective tissue
• Lobules are irregular in size and shape
with impaired vascular flow
• Insidious, prolonged course
5. Statistics
• > 50% of liver disease in the US is directly
related to alcohol consumption
• Of the estimated 15 million alcoholics in the
USA 10-20% have or will develop cirrhosis
6. Statistics
• Growing number of cases related to chronic
hepatitis C
• 4th leading cause of death in people between
35 and 54 years of age
7. Statistics
• Direct correlation between alcohol
consumption in any geographic area and the
death rate from cirrhosis in that area
8. Etiology and Pathophysiology
• Cell necrosis occurs
• Destroyed liver cells are replaced by
scar tissue
• Normal architecture becomes nodular
9. Etiology and Pathophysiology
• Four types of cirrhosis:
– Alcoholic (Laennec’s) cirrhosis
– Postnecrotic cirrhosis
– Biliary cirrhosis
– Cardiac cirrhosis
10. Etiology and Pathophysiology
• Alcoholic (Laennec’s) Cirrhosis
– Associated with alcohol abuse
– Preceded by a theoretically reversible
fatty infiltration of the liver cells
– Widespread scar formation
11. Etiology and Pathophysiology
• Postnecrotic Cirrhosis
– Complication of toxic or viral hepatitis
– Accounts for 20% of the cases of
cirrhosis
– Broad bands of scar tissue form within
the liver
12. Etiology and Pathophysiology
• Biliary Cirrhosis
– Associated with chronic biliary
obstruction and infection
– Accounts for 15% of all cases of
cirrhosis
18. Clinical Manifestations
Jaundice
• Occurs because of insufficient
conjugation of bilirubin by the liver cells,
and local obstruction of biliary ducts by
scarring and regenerating tissue
34. Complications
Peripheral Edema and Ascites
• Ascites:
-- Intraperitoneal accumulation of
watery fluid containing small
amounts of protein
35. Complications
Peripheral Edema and Ascites
• Factors involved in the pathogenesis of
ascites:
- Hypoalbuminemia
−↑ Levels of aldosterone
−↑ Portal hypertension
47. Collaborative Care
Esophageal Varices
• Avoid alcohol, aspirin, and irritating
foods
• If bleeding occurs, stabilize patient and
manage the airway, administer
vasopressin (Pitressin)
51. Collaborative Care
Hepatic Encephalopathy
• Goal: reduce NH3 formation
– Protein restriction (0-40g/day)
– Sterilization of GI tract with antibiotics
(e.g., neomycin)
– lactulose (Cephulac) – traps NH3 in gut
– levodopa
52. Drug Therapy
• There is no specific drug therapy for
cirrhosis
• Drugs are used to treat symptoms and
complications of advanced liver disease
53. Nutritional Therapy
• Diet for patient without complications:
– High in calories
↑ CHO
– Moderate to low fat
– Amount of protein varies with degree
of liver damage
54. Nutritional Therapy
• Patient with hepatic encephalopathy
– Very low to no-protein diet
• Low sodium diet for patient with ascites
and edema
61. Nursing Management
Nursing Implementation
• Ambulatory and Home Care
– Symptoms of complications
– When to seek medical attention
– Remission maintenance
– Abstinence from alcohol