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1. • Subject: Adult Health Nursing
• Topic: Cirrhosis of liver

2. Objectives
• At the end of this presentation the student will be
able to:
• Define cirrhosis of liver
• Describe Pathophysiology of cirrhosis of liver
• Identify types of cirrhosis of liver.
• Enlist signs, symptoms and causes of cirrhosis of
liver.
• Discuss medical diagnosis and treatment cirrhosis of
liver
• Make nursing diagnosis and nursing intervention for
cirrhosis of liver.

3. Liver Cirrhosis
• Cirrhosis
It is a chronic liver disease characterized
by scarring of the liver that involves the
formation of fibrous (scar) tissue associated
with the destruction of the normal
parenchymal cells of the organ.
• It is the result of long-standing injury most
commonly due to alcohol in excess but there
are a number of other important causes .

4. Cont….
• The destruction of the
normal structure and
the loss of liver cells
prevents the liver from
functioning normally.

5. Pathophysiology
• Cirrhosis is often caused by
hepatitis and fatty liver ,
independent of the cause. If
the cause is removed at this
stage, the changes are still fully
reversible.
• The Pathophysiology of
cirrhosis is the development of
scar tissue that replaces
normal parenchyma, blocking
the portal flow of blood
through the organ and
disturbing normal function.

6. Types of cirrhosis
 The major types of cirrhosis based on
pathological classification are:
• Alcoholic cirrhosis (alcohol intake)
• Postnecrotic cirrhosis (hepatitis)
• Biliary cirrhosis (biliary obstruction)
• Cardiac cirrhosis (right sided heart failure) and
• Nonspecific metabolic cirrhosis (GI diseases).

7. Etiology
• Hepatitis C infection (long-term infection).
• Long-term alcohol abuse.
• Autoimmune inflammation of the liver.
• Disorders of the drainage system of the liver
(the biliary system), such as primary biliary
cirrhosis and primary cholangitis.

8. Cont…
• Hepatitis B (long-term infection).
• Hepatotoxic drugs or toxins.
• Metabolic disorders of iron.
(hemochromatosis).
• Nonalcoholic fatty liver disease (NAFLD).

9. Clinical Manifestation
• Peripheral edema.
• Nausea and vomiting.
• Constipation & diarrhea.
• Pain and fever.
• Clubbing.
• An enlarged liver or spleen.
• Acities.
• Red spider-like blood vessels
on the skin
• Jaundice.

10. Diagnosis
• Complete blood count test (CBC).
• Liver function tests including alkaline phospatase,
serum glutamic pyruvic transaminase (SGPT).
• Serum albumin.
• Liver biopsy.
• Liver scan.
• Upper GI barium swallow.
• Computed tomography (CT) of the abdomen
• Magnetic resonance imaging (MRI) of the abdomen
• Ultrasound of the abdomen.

11. Treatment
 All patients with cirrhosis can benefit from certain
lifestyle changes, including:
• Stop drinking alcohol.
• Limit salt in the diet.
• Get vaccinated for influenza, hepatitis A and hepatitis
B, and pneumococcal pneumonia (if recommended by
doctor).
• Generally, liver damage from cirrhosis cannot be
reversed, but treatment could stop or delay further
progression and reduce complications.

12. Cont…
• A healthy diet is encouraged, as cirrhosis may be an
energy-consuming process.
• Antibiotics will be prescribed for infections, and various
medications can help with itching.
• Laxatives, such as lactulose, decrease risk of
constipation.
• Alcoholic cirrhosis caused by alcohol abuse is treated by
abstaining from alcohol.

13. Cont…
• Treatment for hepatic
cirrhosis involves
medications used to treat
the different types of
hepatitis, such as interferon
for viral hepatitis and
corticosteroids for
autoimmune hepatitis.
• Liver transplant.

14. Complications
• Liver failure.
• Spleenomegaly.
• Ascites and bacterial peritonitis.
• Portal hypertension
• Kidney failure.
• Hepatocellular carcinoma.
• Mental confusion.
• Change in the level of consciousness.
• Coma.

15. Nursing diagnosis
• Acute pain related to liver enlargement secondary to
ascites as evidenced by facial grimace.
• Activity intolerance related to fatigue and
discomfort.
• Imbalanced nutrition, less than body requirements,
related to chronic gastritis, decreased GI motility, and
anorexia.
• Altered breathing pattern r/t decreased lung
expansion secondary to intra-abdominal fluid
collection (ascites).

16. Cont….
• Risk for injury and bleeding related to altered clotting
mechanisms.
• Fluid volume excess R/T ascites and edema
formation.
• Altered coping skill related to disease.

17. Nursing interventions
• Provide comfort measures such as back rubbing
&changing position to relieve pain
• Teach the patient relaxation techniques like deep
breathing
• Provide quiet and calm environment.
• Give analgesics to relieve form pain and fever.
• Evaluate pt’s current activity tolerance and adjust
activity and reduce intensity of task that may cause
undesired physiological changes.
• Help and encourage patients to eat, e. Feed the patient
when fatigue or let someone nearby to help patients.

18. Cont…
• Keep head of bed elevated to facilitates breathing by
reducing pressure on the diaphragm
• Restrict intake of caffeine, gas-producing or spicy and
excessively hot or cold foods to aids in reducing gastric
irritation &abdominal discomfort that may impair oral
intake /digestion.
• Protect pt. from bleeding, monitor urine, stool, gums,
skin for signs of bleeding/ bruising
• Teach pt. to use soft toothbrush,avoid constipation
• Administer Vit. K as ordered.

19. References
• Garcia-Tsao G, Lim JK; Members of Veterans Affairs
Hepatitis C Resource Center Program. Management
and treatment of patients with cirrhosis and portal
hypertension:
• Garcia-Tsao G. Cirrhosis and its sequelae. In:
Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed.
Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.
• Mehta G, Rothstein KD. Health maintenance issues in
cirrhosis. Med Clin North Am. 2009;93:901-915