Liver cirrhosis is a chronic liver disease..basically it is a fibrosis and necrosis of liver tissues..damaging of liver functions for a long time.

1. Group#04
Qurat ul ain, Mahruba Hashim, Niyaza Tabasum
Bushra Akram,Zahid khursheed (Post-RN)
Prveen BB, Yasmeen, Bushra (Specialization)
Collage of Nursing, N.M.U Multan

2. Anatomy and Physiology of the Gastrointestinal tract
The gastrointestinal tract (GIT) consists of a hollow muscular tube
starting from the oral cavity, where food enters the mouth, continuing
through the pharynx, oesophagus, stomach and intestines to the rectum
and anus, where food is expelled.
Gastrointestinal physiology is the branch of human physiology that
addresses the physical function of the gastrointestinal (GI) tract. The
function of the GI tract is to process ingested food by mechanical and
chemical means, extract nutrients and excrete waste products. The GI
tract is composed of the alimentary canal, that runs from the mouth to the
anus, as well as the associated glands, chemicals, hormones, and enzymes
that assist in digestion. The major processes that occur in the GI tract are:
motility, secretion, regulation, digestion and circulation. The proper
function and coordination of these processes are vital for maintaining
good health by providing for the effective digestion and uptake of
nutrients.

3. Anatomy of GIT

4. Anatomy and Physiology of the Liver
The liver is located in the upper right-hand portion of the abdominal
cavity, beneath the diaphragm, and on top of the stomach, right kidney,
and intestines. Shaped like a cone, the liver is a dark reddish-brown
organ that weighs about 3 pounds.
The liver is the storage location for fat-soluble vitamins and handles
cholesterol homeostasis. It stores iron and copper. It plays a role in
hematology with clotting factor and protein synthesis. The liver plays a
role in heme breakdown into unconjugated bilirubin and conjugates it.

5. Anatomy of the
liver

6. Introduction of Liver Cirrhosis
Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver
damage. The scar tissue prevents the liver working properly. Cirrhosis is
sometimes called end-stage liver disease because it happens after other
stages of damage from conditions that affect the liver, such as hepatitis,
viral infection, alcohol intake. Scarring leads to altered liver functions.

7. Definition of Liver Cirrhosis
Cirrhosis is complication of liver disease which involves loss of liver
cells and irreversible scaring of liver cells. It is a chronic disease
characterized by replacement of degenerative changes in normal liver
cells. Tissue with diffuse fibrosis and nodules that disturbs the
structure and function of liver. Also scar formation occurs due to
destroyed hepatocytes.
Hepatocytes.
The most common cells of the liver (making up roughly 90% of the
liver's cells) are called hepatocytes. They are all identical. These cells
carry out most of the functions which the liver performs.

8. Healthy Liver and Cirrhotic Liver

9. EtiologyCauses
a) Alcoholism.
b) Hepatitis A, B,C.D.
c) CHF.
d) Biliary obstruction.
e) Diabetes.
f) Glycogen storage disease.
g) Immunological causes.

10. Keys of Cause Mnemonics
ABCDEFGHI
1) A- ALCHOLOSIM
2) B- BILIARY OBSTRUCTION
3) C- CHF
4) D- DIABETES
5) E- ENZYMES DEFICIENCY
6) F- FATTY LIVER
7) G- GLYCOGEN STORAGE DISEASE
8) H- HEPATITIS
9) I- IMMUNOLOGICAL CAUSES

11. Stages of Liver Cirrhosis
Stage 1
It is inflammation of liver, caused by immune system
reacting to a foreign substance, like toxins.
Stage 2
It is liver fibrosis or liver scarring, caused by chronic inflammation.
Stage 3
It is cirrhosis of liver, caused by severe liver scarring.

12. Types of Liver Cirrhosis
There are mainly four types.
1. Post necrotic cirrhosis.
Due to severe inflammation and massive necrosis of hepatocytes
cells.
2. Alcoholic cirrhosis.
It occurs due to excessive intake of alcohol that leads to
accumulation of fat in liver.
3. Biliary cirrhosis.
Due to biliary obstruction for long time and cholestasis(stoppage of
flow and growth).
4. Cardiac cirrhosis.
Main cause of this type is right side congestive heart failure.

13. Signs or Symptoms
Cirrhosis often has no signs or symptoms until liverdamage is
extensive. When signs and symptoms do occur, they may include:
1. Fatigue
2. Easily bleeding or bruising
3. Loss of appetite
4. Nausea
5. Swelling in your legs, feet or ankles (edema)
6. Weight loss
7. Itchy skin

14. Signs or Symptoms (CONT…)
8) Fluid accumulation in your abdomen (ascites)
9) Spiderlike blood vessels on your skin
10) Redness in the palms of the hands
11) For women, absent or loss of periods not related to menopause
12) For men, loss of sex drive, breast enlargement (gynecomastia)
or testicular atrophy
13) Confusion, drowsiness and slurred speech (hepatic
encephalopathy)

15. Pathophysiology of Liver Cirrhosis

16. Nursing Diagnosis
Based on the assessment data, the major nursing diagnosis for the
patient are:
1) Activity intolerance related to fatigue
2) Lethargy, and malaise
3) Imbalanced nutrition: less than body requirements related to
abdominal distention and discomfort and anorexia.

17. Diagnostic Evaluation test for Liver
Cirrhosis
Tests to confirm a diagnosis of cirrhosis include:
1) a complete blood count (CBC).
2) liver enzyme.
3) liver function test .
4) electrolyte testing
5) screening for other health conditions such as hepatitis B and C
viruses.
6) USG for hepatomegaly.
7) a liver biopsy (FNAC- fine needle aspiration cytology).

18. Complications
Some major complications are.
1) Coagulopathies
2) Ascites
3) Peritonitis
4) Portal hypertension
5) Splenomegaly
6) Infection
7) Buildup of toxins in the brain (hepatic encephalopathy). A liver
damaged by cirrhosis isn't able to clear toxins from the blood as well as a
healthy liver can. These toxins can then build up in the brain.

19. Medical and Dietary Management
Medical management is based on presenting symptoms.
1) Antacids
2) Antiemetics
3) Vitamins(A, K, D) and nutritionasl supplements
4) Balanced diet
5) Avoidance of alcohol
6) Low liquid diet
7) Provide albumin containing fluid

20. Surgical Treatment
1. Band Ligation
Endoscopy is used to find the site of bleeding. A narrow tubewith
a camera on the end is inserted in the throat. A rubber band is
then used to tie off the bleeding part of the vein.
2. Liver Transplant
Exchange of liver with a donor.
3. Porta-Caval Shunt
A surgical technique in which hepatic portal vein is joined to inferior
vena cava.

21. Nursing Management
Nursing considerations in the cirrhotic patient are to avoid
infection and circulatory problems.
1) Take vitals sign 2 hourly and monitor intake output.
2) Foot side should be raised due to edema and ascites.
3) Measure and record abdominal girth every shift.
4) Monitor the patient closely for signs of hypovolemia.
5) Test any stool and emesis for blood.
6) Watch for signs of anxiety, restlessness and weakness.

22. Key points about cirrhosis
1) Cirrhosis is when scar tissue replaces healthy liver tissue. This
stops the liver from working normally.
2) Cirrhosis is a long-term (chronic) liver disease.
3) The most common causes are hepatitis and other viruses, and
alcohol abuse. Other medical problems can also cause it.
4) The damage to the liver usually can’t be reversed.
5) The goal of treatment is to slow down the buildup of scar tissue
and prevent or treat any problems that happen.
6) In severe cases, you may need a liver transplant.

23. Overview of the following GIT Disorder
1. Disorders of mouth and esophagus
2. Disorders of stomach
3. Disorders of small and large intestine
4. Alteration in hepatobiliary system

24. 1. Disorders of mouth and esophagus
1) Stomatitis
2) Hiatal hernia
3) Gastro esophageal reflux disorder

25. 1. Stomatitis
Stomatitis is a sore or inflammation inside of the mouth. The sore can be
in the cheeks, gums, inside of the lips, or on the tongue.
Causes
The most common causes are: trauma from ill-fitting dentures or braces,
biting the inside of the cheek, tongue, or lip, and surgery. chemotherapy
treatment for cancer. viral infection, such as herpes.

26. Symptoms
Stomatitis often results in pain, stinging, and soreness. Each person may
experience different symptoms. These can include:
1) mouth ulcers with a white or yellow layer and red base, usually inside
the lips, cheek, or on the tongue
2) red patches
3) blisters
4) swelling
5) lesions that heal in 4-14 days and often recur

27. Nursing intervention
1) using an antiseptic and non-alcoholic mouthwash
2) treating chronic dry mouth
3) using a soft toothbrush
4) maintaining proper nutrition and hydration
5) receiving routine dental care

28. 2. Hiatal Hernia
 A hiatal hernia occurs when part
of the stomach protrudes up into
the chest through the sheet of
muscle called the diaphragm. This
may result from a weakening of the
surrounding tissues and may be
aggravated by obesity and/or
smoking. The esophagus runs
through the diaphragm to the
stomach.

29. Hiatal Hernia Causes
Chronic coughing. Lifting heavy objects. Repetitive vomiting. Straining during
a bowel movement.
Symptoms
1) Heartburn.
2) Regurgitation of food or liquids into the mouth.
3) Backflow of stomach acid into the esophagus (acid reflux)
4) Difficulty swallowing.
5) Chest or abdominal pain.
6) Feeling full soon after you eat.
7) Shortness of breath.
8) Vomiting of blood or passing of black stools, which may indicate
gastrointestinal bleeding.

30. Nursing Interventions
Eating smaller meals to reduce stomach bulk. Avoiding stimulation of
gastric secretions by omitting caffeine and alcohol, which may intensify
symptoms. Refraining from smoking, which stimulates gastric acid
secretions. Avoiding fatty foods, which promote reflux and delay gastric
emptying.

31. 3.Gastro
esophageal reflux
disorder
Gastroesophageal reflux
disease (GERD) occurs
when stomach acid
repeatedly flows back into
the tube connecting your
mouth and stomach
(esophagus). This
backwash (acid reflux) can
irritate the lining of your
esophagus.

32. Causes
Factors that can aggravate acid reflux include:
1) Smoking.
2) Eating large meals or eating late at night.
3) Eating certain foods (triggers) such as fatty or fried foods.
4) Drinking certain beverages, such as alcohol or coffee.
5) Taking certain medications, such as aspirin.
Nursing interventions
1) Improve nutrition.
2) Relieve pain.
3) Prevent aspiration.
4) Enforce health education.
5) Relieve anxiety.
6) Prevent injury.

33. 2. Disorders of stomach
1) Gastritis
2) Gstric ulcer

34. 1. Gastritis
 Gastritis is a Inflammation of the
lining of the stomach. The
inflammation of gastritis is most
often the result of infection with the
same bacterium that causes most
stomach ulcers or the regular use of
certain pain relievers.

35. Causes
The inflammation of gastritis is most often the result of infection with the
same bacterium that causes most stomach ulcers or the regular use of certain
pain relievers. Drinking too much alcohol also can contribute to gastritis.

36. Nursing interventions
Taking antacids and other drugs (such as proton pump inhibitors or H-2
blockers) to reduce stomach acid. Avoiding hot and spicy foods. For
gastritis caused by H. pylori infection, so doctor will prescribe a regimen
of several antibiotics plus an acid blocking drug (used for heartburn).

37. 2. Gastric ulcer
 Stomach ulcers (gastric ulcers)
are open sores that develop on the
lining of the stomach. Ulcers can
also occur in part of the intestine
just beyond the stomach. These are
called duodenal ulcers. Stomach
and duodenal ulcers are sometimes
called peptic ulcers. This
information applies to both.

38. Causes
and
Symptoms
PEPTIC ULCER

39. Nursing interventions
Encourage patient to eat regular meals in a relaxed setting and to avoid
overeating. Explain that smoking may interfere with ulcer healing; refer
patient to programs to assist with smoking cessation. Alert patient to
signs and symptoms of complications to be reported.

40. 3. Disorders of small and large intestine
1. Irritable Bowel Syndrome
2. Intestinal Obstruction

41. 1.Irritable Bowel Syndrome
 Irritable bowel syndrome (IBS) is a
common disorder that affects the
stomach and intestines due to
anatomical contractions and
deformity of muscle layer, also
called the gastrointestinal tract.
Symptoms include cramping,
abdominal pain, bloating, gas, and
diarrhea or constipation, or both.

42. Causes

43. Nursing management of irritable bowel syndrome
Nursing Management
1) Eating a well balanced, high-fiber diet; avoiding gas-forming foods;
and avoiding fluid intake with meals because it causes abdominal
distention.
2) Adhering to a schedule of regular work and rest periods.
3) Participating in regular exercise, which reduces anxiety and
increases intestinal motility.

44. 2. Intestinal Obstruction
 Intestinal obstruction is a blockage that
keeps food or liquid from passing through
your small intestine or large intestine
(colon).
 Signs and symptoms of
intestinal obstruction include:
1) Crampy abdominal pain that comes and
goes.
2) Loss of appetite.
3) Constipation.
4) Vomiting.
5) Inability to have a bowel movement or pass
gas.
6) Swelling of the abdomen.

45. Causes of intestinal obstruction may include:
1) Adhesions or scar tissue that forms after surgery.
2) Foreign bodies (objects that are swallowed and block the
intestines)
3) Gallstones (rare)
4) Hernias.
5) Impacted stool.
6) Intussusception (telescoping of one segment of bowel into
another)
7) Tumors blocking the intestine

47. 4. Alteration in hepatobiliary system
1) Pancreatitis
2) Cholecystitis
3) cholelithiasis

48. 1. Pancreatitis
 Pancreatitis is inflammation of the
pancreas. The pancreas is a long,
flat gland that sits tucked behind
the stomach in the upper abdomen.
The pancreas produces enzymes
that help digestion and hormones
that help regulate the way your body
processes sugar (glucose).

49. Causes & Symptoms
1) Gallstones.
2) Alcoholism.
3) Certain medications.
4) High triglyceride levels in the blood
(hypertriglyceridemia)
5) Pancreatic cancer.
6) Abdominal surgery.
7) Cystic fibrosis.
 Symptoms
1) Upper abdominal pain.
2) Abdominal pain that radiates to
your back.
3) Tenderness when touching the
abdomen.
4) Fever.
5) Rapid pulse.
6) Nausea.
7) Vomiting.

51. Cholecystitis & Cholelithiasis
Cholecystitis Cholelithias
 Cholecystitis is when your
gallbladder is inflamed.
Gallbladder inflammation can be
caused by: Gallstones. Most
often, cholecystitis is the result of
hard particles that develop in
your gallbladder (gallstones).
Gallstones can block the tube
(cystic duct) through which bile
flows when it leaves the
gallbladder.
 Cholelithiasis involves the presence of
gallstones, which are concretions that
form in the biliary tract, usually in the
gallbladder. Choledocholithiasis refers
to the presence of one or more
gallstones in the common bile duct
(CBD). Treatment of gallstones
depends on the stage of disease.

52. What are the five F's of gallbladder disease?
The five Fs were a mnemonic device that healthcare providers used in the
past to memorize common risk factors for gallbladder disease. The five Fs
were: fair, female, fat, fertile and 40. They were based on statistics,
but they are controversial today because they add up to a kind of stereotype.

53. Nursing Care Plans
Nursing care planning and management for patients with cholecystitis and
cholelithiasis include relieving pain and promoting rest, maintaining fluid
and electrolyte balance, preventing complications, and provision of
information about disease process, prognosis, and treatment.