Liver is a largest gland in body. It has 4 lobes; right,left, caudate,and quadrant. It is located at right side of the abdomen, inferior to the diaphragm and anterior to the stomach. Functions: Carbohydrate, protein and fat metabolism. Breakdown of red blood cell. Defence against microbes. Detoxification of drugs and toxics. Inactivation of hormones. Secretion of bile. Storage.
Livercirrhosis results of long-term injury caused by variety agents. Definition:A chronic disease that causes cell destruction and fibrosis(scarring)of hepatic tissueo Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow, resulting in hepatic insufficiency and hypertension in the portal vein.o Progressive and irreversible.
Alcohol intakeObstruction and inflammation of biliary tractviral hepatitisHeart failure (right side)Metabolic disease
Inflamation and destroyed a liver tissue Replaced fibrous tissueThere is hyperplasia of Hepatocyte adjacent to damage area to compensate for destroyed cell
Formation of nodule consisting of hepayocyte confined within sheets of fibrous tissue Can cause : Early- liver enlargement, tendernest pain in RUQ ,weight loss,fatigue anorexia,diarrea,constipation Progress –to ompaire metabolism cause bleeding, ascites,jaundise Condition progress portal hypertensiondevelop, leading to congestion in the organ drained by the tributanes of the portal vein to ascites and develop of oesophageal varices
Liver failure may occur when hyperplasiaunable to keep pace with the cell destruction and increase risk liver cancerHypertention may acoccur when abnormal nodule encircled conective tissue Fibrous connective tissue constrictve
Disturb blood and bile flow within liver lobuleBlood no longer flows freely throw the liver to inferior vena cavaRestrict blood flow lad to portal hypertension ,increase presssure in the portal venous system
Alcoholic cirrhosis Usually occur after years of drinking too much.Alcohol may cause swelling and inflammation in the liver.Also may cause malnutrition.
Biliary cirrhosis Occur due to obtruction to the flow of bile duct either within the liver or outside the liver.Primary biliary cirrhosis is a condition where small and medium sized bile duct within the liver are inflamed undergo destruction and scarring.Thus bile produced by the liver cannnot reach the intestine lead to accumulation of bile in the liver,resulting in liver damaged.
Cardiac cirrhosis Liver dysfunction due to venous congestion usually cardiac dysfunction for example right heart failure.When severe and longstanding hepatic congestive can lead to fibrosis.Increase pressure in the sublobular branches of the hepatic vein cause an engorgement of venous blood being dammed back in the inferior vena cava and hepatic veins.
Posthepatic cirrhoss Is characterized by scarring following chronic destructive inflammationof the liver parenchyma that slowly spreads from the portal regions throughout the lobe of the portal region.Metabolic cirrhosis Associated with metabolic disease such as hemochromatasis and wilson’s disease.
In early stage, the patient may experience only vague sign and symptoms , but typically he complains of abdominal pain, diarrhea, fatigue, nausea and vomiting. Later, as the disease progresses, he may complains of chronic dyspepsia, constipation, pruritus,(high serum bilirubin produce) and weight loss. He also may report may report tendency for easy bleeding, such as easy bruising and bleeding gum
Liver function studies- ALT,AST, alkalinephosphatase,GGT. All may elevated incirrhosis Is characterized by scarring following chronicLiver biopsy- not necessary for cirrhosis but destructive inflammationof the liver parenchyma that slowly spreads from thecan be determine the extent of the nature of portal regions throughout the lobe and portal region.the liver damage.Esophagascopy – to identify presence ofesophageal varices.
Abdomen ultarsound to evaluate liver size,detect ascites and liver nodules. CBC with platelet count- low RBC,HCT and Hb demonstrate anemia related to bone marrow suppression. -increase RBC destruction causes platelet low due to spleenomegaly.
TREATMENTDietary and fluid management1. Restrict fluid and sodium based on diuretictherapy, urine output, electrolytes values todecrease fluid retention in abdomen and preventhypernatremia.2. Consume protein at least 75-100 grams perday because accumulation of abdomen fluid richin protein will lead to hypoalbunemia.3. Increase carbohydrates intake and consumemoderate amount of fats or administer totalparenteral nutrition due to loss in body weightresulted from impaired metabolism.
4.Increase intake of vitamin and mineral supplements. For examples, vitamin A, B, D, E, K and Mg due to the failure of liver to store vitamins and lost of these vitamins and minerals resulted from diarrhea.
Complication management 1. Perform paracentesis to remove fluid form the abdomen thus prevent ascites and associated respiratory distress. It is able to remove 5 or more liters of fluid. 2. For bleeding esophageal varices: Perform blood transfusion, fresh frozen plasma transfusion, infuse fluids to restore hemodynamic stability after a severe bleeding. Administer vasoconstrictive medications such as somatotastin, octreotide and vasopressin to control bleeding. Perform upper endoscopy such as variceal ligation or endoscopic sclerosis to treat varices with banding.
Perform ballon tamponade if bleeding not controlled or endoscopy unavailable as short term measure to control bleeding.3. Perform insertion of transjugular intrahepatic portosystmic shunt ( TIPS ): Using a stent to channel blood between portal and hepatic vein and bypassing liver due to obstruction of blood through liver. It is a short term measure to control portal hypertension
SurgeryLiver transplant indicated when: Bilirubin increases Albumin level decreases Problems with complication increases and patient responds poorly to treatment Contraindicated in maglinant case, alcohol or drugs abused case.
Diuretics -Can be given to cirrhosis patients who are also affected by ascites and edema. The diuretics work to remove extra fluids from the body.-example:-furosemide(lasix) Beta-Blockers -Doctors may recommend beta-blockers to reduce or eliminate bleeding in the gastrointestinal tract -Prevent esophageal from rebleeding -example:-beta blocker nadolol(corgard) with isosorbide mononitrate
Activity intolerance related to fatigue, general debility and discomfort.1) Assess the condition and ability of patient to perform work to plan next nursing intervention.2) Encourage alternating periods of rest and ambulation to promote rest and avoids patient fatigue.3) Elevate the leg with pillow to mobilize edema and ascites4) Encourage and assist patient with gradually increasing periods of exercise to avoid patient fall and fatigue.5) Put the call bell and cardiac table near to patient’s bed so that patient able can get the things easily.
Altered nutrition: Less than body requirements related to anorexia and GI disturbances1) Assess nutrition level of the patient from intake and output chart to perform next intervention.2) Encourage patient to eat high calorie, moderate protein meal due to impaired protein metabolism.3) Suggest small, frequent feeding and attractive meal to increase patient’s appetite.4) Encourage oral hygiene before meal to increase patient’s appetite.5) Administration of medication antiemetic such as maxalon as doctor order to prevent nausea and vomiting.6) Daily weight the patient with same weighing scale, same cloth, same time to identify the effectiveness of the treatment.7) Provide IV therapy such as total parental nutrition (TPN) as doctor prescribed to maintain the nutrition need the by patient.
Impaired skin integrity related edema, jaundice and compromised immunologic status.1)Note and record degree of jaundice of skin and sclerae and scratches on the body so that next intervention can be planned.2)Encourage frequent skin care, bathing without soap and massage with lotion to moisture the skin3)Advise patient to keep fingernails short to prevent injury to the skin.4)Perform any procedure gently to prevent the skin from injury.5)Elevate the leg to reduce the edema and promote venous return.
1)Observe Risk for injury related to altered clotting mechanisms1)Observe stool and emesis about colour, consistency, amount and test each one for occult blood.2)Be alert for symptoms of anxiety, epigastric fullness, weakness, restless which may indicate GI bleeding.3)Observe for internal bleeding such as eechymosis,epistaxis,petechiae and bleeding gums.4)Stay with patient and give pressure at the bleeding sites during episodes of bleeding to stop the bleeding.5)Institute and teach measures to prevent trauma such as maintain safe environment,gentle blowing of nose and use soft tooth brush to prevent bleeding from occur.6)Administer vit K(Aqua Mephyton) as doctor prescribed to increase clotting factor.
Altered thought process related to deterioration of liver function and increased serum ammonia1)Restrict high protein load while serum ammonia is high to prevent hepatic encephalopathy2)Monitor ammonia level by the urine test to know the effectiveness of treatment3)Protect from sepsis through good hand ashing and management from infection because the liver cannot function well.4)Monitor fluid intake and output and serum electrolyte level to prevent dehydration and hypokalemia may occur with the use of diuretics which may precipitate hepatic coma