Compiled By: Mr. Ashish Roy

1. HEPATIC/LIVER CIRRHOSIS
COMPILED BY :
MR. ASHISH ROY
(Nursing Tutor)

2. INTRODUCTION
 LIVER CIRRHOSIS is the severe scarring of liver and poor function at last stage of
chronic liver disease scarring is most often Caused by prolonged exposure in toxins.
E.g., alcohol or viral infection, scarring leads to altered liver functions.

3. ANATOMY OF LIVER

4. ANATOMY OF LIVER

5. DEFINITION
 CIRRHOSIS IS COMPLICATION OF LIVER DISEASE WHICH INVOLVES LOSS OF
LIVER CELLS AND IRREVERSIBLE SCARING OF LIVER CELLS. IT IS A CHRONIC
DISEASE CHJARACVTERIZED BY REPLACEMENT OR DEGENRATIVE CHANGES IN
NORMAL LIVER CELLS. TISSUE WITH DIFFUSE FIBROSIS AND NODULES THAT
DISTURBS THE STRUCTUREVAND FUNCTION OF LIVER. ALSO SCAR FORMATION.
OCCURS DUE TO DESTROYED HEPATOCYES.

6. TYPES
 POST NECROTIC CIRRHOSIS
DUE TO SEVERE INFLAMMATION AND MASSIVE NECROSIS OF HEPATOCYTES
CELLS.
 ALCOHOLIC CIRRHOSIS
IT OCCURS DUE TO EXCESSIVE INTAKE OF ALCOHOL THAT LEADS TO
ACCUMULATION OF FAT IN LIVER
 BILIARY CIRRHOSIS
DUE TO BILIARY OBSTRUCTION FOR LONG TIME AND CHOLESTATSIS (STOPPAGE
OF FLOW OR GROWTH)
 CARDIAC CIRRHOSIS
MAIN CAUSE OF THIS TYPE OF CIRRHOSIS IS RIGHT SIDE CONGESTIVE HEART FAILURE.

7. ETIOLOGICAL FACTORS / CAUSES
 ALCOHOLISM
 HEPATITIS A,B,C,D
 HEPATOTOXIC DRUGS
 CHF
 BILIARY OBSTRUCTION
 DIABETES
 GLYCOGEN STORAGE DISEASE
 IMMUNOLOGICAL CAUSES

8. CLINICAL MANIFESTATIONS/ SIGNS AND SYMPTOMS
 EARLY SYMPTOMS DUE TO INFLAMMATION :
- FEVER
- PAIN
- ANOREXIA
- FATIGUE
- NAUSEA
 OTHER SYMPTOMS ARE :
- ODEMA
- FOUL SMELL
- YELLOWISH SKIN
- HEPATIC ENCEPHALOPATHY
- LOSS OF SENSORY FUNCTION
- DIFFICULTY IN BREATHING
- INCREASED SERUM NH3 ( AMMONIA ) LEVEL.
- ASCITES
- HYPOALBUMINEMIA
- ABDOMINAL DISTENSION
- INCREASED ABDOMINAL GIRTH
- SPIDER ANGIOMA

9. CONTINUED SIGNS AND SYMPTOMS
 IF BILIARY OBSTRUCTION :
- ABSENCE OF UROBILINOGEN IN DIGESTIVE TRACT
- INCREASE SERUM BILIRUBIN LEVEL SO APPEAR DARK COLOUR URINE
- JAUNDICE DUE TO ACCUMULATION OF BILIRUBIN UNDER SKIN.
HORMONAL OBSTRUCTION :
REDUCE ANDROGEN AND ESTROGEN WHICH PRODUCE ABNORMAL MENSES.
- AMENORRHOEA
- LOSS OF BODY HAIR
- GYNECOMASTIA (UPPER SWELLING ON BREAST IN MEN)
 BLEEDING DISORDERS :
REDUCE ABSORPTION OF VITAMIN K AND REDUCE SYNTHESIS OF PROTHROMBIN

10. PATHOPHYSIOLOGY
DUE TO ANY CAUSE LIKE ( ALCOHOL ABUSE, MALNUITRITION, INFECTION, DRUGS OR BILIARY
OBSTRUCTION)
DESTRUCTION OF HEPATOCYTES
FIBROSIS / SCAR FORMATION
OBSTRUCTION OF BLOOD FLOW
INCREASE PRESSURE IN VENOUS AND SINUSOIDAL CHANNELS
FATTY INFILTRATION FIBROSIS/ SCARRING
PORTAL HYPERTENSION

11. DIAGNOSTIC EVALUATION
 LIVER FUNCTION TEST (LFT)
 ASPIRATEW AMINOTRANSFERASE
 ALT – ALANINE TRANSFERASE
 LDH – LACTATE DEHYDROGENASE
 USG – FOR HEPAṬOMEGALY
 WBC – (FOR DETERMINATION OF INFECTION )
 RBC – (ANEMIA)
 LIVER BIOPSY – FNAC (FINE NEEDLE ASPIRATION CYTOLOGY)
 SERUM EXAMINATION –
- INCREASE SGOT/SGPT LEVEL
- LOW PROTEIN
- INCRTEASE BILIRUBIN LEVEL RAISED
 ABDOMINAL PARACENTESIS ( FOR DETERMINE PUS CELLS BACTERIAL INFECTION OR PROTEIN
COMPONENT IN ACCUMULATED FLUYID

12. COMPLICATIONS
 ASCITES
 PORTAL HYPERTENSION
 PERITONITIS
 COAGULOPATHIES

13. MANAGEMENT
MEDICAL MANAGEMENT
 MEDICAL M,ANAGEMENT IS BASED ON PRESENTING SYMPTOMS.
- ANTACIDS
- ANTIEMETICS
- VITAMINS AND NUTRITIONAL SUPPLEMENT
- BALANCED DIET
- POTASSIUM SPARRING DIURETICS (FOR ASCITES.) E.G., SPIRONOLACTONE.
- AVOIDANCE OF ALCOHOL

14. DIETARY MANGEMENT
 PROVIDE HIGH CALORIE DIET AND LOW LIQUID DIET (800 – 1000 ml/dl )
 IN HEPATIC COMA, GIVE LOW PROTEIN AND LOW SODIUM DIET.
 PROVIDE ALBUMIN CONTAINING FOOD.
 VITAMIN A,D,E,K INCLUDED WITH DIET OF THE PATIENT.

15. SURGICAL MANAGEMENT
 PORTAL- CAVAL SHUNT (PORTA CAVAL ANASTOMOSIS)
 SPLENORENAL SHUNT (SPLEENORENAL ANASTOMOSIS)
- A SURGICAL TECHNIQUE IN WHICH SPLEEN VEIN IS JOINED TO THE LEFT RENAL
VEIN. (MOSTLY FOR TREATIONG PORTAL HYPERTENSION).
 LIVER TRANSPLANTATION

16. NURSING DIAGNOSIS WITH NURSING
MANAGEMENT
 ACTIVITY INTOLERANCE RELATED TO FATIGUE AND DISCOMFORT.
Interventions:
-Nurse should encourage patient to take proper rest and need to ambulation.
-Instruct the patient to elevate legs to mobilize edema and ascites
-Encourage for active and passive exercises to patient to promote muscle strength.
-instruct to take nutritional and proper calorific diet to maintain energy level of
patient.

17. Contd...
 RISK OF INJURY RELATED TO COAGULOPATHY
Interventions:
-Assess sign of bleeding, observe stools and vomiting for colour,consistency.
-Instruct to avoid or limit activities if sign of bleeding show.
-Administer vitamin K as prescribed.
-Nurse should teach risk preventive measures e.g.,
- #Maintain safe environment
- #Gentle blowing of nose
- #Use of soft toothbrush
-Encourage patient to intake of foods with high vitamin C content.
-Nurse should use small gauze needles for injections and maintain pressure over
puncture site until bleeding stops.

18. Contd...
 IMPAIRED SKIN INTEGRITY RELATED TO JAUNDICE.
Interventions:
-Assess and document degree of jaundice of skin and sclera.
-Promote adequate nutrition.
-Assess dietary intake and nutritional status. Encourage the client to adhere to a high
carbohydrate diet with protein intake consistent with that recommended for hepatic
encephalopathy.
-Assess for adequate hydration.
-Instruct patient to keep the incision site or wound site dry for five to seven days and to report
any signs and symptoms of redness pain and drainage if available.
-Encourage physical activity as permitted.
-Teach client importance of skin integrity and its care.

19. Contd...
 KNOWLEDGE DEFICIT RELATED TO DISEASE CONDITION.
Interventions:
-Nurse should review underlying cause, disease process and prognosis to the patient.
-Discuss with patient about medication regimen, schedule and possible side effect.
-Instruct to avoid foods cause gastric irritations, eg., chocolate, spicy food, whole grains, raw
vegetables.
-Discuss and identify stress situations and how to avoid them, investigate job related issues.
-Discuss avoidance of NSAIDS, forceful bleeding of nose, straining for Bowel movement,to
reduces risk of bleeding in case of coagulopathy.
-Instruct to eat frequent small meals.
-Provide information for patient to plan for return to usual routine with untoward incidents.
-Nurse should recommend gradual resumption of daily usual activities, and take proper rest
to prevent fatigue and increase feeling of well-being.

20. THANKYOU FOR YOUR ACTIVE LISTENING
AND ATTENTION..
IF ANY QUERY REGARDING THE TOPIC
KINDLY ASK….
The End.