Discus the scenario of my case base selective patient Explain the patient’s present and previous health history Discus the chronic liver disease Explain the causes of chronic liver disease Review the psychopathology of chronic liver disease Prepare the nursing management

1. CASE BASE PRESENTATION ON
CHRONIC LIVER DISEASE
Presenter:
Muhammad Saber
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2. Objectives
• Discus the scenario of my case base selective
patient
• Explain the patient’s present and previous health
history
• Discus the chronic liver disease
• Explain the causes of chronic liver disease
• Review the pathophysiology of chronic liver
disease
• Prepare the nursing management
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3. Case base Scenario
• A male 53 Y old patient admitted in Hospital
with Diagnosis of Chronic Liver Disease,
known case of hepatitis C from one year, came
in ER with complain of abdominal distention
and swelling on feet's from one week and
umbilicus hernia on admitting day.
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4. Physical assessment Findings
• Inspection:
General condition sunken eyes, abdominal
distention, palmer erythema , bruises, lower
extremities, confused status, jaundice, ascites
(fluid), dilated veins and vascular spiders present.
edema grade +2, umbilical hernia.
• Auscultation:
Bowl sounds present 14, bruits not heard due to
abdominal distention
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5. Cont.….
• Palpation:
fluid wave/ fluid thrill sign positive, no any mass
tenderness palpable, hepatomegaly present.
• Percussion
• Enlarge liver size , dull sound present in
abdominal area
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6. Past Medical History (PMH)
• Patient is non diabetic, non asthmatic, non
hypertensive and no any other previous history
of surgery
• Patient frequent visit general practitioner
monthly 2 to 3 times in a month they inject i.m
Injections due to body and back pain.
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7. Cont.…
• Patient have no know any allergy
• Patient Smoking daily 2 pack form last 38
Years
• No any history alcoholism and drug abuse
• No any history of genetic disorders in family
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8. Cirrhosis of liver
Cirrhosis is a chronic disease characterized by
replacement of normal liver tissue with diffuse
fibrosis that disrupts the structure and function of
the liver.
Late stage progressive hepatic fibrosis
characterized by the destruction of the hepatic
architecture and formation of regenerative
nodules.
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9. Causes
Common Causes Less common causes
• Autoimmune
Hepatitis
• Wilson’s Disease
• Medications
• Celiac disease
• Prolong viral
hepatitis
• Alcoholic liver
disease
• Hematoma
chromatosis
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10. Sign and Symptoms
• Earlier sign asymptomatic
• Hepatomegaly
• Splenomegaly
• Ascites
• Hepatic encephalopathy
• Browsing
• Spider nevi
• Jaundice
• Gynecomastia
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11. Prevalence
Liver cirrhosis has many possible causes:
• Globally, 57% of cirrhosis is attributable to
either hepatitis B (30%) or hepatitis C (27%).
• Alcohol consumption is another major cause,
accounting for about 20% .
• Primary biliary cholangitis
• Autoimmune hepatitis.
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12. Infection/alcohol/other long time hepatocytes
It form scared tissue
Cells become fibrotic and thickened with protein
Linen become scaring and damage
It doesn't reversible changes become fibrotic
Called Liver Cirrhosis (End stage of Liver damage)
Pathophysiology
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13. Diagnosis
• Liver function tests
Serum Alkaline Phosphatase, Aspartate
Aminotransferase
• ALT
Serum Glutamic Pyruvic Transaminase
• ABGs
• Biopsy
• Ultrasound Abdomen
• CT scan
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14. Diagnostic Labs
HB: 9.2 g/dl ( >12.0.<14.4.0%)
Platelets 103000/ mm3 (>150000.<450000.0%)
Neutrophils 68 (>31.<61.0%)
Urea 28 mg/dl (10-50 mg/dl)
Creatinine 0.7 mg/dl (0.7-1.2 mg/dl)
ALT 24 u/l (10-40 u/l)
ALP 490 u/l (30-645)
T.Bilirubin 0.5 mg/dl (0.2-1.1 mg/dl)
Blood Group B +ve
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15. Diagnostic Procedures
• Ultrasound abdomen
Findings are of coarse liver with nodular margins and
enlarged spleen with gross ascites, features are likely
chronic liver disease
• Asiatic R/E
White Cell 199/ mm3, Neutrophils 59%, Mononuclear
Cells 41%
Albumin 2.5g/dl
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16. Risk Factors for Hepatitis C
• Recipient of blood products or organ transplant
before1992 or clotting factor concentrates before 1987
• Health care and public safety workers after needle
stick injuries or mucosal exposure to blood
• Children born to women infected with hepatitis C
virus
• Past/current illicit IV/injection drug use
• Past treatment with chronic hemodialysis
• Multiple sex partners, history of sexually transmitted
disease, unprotected sex
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17. Treatment
• Preventing further liver damage
• Treat the underlying cause.
• Transplantation
• Decompensated cirrhosis
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18. Medication
• Inj Rocepin 1g x BID x I/V
– (Ceftriaxone)
• Inj Risek 40mg x OD x I/V
– (Omeprazole)
• Syp Lilac 2TSF x TDS x P/O
– (lactulose)
• Cap Rifaxa 550mg x BID x P/O
– (Rifaximin)
• Tab Carvida 3.12mg x BID x P/O
– (Carvidalol)
• Tab Lasix 80mg x OD x P/O
– (Furosmide)
• Tab Aldactone 200mg x OD x P/O
– (Spironolactone)
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19. Complications
• Portal Hypertension
• Ascites
• Hepatic encephalopathy
• Bacterial peritonitis
• Hepatorenal Syndrome
• Varsial hemorrhage
• Encephalopathy
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20. Nursing management
Ineffective breathing pattern related to intra abdomen
fluid collection as evidence by ascites:
i. Daily weight and abdomen girth.
ii. Keep head elevated, position on side
iii. Encourage frequent repositioning and deep breath
exercise.
iv. Monitor SpO2 and ABG’s
v. Educate and assist the innovative spirometry.
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21. Nursing management
Excessive fluid volume related to excessive sodium
and fluid intake as evidence by edema:
i. Measure intake, out put and daily weight.
ii. Monitor BP and abdominal veins distention.
iii. Monitor for cardio arrhythmias.
iv. Assess degree of peripheral edema.
v. Monitor the electrolyte balance.
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22. Nursing management
• Imbalance nutrition less their body requirements
related to inadequate diet as evidence by weight
loss and poor muscle tone:
i. Measure the datary intake by calories count.
ii. Tell the patient diet and encourage to eat food as
body requirement.
iii. Restrict intake of coffee, spicy food and drinks.
iv. Monitor laboratory labs
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23. Nursing management
• Deficit knowledge related to lack of exposure as
evidence request for information:
i. Review the disease process and future
expectations.
ii. Emphasize the importance of good nutrition
recommend avoid of high protein diet.
iii. Discus sodium and salt substitute rustication.
iv. Encourage to follow schedule activities and
Ceducate
v. Provide mind devotion activitied
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24. Reference:
• Handbook for Brunner and Suddarth's Textbook of Medical-
Surgical Nursing, 12th Edition-Suzann
• Brunner and Suddarth's Textbook of Med.-Surg. Nursing 12th
ed. (2 vols) - S. Smeltzer, et al., (Lippincott, 2010) BBS
• Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP
(October 2006). "The contributions of hepatitis B virus and
hepatitis C virus infections to cirrhosis and primary liver
cancer worldwide". J. Hepatol. 45 (4): 529–38.
doi:10.1016/j.jhep.2006.05.013. PMID 16879891.
• Nursing Diagnosis Application to Clinical Practice 14th
edition Lynda JUALL Carpenito, RN, MSN, CRNP
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25. Thank You
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