Chronic alcoholism, viral hepatitis, Wilson's disease, and congestive heart failure are leading causes of cirrhosis of the liver. Complications include portal hypertension, esophageal varices, ascites, and hepatic encephalopathy. Management involves medical treatment with diuretics and beta-blockers. Surgical options are paracentesis, TIPS procedure, and banding of varices. Lactulose and antibiotics are used to treat hepatic encephalopathy. Prevention focuses on vaccinations, vitamins, rest, and avoiding alcohol.

7. Causes and predisposing factors
of cirrhosis of liver
Chronic alcoholism
Chronic viral hepatitis type A,B,C .
Wilson’s disease (Wilson's disease is a
genetic disorder in which copper builds up in
the body. )
Chronic congestive heart failure.

8. Predisposing factors
Non necrotic liver disease .
Gall bladder stone and surgery .
Blockage in the bile ducts .
Glycogen storage disease .
Alpha 1 antitrypsin deficiency .
Autoimmune hepatitis .
Cystic fibrosis.

10. spider
angioma
Asterixis Jaundice

11. PurpuraPetechiae Caput medusae

12. COMPLICATIONS
Portal hypertension and esophageal
varices.
 Peripheral edema and ascites.
 Hepatic encephalopathy.
 Hepatorenal syndrome

13. MANAGEMENT
Medical management surgical management
nursing management `
(All medications )

14. Management of ascites
MEDICAL
MANAGEMENT
Diuretic
 Spironolactone
 Amiloride
 Triamterene
 Furosemide
SURGICAL
MANAGEMENT
 Paracentesis
 peritoneovenous
shunt

16. Management of esophageal varices
Medical management
 Beta blockers
Vasopressin
Surgical management
 Endoscopic sclerotherapy
 Balloon tamponade
 Sandostatin (octreotide)
 Transjugular intrahepatic
portosystemic
shunt (TIPS)

20. Drug’s name Mechanism of actions
Vasopressin(ADH) Its two primary functions are to retain water in the
body and to constrict blood vessels.
Propranolol Reduction of portal venous pressure, reduction of
esophageal varices bleeding.
Lactulose Acidifications of feces in bowel and trapping of
ammonia, causing its eliminations in feces.
Neomycin Decrease in bacteria flora, decreasing formation
of ammonia .

21. Drug’s name Mechanism of actions
Triamterene is a potassium-sparing diuretic inhibits
reabsorption of sodium and secretion of
potassium.
Magnesium
sulphate
Magnesium replacement, hypomagnesemia
occurs with liver dysfunction.
Vitamin K Plays a key role in helping the blood clot,
preventing excessive bleeding.

22. Drug’s name Mechanism of actions
Cimetidine Decrease gastric acidity
Spironolactone Blocking of action of aldosterone, potassium sparing.
Amiloride Eliminate sodium (salt) and water from the body while
retaining potassium.
Chlorothiazide Decrease reabsorption of sodium and water .
Furosemide To prevent reabsorption of sodium and water.

23. Management of hepatic
encephalopathy
 Antibiotics
 Lactulose/lactitol
 Diet (high protein diet )
 Phosphate enema.

24. Other preventives measures
 Get vaccination for influenza and hepatitis
A,B.
 Administration of B- complex vitamins .
Vitamin K
 Rest.
 Avoidance of alcohol and aspirin

25. BIBLIOGRAPHY
 Lewis S L,Heilkemper, M,Dirksen SR. Medical Surgical
Nursing. 1st ed. Canada: Ann Millar; 2006.p 1126-30.
Smeltzer C.Suzanne ,Bare G.Brenda,Hinkle L .Janice
,Cheever H Kerry. Brunner and Suddarth’s “Text book
of Medical Surgical Nursing.23rd .New Dehli:Wolters
Kluwer; 2014.p 1366-75.

26.  Smeltzer C . Suzanne, Bare, G Brenda , Hinkle L .
Janice , Cheever H. Kerry. Brunner and Suddarth’s,
Textbook of Medical and Surgical Nursing.12 th ed.
New Delhi: wolters Kluwer; 2010. P 1116 - 46
 Black m. Joyce Hawk’s Hokkanson Jane. Medical
and Surgical Nursing. 7 th ed. USA: BarbaraCullen;
2001. p 1135-49