INTRODUCTION

Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and
the liver is permanently damaged. Scar tissue keeps your liver from working properly.

Many types of liver diseases and conditions injure healthy liver cells, causing cell death and
inflammation. This is followed by cell repair and finally tissue scarring as a result of the repair
process.

The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process
nutrients, hormones, drugs and natural toxins (poisons). It also reduces the production of proteins
and other substances made by the liver. Cirrhosis eventually keeps the liver from working
properly. Late-stage cirrhosis is life-threatening.

INCIDENCE

Liver diseases accounts for approximately 2 million deaths per year worldwide, one million due
to complications of cirrhosis and one million due to viral hepatitis and hepatocellular carcinoma.

According to the latest WHO data published in 2018 Liver Diseases Deaths in India reached
264,193 or 3.00% of total deaths. The age adjusted Death Rate is 23.00 per 1000,000 of
population ranks India #62 in the world.

CIRRHOSIS OF THE LIVER

Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration

and destruction of the liver parenchymal cells. The liver cells attempt to regenerate, but the
regenerative process is disorganized, resulting in abnormal blood vessel and bile duct
architecture.

The over-growth of new and fibrous connective tissues distorts the liver’s normal lobular
structure, resulting in lobules of irregular size and shape with impeded blood flow.
CLASSIFICATION
These clinical types of cirrhosis reflect its diverse etiology:
 Laennec’s cirrhosis. The most common type, this occurs in 30% to 50% of cirrhotic
patients, up to 90% of whom have a history of alcoholism.
 Biliary cirrhosis. Biliary cirrhosis results in injury or prolonged obstruction.
 Postnecrotic cirrhosis. Postnecrotic cirrhosis stems from various types of hepatitis.
 Pigment cirrhosis. Pigment cirrhosis may result from disorders such as
hemochromatosis.
 Cardiac cirrhosis. Cardiac cirrhosis refers to cirrhosis caused by right-sided heart
failure.
 Idiopathic cirrhosis. Idiopathic cirrhosis has no known cause.

RISK FACTORS
 Abuse alcohol for many years- Alcohol is toxic to liver cells. It damages the liver by
changing how the body breaks down food. Drinking excess amounts of alcohol over a
long period of time raises the risk of cirrhosis.
 Health problems:

 Have viral hepatitis- Hepatitis infections are caused by viruses that are spread from
exposure to the body fluids of an infected person. Some infections go away on their own.
Others may last a long time and lead to liver inflammation and injury. Over time, this can
lead to cirrhosis. Common types are;
o Hepatitis B
o Hepatitis C
o Hepatitis D- only infects people who are already infected with hepatitis B
 Have diabetes/ are obese-- Non- alcoholic fatty liver disease (NAFLD) is a buildup of
fat in the liver that is not caused by drinking alcohol. It can lead to a type of NAFDL
called nonalcoholic steatohepatitis (NASH). This can lead to cirrhosis. This type of
hepatitis is associated with;
o Diabetes
o Obesity
o High triglyceride levels in the blood
o Coronary artery disease (CAD)
o Intestinal bypass surgery
o Long term treatment with corticosteroids
 Bile duct diseases- Health problems that damage the bile ducts can cause bile to back up
and damage liver tissues. This can lead to cirrhosis. some of these issues are;
o Primary biliary cirrhosis
o Primary sclerosing cholangitis
o Gallstones
o Pancreatitis
o Injuries from gall bladder surgery
 Inherited diseases:
o Alpha-1 antitrypsin deficiency (build-up of an abnormal protein in the liver)
o Hemochromatosis (excess iron stored in the liver).
o Wilson disease (excess copper stored in the liver).
o Cystic fibrosis (sticky, thick mucus builds up in the liver).
o Glycogen storage diseases (liver can’t store or break down glycogen, a form of
sugar).
o Alagille syndrome (born with fewer than normal number of bile ducts; affects bile
flow and causes jaundice).
 Autoimmune hepatitis (your body’s own immune system attacks healthy liver tissue causing
damage).
 Diseases that damage or block bile ducts in the liver (tubes that carry bile from the liver to
other parts of digestive system; bile helps digest fats):
o Primary biliary cholangitis (bile ducts become injured, then inflamed, then
permanently damaged).
o Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and
narrowing of the ducts and buildup of bile in the liver).
o Blocked bile duct (can cause infections, backup of products in the liver).
o Biliary atresia (infants are born with poorly formed or blocked bile ducts, causing
damage, scarring, loss of liver tissue and cirrhosis).
 Chronic heart failure (causes fluid to back up in your liver, swelling in other areas of your
body and other symptoms).
 Rare diseases, such as amyloidosis, in which abnormal deposits in the liver of an abnormal
protein called amyloid disrupts normal liver function.

Other Factors;
o A severe reaction to prescription drugs, such as isoniazid and methotrexate
o Long term exposure to toxins , such as arsenic
o Repeat episodes of heart failure with liver congestion
Schistosomiasis- a parasitic infection.

ETIOLOGY

The most common causes of cirrhosis of the liver are:

 Alcohol abuse (alcohol-related liver disease caused by long-term [chronic] use of alcohol).
 Chronic viral infections of the liver (hepatitis B and hepatitis C).
 Fatty liver associated with obesity and diabetes and not alcohol. This condition is called non-
alcoholic steatohepatitis.
 Other causes include:
o Autoimmune hepatitis
o Inherited diseases
o Blocked bile ducts
o Drugs, toxins and infections.
 Changes from liver diseases that lead to cirrhosis are gradual. Liver cells are injured and if
injury – from whatever cause – continues, liver cells start to die. Over time, scar tissue
replaces the damaged liver cells and the liver can’t function properly.

PATHOPHYSIOLOGY

Liver cirrhosis has several etiologies that ultimately lead to the same process that is hepatic
fibrosis that leads to impaired function. According to stimuli, the damage can be faster or slower;
for example, alcohol and viral hepatitis produce earlier. Progression degeneration of hepatocytes
occurs and leads to necrosis, and an extracellular fibrotic scar material is formed to replace the
parenchyma with regeneration nodules.

The process of fibrosis is dynamic, and the early stages can be reversible. It is considered that the
main mechanism for the initiation of fibrosis id the hepatic stellate cell; this occurs in two
phases.

The first called initiation or pre-inflammatory is produced by bodies formed from cellular
apoptosis, perpetuation phase begins where there is cell proliferation and fibrogenesis with an
important inflammatory response.

There is a degradation of the extracellular matrix by the action of metalloproteinases, which are
produced mainly by stellate cells, when there is an imbalance between production and
degradation, and then the fabric begins to be replaced by fibrosis. It is believed that the
reabsorption of this excess degraded matrix could reverse the liver alteration and therefore is the
goal of the search of the new treatments

SIGNS AND SYMPTOMS

The symptoms of cirrhosis depend on the stage of the disease. In the beginning stages, the patient
may not have any symptoms.

Early symptoms and signs of cirrhosis include:

 Loss of appetite.
 Feeling weak or tired.
 Nausea.
 Fever.
 Unexpected weight loss.

As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear
including:

 Easy bruising and bleeding.

 Yellow tint to your skin or the whites of your eyes (jaundice).
 Itchy skin.
 Swelling (edema) in your legs, feet and ankles.
  Fluid buildup in your belly/abdomen (ascites).
 Brownish or orange color to your urine.
 Light-colored stools.
 Confusion, difficulty thinking, memory loss, personality changes.
 Blood in your stool.
 Redness in the palms of your hands.
 Spider-like blood vessels that surround small, red spots on your skin (telangiectasias).
 In men: loss of sex drive, enlarged breasts (gynecomastia), shrunken testicles.
 In women: premature menopause (no longer having your menstrual period).

DIAGNOSTIC STUDIES

If your doctor suspects you have cirrhosis, one or more of the following imaging tests may be
performed:

 Abdominal computed tomography (CT) scan: This procedure combines special x-ray
equipment with sophisticated computers to produce multiple, digital images or pictures of
the liver. It can help determine the severity of cirrhosis as well as other liver diseases. 
 Abdominal ultrasound: Ultrasound is a type of imaging exam that uses sound waves to
create pictures of the inside of the abdomen and/or pelvis, including images of the liver.
Doppler ultrasound allows for evaluation of blood flow to and from the liver.
 Elastography: This exam assesses the stiffness of your liver and can help diagnose how
severe the scarring is in your liver (known as liver fibrosis). Left untreated, liver fibrosis
can eventually lead to cirrhosis of the liver which is not reversible. Elastography can
detect stiffness of the liver caused by liver fibrosis earlier than other imaging tests. The
test can be performed by ultrasound or MRI.
 Body magnetic resonance imaging (MRI): This imaging exam uses a powerful magnetic
field, radio frequency pulses and a computer to produce detailed pictures of the liver
allowing for assessment of damage caused by various liver diseases. 
 Magnetic resonance cholangiopancreatography (MRCP): MRCP is special type of
MRI protocol that is designed to evaluate a part of the liver and gallbladder, known as
the biliary system that is part of your liver.
Other tests include:

 Biopsy: Part of the liver tissue is sampled and examined by a pathology doctor to analyze
the extent of liver damage. The biopsy is often done by a radiologist using ultrasound
guidance and is minimally invasive.
 Liver function test: This test involves analyzing the blood for particular enzymes that
signal that liver damage is present.
Liver tests measure levels of enzymes and proteins your liver makes. These tests include:

 Alanine transaminase (ALT) and aspartate transaminase (AST): These help your body
break down protein and amino acid. Levels of both ALT and AST in your blood are
usually low. High levels can mean that your liver is leaking these enzymes because it's
 damaged from cirrhosis or another disease. However, levels can still be normal if you
have cirrhosis.
 Albumin test: Albumin is a protein that’s made by the liver. When the liver is damaged,
the level of albumin in the blood falls.
 Bilirubin level: This is a yellow pigment that’s left over when old blood cells are broken
down. The liver normally removes bilirubin from the blood and gets rid of it in the stool.
But when the liver isn’t working properly, bilirubin builds up in the blood and can cause
the skin and eyes to become yellow. This is called jaundice.
 Creatinine: This is a waste product made by your muscles. Your kidneys normally filter it
out of your blood. A high creatinine level is a sign of kidney damage, which can happen
in the late stages of cirrhosis.
 Prothrombin time or international normalized ratio: Your liver makes substances that
help your blood clot. This test checks to see how well your blood clots. If it clots too
slowly, cirrhosis could be a possible cause.
 Sodium blood test: If the sodium level in your blood is low, it could be an indicator that
you have cirrhosis. A low level of sodium in the blood is called hyponatremia.

The doctor can use the results of these tests to give the patient a Model for End-Stage Liver
Disease (MELD) score. This shows how much the liver has been damaged, and whether a liver
transplant is needed.
Other blood tests include:

 A complete blood count (CBC). This test checks your red and white blood cells, as well
as platelets, to get a picture of your overall health.
 A viral hepatitis blood test. Viral hepatitis is caused by viruses that damage your liver and
can lead to cirrhosis. These tests check your blood for hepatitis A, B, and C.
 Tests to check for autoimmune hepatitis, Wilson's disease, hemochromatosis and other
diseases.

MANAGEMENT

There is no cure for cirrhosis. The damage already done to the liver is permanent. However,
depending on the underlying cause of cirrhosis, there may be actions one can take to keep
cirrhosis from getting worse. These actions include:

 Stop drinking alcohol.

 Treat chronic hepatitis (if you have it).
 Avoid medications that stress the liver.
 Eat a healthy, well-balanced, low-fat diet, such as the Mediterranean diet.

Goals of Cirrhosis Treatment: The goals of treatment for cirrhosis of the liver are to:

 Slow further damage to the liver.

 Prevent and treat symptoms.
 Prevent and treat complications.
Treatment depends on what’s causing cirrhosis and how much damage exists.

Although there is no cure for cirrhosis, treatments can delay or stop its progress and reduce
complications.

 Diet. The patient may benefit from a high-calorie and a medium to high protein diet, as
developing hepatic encephalopathy mandates restricted protein intake.
 Sodium restriction.is usually restricted to 2g/day.
 Fluid restriction. Fluids are restricted to 1 to 1.5 liters/day.
 Activity. Rest and moderate exercise is essential.
 Paracentesis. Paracentesis may help alleviate ascites.
 Sengstaken-Blakemore or Minnesota tube. The Sengstaken-Blakemore or Minnesota
tube may also help control hemorrhage by applying pressure on the bleeding site

MEDICAL MANAGEMENT

One or more medicines may be used for cirrhosis. They may be used to control the cause and
prevent more damage.

Prescription Medicines
Medicines to Treat the Causes Alcohol-related

Common names are:

 Disulfiram
 Naltrexone
 Acamprosate
These medicines treat alcohol use disorder. A person who drinks while taking disulfiram will
have hangover symptoms that are much worse than normal. Problems may be headache, nausea,
confusion, and uneasiness. Naltrexone lowers the craving for alcohol. Acamprosate lowers both
the physical and emotional unrest that happens from quitting drinking, such as sweating, sleep
problems, and unease.

Some problems may be:

 drowsiness, erectile dysfunction, headache, mood changes, peripheral neuropathy,

psychosis, belly cramps, skin problems, such as rash and itching, problems sleeping, muscle
pain, vomiting, diarrhea.

Antiviral Medicines

Common ones are:

 Interferons
 Protease inhibitors
 Reverse transcriptase inhibitors
Chronic viral hepatitis B and C may get better with antiviral medicines. These may be interferon
for hepatitis B and C. Taking both interferon and ribavirin may be more helpful for hepatitis C
than taking one alone.

Lamivudine, tenofivir, adefovir, entecavir, and telbivudine are used to treat hepatitis B infection.
They are often taken by mouth once a day for a year or more. Sometimes these drugs are taken
with interferon.

Some problems may be:

 belly pain, a feeling of fullness, nausea, peripheral neuropathy, flu-like symptoms, such
as fever, body aches, and chills.

Corticosteroids

Common names are:

 Prednisone
 Prednisone and azathioprine
Some forms of hepatitis are caused by the body's immune system attacking normal, healthy
tissue. Corticosteroids can help suppress the attack. This helps ease liver inflammation, which
helps prevent cirrhosis from getting worse. High doses of prednisone taken for a long time may
cause serious side effects. Lower doses of prednisone may be used when taken with azathioprine.

Some problems may be: stomach upset, glucose intolerance, bone thinning, a higher risk of
infection, changes in behavior

Chelating Agents

Common names are:

 Penicillamine
 Trientine
 Deferoxamine
Chelating agents are drugs that draw toxic metals from the blood. This lets them pass more easily
in urine or stool. Chelating agents are used to rid the body of excess copper in a person
with Wilson disease or excess iron in a person with hemochromatosis. These are rare inherited
problems can cause liver damage that leads to cirrhosis.

Penicillamine and trientine are used to treat Wilson disease. Deferoxamine is used to treat iron
overload from hemochromatosis. It is given as an injection. Chelating agents are strong
medicines that can cause serious side effects.

Some problems may be:

 fever, joint pain, skin rash, blurry eyesight or other sight problems, problems breathing,
fast heartbeat, nausea and vomiting, diarrhea

Surgical Management
Esophageal varices are like varicose veins. They line the lower esophagus. This is the tube that
moves food from the throat to the stomach. They are a common complication of cirrhosis. If the
veins rupture, they can cause serious bleeding and the need for a blood transfusion. This can be
deadly. Once bleeding is controlled, treatment focuses on preventing it from happening again.
Band Ligation
Endoscopy is used to find the site of bleeding. A narrow tube with 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.

Transjugular Intrahepatic Portosystemic Shunting (TIPS)

TIPS is a good choice for bleeding that is not controlled by endoscopy. The TIPS procedure
creates an artificial connection between the portal veins and hepatic veins of the liver. This lets
the blood bypass blood vessels in the liver on its way back to the heart. This lowers pressure in
the veins and varices.

A catheter (tube) with a stent (a tube that shunts blood) attached to it is threaded through a vein
in the neck to the liver. X-rays are used to place the stent in the liver. This lets blood flow more
easily through the portal vein. Once in place, the shunt allows blood to return directly to the
heart.

Other Surgical Shunts

A splenorenal shunt helps lower the pressure in the variceal system by connecting the spleen
vein to a kidney vein. A porta-caval shunt lowers pressure in varices by completely bypassing
the liver. This is done through a shunt that moves blood returning to the heart from the body into
the inferior vena cava (the main vein of the body).

Surgical shunts are used in people who:

 Have recurrent bleeding varices

 Cannot be followed closely after TIPS
 Cannot have a liver transplant
Paracentesis
Severe cirrhosis can cause fluid to build up in the abdomen. Paracentesis is done to take excess
fluid out.
A numbing medicine is injected. Imaging is used to help guide the needle and insert it into the
belly. Fluid will be drawn out through the needle.

Liver Transplantation
A liver transplant may be needed when:
 Other methods fail
 The liver becomes so damaged that it stops working as it should
During a liver transplant, a diseased liver is replaced with a healthy liver from a donor who has
died. Sometimes, a portion of the liver from a living, related donor may be used. Medicines will
be needed to suppress the immune system and keep it from attacking and damaging the new liver
Nursing Management

Nursing management for the patient with cirrhosis of the liver should focus on promoting rest,
improving nutritional status, providing skin care, reducing risk of injury, and monitoring and
managing complications.

Nursing Assessment
Assessment of the patient with cirrhosis should include assessing for:

 Bleeding. Check the patient’s skin, gums, stools, and vomitus for bleeding.
 Fluid retention. To assess for fluid retention, weigh the patient and measure abdominal
girth at least once daily.
 Mentation. Assess the patient’s level of consciousness often and observe closely for
changes in behavior or personality.
Nursing Diagnosis
Based on the assessment data, the major nursing diagnosis for the patient are:

 Activity intolerance related to fatigue, lethargy, and malaise.

 Imbalanced nutrition: less than body requirements related to abdominal distention
and discomfort and anorexia.
 Impaired skin integrity related to pruritus from jaundice and edema.
 High risk for injury related to altered clotting mechanisms and altered level of
consciousness.
 Disturbed body image related to changes in appearance, sexual dysfunction, and role
function.
 Chronic pain and discomfort related to enlarged liver and ascites.
 Fluid volume excess related ascites and edema formation.
 Disturbed thought processes and potential for mental deterioration related to
abnormal liver function and increased serum ammonia level.
 Ineffective breathing pattern related to ascites and restriction of thoracic excursion
secondary to ascites, abdominal distention, and fluid in the thoracic cavity.

Nursing Care Planning & Goals

The major goals for a patient with cirrhosis are:

 Report decrease in fatigue and increased ability to participate in activities.

 Maintain a positive nitrogen balance, no further loss of muscle mass, and meet nutritional
requirements.
 Decrease potential for pressure ulcer development and breaks in skin integrity.
 Reduce the risk of injury.
 Verbalize feelings consistent with improvement of body image and self-esteem.
 Increase level of comfort.
  Restore normal fluid volume.
 Improve mental status, maintain safety, and ability to cope with cognitive and behavioral
changes.
 Improve respiratory status.
Nursing Interventions
The patient with cirrhosis needs close observation, first-class supportive care, and sound
nutrition counseling.
Promoting Rest

 Position bed for maximal respiratory efficiency; provide oxygen if needed.

 Initiate efforts to prevent respiratory, circulatory, and vascular disturbances.
 Encourage patient to increase activity gradually and plan rest with activity and mild
exercise.

Improving Nutritional Status

 Provide a nutritious, high-protein diet supplemented by B-complex vitamins and others,

including A, C, and K.
 Encourage patient to eat: Provide small, frequent meals, consider patient preferences, and
provide protein supplements, if indicated.
 Provide nutrients by feeding tube or total PN if needed.
 Provide patients who have fatty stools (steatorrhea) with water-soluble forms of fat-
soluble vitamins A, D, and E, and give folic acid and iron to prevent anemia.
 Provide a low-protein diet temporarily if patient shows signs of impending or advancing
coma; restrict sodium if needed.

Providing Skin Care

 Change patient’s position frequently.

 Avoid using irritating soaps and adhesive tape.
 Provide lotion to soothe irritated skin; take measures to prevent patient from scratching
the skin.

Reducing Risk of Injury

 Use padded side rails if patient becomes agitated or restless.

 Orient to time, place, and procedures to minimize agitation.
 Instruct patient to ask for assistance to get out of bed.
 Carefully evaluate any injury because of the possibility of internal bleeding.
 Provide safety measures to prevent injury or cuts (electric razor, soft toothbrush).
 Apply pressure to venipuncture sites to minimize bleeding.

Monitoring and Managing Complications

 Monitor for bleeding and hemorrhage.

  Monitor the patient’s mental status closely and report changes so that treatment of
encephalopathy can be initiated promptly.
 Carefully monitor serum electrolyte levels are and correct if abnormal.
 Administer oxygen if oxygen desaturation occurs; monitor for fever or abdominal pain,
which may signal the onset of bacterial peritonitis or other infection.
 Assess cardiovascular and respiratory status; administer diuretics, implement fluid
restrictions, and enhance patient positioning, if needed.
 Monitor intake and output, daily weight changes, changes in abdominal girth, and edema
formation.
 Monitor for nocturia and, later, for oliguria, because these states indicate increasing
severity of liver dysfunction.
Home Management

 Prepare for discharge by providing dietary instruction, including exclusion of alcohol.

 Refer to Alcoholics Anonymous, psychiatric care, counseling, or spiritual advisor if
indicated.
 Continue sodium restriction; stress avoidance of raw shellfish.
 Provide written instructions, teaching, support, and reinforcement to patient and family.
 Encourage rest and probably a change in lifestyle (adequate,well-balanced diet and
elimination of alcohol).
 Instruct family about symptoms of impending encephalopathy and possibility of bleeding
tendencies and infection.
 Offer support and encouragement to the patient and provide positive feedback when the
patient experiences successes.
 Refer patient to home care nurse, and assist in transition from hospital to home.

Evaluation
Expected patient outcomes include:

 Reported decrease in fatigue and increased ability to participate in activities.

 Maintained a positive nitrogen balance, no further loss of muscle mass, and meet
nutritional requirements.
 Decreased potential for pressure ulcer development and breaks in skin integrity.
 Reduced the risk of injury.
 Verbalized feelings consistent with improvement of body image and self-esteem.
 Increased level of comfort.
 Restored normal fluid volume.
 Improved mental status, maintain safety, and ability to cope with cognitive and
behavioral changes.
 Improved respiratory status.

Discharge and Home Care Guidelines

The focus of discharge education is dietary instructions.
  Alcohol restriction. Of greatest importance is the exclusion of alcohol from the diet, so
the patient may need referral to Alcoholics Anonymous, psychiatric care, or counseling.
 Sodium restriction. Sodium restriction will continue for considerable time, if not
permanently.
 Complication education. The nurse also instructs the patient and family about symptoms
of impending encephalopathy, possible bleeding tendencies, and susceptibility to
infection.

Documentation Guidelines
The focus of documentation may include:

 Level of activity.
 Causative or precipitating factors.
 Vital signs before, during, and following activity.
 Plan of care.
 Response to interventions, teaching, and actions performed.
 Teaching plan.
 Changes to plan of care.
 Attainment or progress toward desired outcome.
 Caloric intake.
 Individual cultural or religious restrictions, personal preferences.
 Availability and use of resources.
 Duration of the problem.
 Perception of pain, effects on lifestyle, and expectations of therapeutic regimen.
 Results of laboratory tests, diagnostic studies, and mental status and cognitive evaluation

PROGNOSIS

 Damage already done to your liver is permanent. But your liver is a large organ. If part of your
liver is still working, you might be able to slow the progression of disease, depending on its
cause. For instance, if your cirrhosis is caused by alcohol abuse, you need to stop drinking
immediately. If you are obese or have diabetes, you will need to lose weight and manage your
blood sugar so you can lower the damage caused by fatty liver disease.
 You and your healthcare provider or team will work together to determine what’s causing your
cirrhosis and what complications may have resulted from your cirrhosis and treat them
accordingly.

COMPLICATIONS

The complications of hepatic cirrhosis include the following:

  Portal hypertension. Portal hypertension is the elevation of pressure in the portal vein
that occurs when blood flow meets increased resistance.
 Esophageal varices. Esophageal varices are dilated tortuous veins in submucosa of the
lower esophagus.
 Hepatic encephalopathy. Hepatic encephalopathy may manifest as deteriorating mental
status and dementia or as physical signs such as abnormal involuntary and voluntary
movements.
 Fluid volume excess. Fluid volume excess occurs due to an increased cardiac output and
decreased peripheral vascular resistance.

HEALTH EDUCATION
Discharge Instructions:
Seek care immediately if:
 pain during a bowel movement and it is black or contains blood.
 a fast heart rate and fast breathing.
 dizzy or confused.
 severe pain in your abdomen.
 trouble breathing.
 vomit looks like it has coffee grinds or blood in it.
Contact your healthcare provider if:
 have a fever.
 have red or itchy skin.
 in pain and feel weak.
 have questions or concerns about your condition or care.
Medicines:
You may need any of the following:

 Antiviral medicine may be needed if your cirrhosis is caused by hepatitis. Antiviral

medicine may prevent or decrease swelling and damage to your liver.
 Blood pressure medicine is used to treat high blood pressure in the portal vein (the vein
that goes to your liver).
 Diuretics decrease extra fluid that collects in a part of your body, such as your legs and
abdomen. Diuretics can also decrease your blood pressure. You will urinate more often when
you take this medicine.
 Antibiotics help prevent or treat a bacterial infection.
 Take your medicine as directed. 
 Do not drink alcohol
 Do not smoke. 
 Eat a variety of healthy foods. 
 Reach or maintain a healthy weight. 
 Limit sodium (salt). 
 Drink liquids as directed.
 Ask about vaccines.
 Ask about medicines. 
Follow up with your doctor as directed

JOURNAL REFERENCE

Deutsches Ärzteblatt International; The Etiology, Diagnosis and Prevention of Liver Cirrhosis,
part 1 of a series on Liver Cirrhosis; Johannes Wiegand, PD Dr. med. And Thomas Berg, Prof.
Dr. med; published online 2013 feb 8.

Abstract

Background: Cirrhosis of the liver is the end stage of chronic liver disease. Among the many
liver disorders that can lead to cirrhosis, some progress rapidly (years) and others more slowly
(decades). In Germany, cirrhosis is often a consequence of fatty liver disease due to alcoholism
or other causes, but can also be caused by hepatitis B and hepatitis C. Cirrhosis is more common
in overweight persons and smokers. The underlying causes of cirrhosis determine its rate of
progression and are the focus of preventive efforts and treatment. The prevalence of cirrhosis in
Germany is rising; it now ranks among the top 20 causes of death in the country.

Methods: This article is based on a selective review of pertinent literature, including reviews

and current guidelines.

Results: Strictly speaking, cirrhosis is a pathological diagnosis; it is, nevertheless, usually

diagnosed clinically, by history, physical examination (e.g., cutaneous signs of liver disease),
ancillary testing (e.g., ultrasonography, transient elastography) and laboratory analyses (e,g.,
APRI, which is the quotient of the GOT concentration and the platelet count). There are no
laboratory cutoff values for the diagnosis of cirrhosis. Early detection of chronic liver disease,
followed by individually tailored, risk-adapted treatment, is the best way to prevent it.
Esophagogastroduodenoscopy can be performed early on to assess the risk of variceal bleeding.
In most patients, the progression of fibrosis can be averted by early detection and appropriate
treatment.

Conclusion: Screening for chronic liver disease should include history and physical
examination, serum transaminase measurement, upper abdominal ultrasonography, and, in some
cases, transient elastography
BIBLIOGRAPHY
1. Chintamani; Lewis’s Medical Surgical Nursing, Assessment and Management of
Clinical Problems; Elsevier, 2011, Reprint 2013, Page no- 1117-1130.
2. Mariann M. Harding; Lewis;s Medical Surgical Nursing; Assessment And Management
of Clinical Problems; Eleventh edition; Elsevier; Page no. 980-987, 988b.
3. Net reference:
www.nurseslabs.com
www.winchesterhospital.org
www.drugs.com/cg/cirrhosis-discharge-care.html