LIVER CIRRHOSIS and

CHOLELITHIASIS
By:
BALINGGAN, CHARRY KATE
CALATERO, JOHANEY
DUCLAYAN, QUEZELLE JN
VALDEZ, KATE ROSELETTE

BSN 3A-GROUP 8
 LIVER
CIRRHOSIS
Reporters:
DUCLAYAN, QUEZELLE JN
VALDEZ, KATE ROSELETTE
BSN 3A-GROUP 8
LIVER CIRRHOSIS
HEPATIC CIRRHOSIS

a late-stage or end-
stage liver disease in which
healthy liver tissue is
replaced with scar tissue
and the liver is
permanently damaged
 3 types of cirrhosis:
1. Alcoholic – Laennec’s cirrhosis;
most common cause of cirrhosis.
2. Post necrotic – viral hepatitis is the
most common cause.
3. Biliary – obstruction of bile.
HISTORY (most common):

✓ Heavy alcohol
drinker
✓ hepatitis.
✓ complicated
biliary disease.
 CAUSES RISK FACTORS SIGNS AND SYMPTOMS
✓ Chronic Viral Hepatitis ▪ Drinking too much ✓ Fatigue
Infection (Chronic alcohol ✓ weakness
Hepatitis B or C) ▪ overweight ✓ Jaundice
✓ Excessive Alcohol ▪ viral hepatitis ✓ Skin lesions: Spider
Intake angioma/nevi and Palmer
✓ Autoimmune Liver erythema
Disease ✓ Peripheral edema and
✓ Fatty Liver Disease ascites
✓ Peripheral neuropathy
 Palmer erythema Spider angioma/nevi
Exaggeration of normal Red to purple dots on
speckled mottling of the skin that have
the palm lines
 DIAGNOSIS
❑ Liver imaging (ultrasound, CT or MRI of the liver)

ULTRASOUND allows CT Scan helps determine Magnetic Resonance Imaging

evaluation of the blood the severity of cirrhosis as (MRI) produce detailed
flow to and from the liver. well as other liver disease. picture of the liver allowing
for assessment of damaged
caused by various liver disease.
 DIAGNOSIS
❑ Liver stiffness ❑ Liver biopsy (removal of a
measurement using small sample of liver tissue
Fibroscan (non-invasive) for histological analysis)
 fluid restriction
High carb
High protein
DIET

Low to moderate fat

Low sodium
Low potassium
Furosemide, a loop diuretic – used to treat edema seen in patients with liver cirrhosis and portal
hypertension.
Aldactone (spironolactone) – a potassium-sparing diuretic- helps remove built up fluid in the
MEDICATION

body (edema)
Propranolol – Treatment for cirrhotic liver causes ascites
Octreotide – given to patients with cirrhosis and portal hypertension: lowers the portal pressure
Vasopressin – management of the complications of cirrhosis such as high portal tension
Surgical management:

❑ Liver transplant – if liver is severely

damaged, liver transplant may be the
only treatment option.
PATHOPHYSIOLOGY
NSG. CARE
PLAN
IT’S LIVER LOVER BOY
CHOLELITHIASIS
Reporters:
BALINGGAN, CHARRY KATE
CALATERO, JOHANEY
BSN 3A-GROUP 8
CHOLELI ✓Also known as
THIASIS gallstone

✓formation of stones
in the gallbladder or
biliary duct system.
 2 types:
1. Cholesterol –
more common
2. Pigment – to
be surgically
removed
HISTORY

Cystic fibrosis
diabetes
RISK FACTORS

Gender (FEMALE – multiple pregnancy)

Ethnicity
Frequent change in weight (Obesity/RAPID WEIGHT LOSS)
Hyperinsulinemia
Dyslipidemia
 DIAGNOSIS
❑ Ultrasound ❑ Computed tomography (CT)
scan

CT Scan can show gallstones or

ULTRASOUND allows to
complications such as infection
look for signs of
and blockage of the
gallstones.
gallbladder or bile duct
 DIAGNOSIS
❑ Magnetic resonance imaging ❑ Chol scintigraphy
(MRI)

Chol scintigraphy is most useful for

MRI can show gallstones evaluating pt.s with suspected acute
in the ducts of biliary cholecystitis, tumor, bile stone or
tract. blockage
 DIAGNOSIS
❑ Endoscopic retrograde cholangiopancreatography (ERCP)

To dye and highlight the

bile ducts on the x-ray
images
 low-fat and low fiber diet
DIET

▪ Nsaids (diclofenac)- may decrease the frequency of short-term

complications caused by gallstones.
▪ Anticholinergics (Bentyl)- for muscle relaxation
MEDICATION

▪ Antibiotics (Ciprofloxin)- to treat gallbladder wall infections

▪ Antiemetics (Emeset)- help make pt. more comfortable and prevent fluid
and electrolyte abnormalities.
▪ Ursodiol – used to dissolve gallstones in people who don’t want surgery
or can’t have surgery to remove gallstones.
 Surgical management:
1. Oral dissolution therapy - bile acid-cholesterol
solvents to dissolve stones;
bad effect: recur stone formation
ex. Ursodeoxycholic acid & Chenodeoxycholic acid

2. ERCP w/ sphincterotomy - used to remove stones; allow

visualization, cut & open, stones is drain into small
intestines;
bad effects: bleeding, infection
 Surgical management:
3. Extracorporeal shockwave lithotripsy (ESWL):
- if stones cannot be removed via endoscopy
- high energy shock waves disintegrate stones
- take 1-2 hrs
- used in conjunction with bile acids therapy.
 Surgical management:
4. Surgical Therapy: treatment of choice
A. Laparoscopic Cholecystectomy- for pt w/ symptomatic
gallstone; remove stones via 4 puncture holes;
- Good: minimal pain, resume normal activities-work w/in 1
week, small band aids/usually shower next day

A. Open (incisional)cholecystectomy- for pt w/ complicated

gallstones; removal of stones via right subcostal incision;
bad effect: not quick recovery time
PATHOPHYSIOLOGY
NSG. CARE
PLAN