MARKING KEY- LIVER CIRRHOSIS

a. i. define Liver Cirrhosis 5%

This is a chronic, progressive disease characterized by widerspread fibrosis

(Scarring) and nodule formation

ii. State the four (4) types of liver Cirrhosis 12%

-Laerine’s Cirrhosis (Alcoholic or Nutritional Cirrhosis)-Associated with

malnutrition and alcoholism in which there is massive collagen formation, liver
is fatty and reversible

-Postnecrotic Cirrhosis-is a complication of massive necrosis from hepatotoxins

such as viral hepatitis in which there is broad bands of scar tissue from within
liver.

-Primary or Biliary Cirrhosis- is associated with inflammation of intrahepatic

bile ductules resulting in biliary obstruction in liver and common bile duct

-Cardiac Cirrhosis-results from long –standing, severe, right-sided heart failure

in patient with construction pericarditis, corpulmonale and tricuspid
insufficiency.

b. Five Investigations 15%

 History- age, gender, race, exposure to harmful substances, alcoholism and

cigarette smoking, history of drug abuse or use (Narcotics)
 Physical examination-Palpation will reveal hepatomegaly
 CT Scan
 Laboratory tests-Liver function test serum- enzymes are raised
o Asparate Aminotransferase (AST)
o Alumine Aminotransferase (ALT)
o Serum Glutamic Pyruvic Transferase (SGPT)
o Y-glutamyl Transferase

1
  Bilirubin (conjugated) urine bilirubin decreased faced bilirubin
 Serum ammonia – elevated
 Prolonged prothrombin time.
 Laboratory results will reveal impaired hepatocellular enzymes.

c. Management till discharge 48%

Objectives

1. To maximize liver function. Minimize trauma risk and promote a nutritious

diet and adequate rest.
2. To prevent infection. Provide adequate rest, diet, and environmental
control.
3. To control disabling complications. Such as ascites, bleeding esophageal
varies and hepatic encephalopathy

Drugs

 Spironolactone

 Action- induces diuresis

 Used in the management of ascites

 Dose- 60-100mg daily

 Side Effects- Hypokalaemia and Hyponatraemia

 NURSING IMPLICATION – Give slow vitamin K or advise patient to take

bananas give sodium supplements.

 Neomycin

 Action- Promotes towel colony and lead to the production of Vitamin K which
helps to prevent haemorrhagic state and at the same time acting as
prophylactic therapy for other bacterial infection.

 Dose- 125-250mg QID

2
  Contraindication- people who are sensitive to neomycin

 Intravenous fluids 5%-10% Dextrose

Action - provision of energy and reduces lives activity and promotes rest of

the liver

Abdominal paracentesis

Tapping fluid from the ascetic abdomen using cannula to decrease abdominal
pressure

Effects- May lead to hypovolaemia and electrolyte imbalance, plasma protein is

reduced.

Nursing Care

Environment

 Adult in a general medical ward which is clean and well ventilated

 Prepare necessary equipment such as a drip stand.

 Reverse barrier nurse the patient

Psychological care

 Explain the disease process to the patient that the liver cells are not
functioning normally.

 Explain to him all the procedure that are done on him to gain cooperation

 Involve him and his relatives in his care to gain cooperation

 Encourage him to ask questions and answer him truthfully.

Observations

3
  Temperature, pulse respiration, blood pressure should be checked 4 hourly
and reput any levitation from normal

 Daily weight should be done and monitor the intake and output

 Observe the skin reaction to bilirubin such as priorities.

 Observe for any brain involvement of the disease

 Observe for any muscular involvement

Hygiene or big bath

 Provide bed bath daily to promote hygiene.

 Encourage the patient to be doing oral care to prevent oral diseases and
promote appetite

 Apply calamine lotion when the patient has pruritis.

Nutrition

 Provide a well nutritious meal.

 Give a high protein as long as the blood ammonia levels are normal and high
calories for energy

 Restrict fat intake as the liver is unable to emulsify this

 If there is Paracentesis, increase fluid intake to replace the fluids last through
paracentesis and to prevent hypovolaemia

 Give vitamin B rich foods and fat soluble foods to patient if his cirrhosis is due
to alcohol

Elimination

 Strictly monitor the intake and output and record on the fluid balance chart.

4
D) Explain five (5) complications of Liver Cirrhosis 20%

i. Portal hypertension which results in ascites aid esophageal varices

ii. Ascites as a result of accumulation of fluid in the peritoneal cavity due to changes
in the hemodynamics of the abdominal circulation.

iii. Portal systemic encephalopathy or hepatic coma or hepatic encephalopathy due

to several metabolic derangements

iv. Hepatorenal syndrome characterized by sudden kidney failure in a patient with

progressively worsening liver failure

v. Hypoghycaemia/malnutrition due to metabolic derangement

vi. Bleeding tendency due to decreased vitamin K absorption as fat metabolism is

reduced

vii. Anaemia due to liver necrosis

viii. Infections due to thrombocytopenia and Leukopenia

ix. Changes in secondary sexual characteristics such as menstrual changes, testicular

atrophy due to decreased antrogen and oestrogen detoxification