HEPATIC CIRRHOSIS

DE LOS SANTOS, KRISTINE

BERNADETTE R.
USANA, NOAH BILLY D.R.
 The LIVER is the largest gland in the
body…
 Regulates glucose and protein metabolism
 Produces and secretes bile for the digestion and
absorption of fat
 Removes waste products from the bloodstream
and secretes them into the bile
HEALTHY LIVER
LIVER CIRRHOSIS
 Hepatic Cirrhosis
 Chronic disease where the normal liver tissue
is replaced by diffuse fibrosis which then
disrupts the structure and function of the liver
THREE TYPES OF CIRRHOSIS
 ALCOHOLIC cirrhosis
 Scar tissue surrounds the portal area
 Caused by chronic alcoholism
 Most common type
 POSTNECROTIC cirrhosis
 Presence of broad bands of scar tissue
 Late result of acute viral hepatitis
 BILIARY cirrhosis
 Scarring in the liver around bile ducts
 Results from chronic biliary obstruction and cholangitis
 RISK FACTORS
 Exposure to carbon tetrachloride, chlorinated
naphthalene, arsenic, or phosphorus
 Infectious schistosomiasis
 Men are affected more often
 Women are at greater risk of developing
alcoholic cirrhosis
 40 to 60 years of age
 CLINICAL MANIFESTATIONS
COMPENSATED
 Intermittent mild fever
 Vascular spiders
 Palmar erythema
 Unexplained epistaxis
 Ankle edema
 Vague morning
indigestion
 Flatulent dyspepsia
 Firm, enlarged liver
 Splenomegaly
DECOMPENSATED
 Ascites
 Jaundice
 Weakness
 Muscle wasting
 Weight loss
 Continuous mild fever
 Purpura (decreased platelet)
 Spontaneous bruising
 Epistaxis
 Hypotension
 Sparse body hair
 White nails
 Gonadal atrophy
 DIAGNOSTIC METHODS
 Laparoscopy in conjunction with biopsy
 Also called minimally invasive surgery (MIS),
bandaid surgery, keyhole surgery
 Biopsy confirms diagnosis
 Ultrasound scanning
 Measures the difference in density of parenchymal
cells and scar tissue
 CT scan, MRI, radioisotope liver scans
 Give information about liver size and hepatic blood
flow and obstruction
 DIAGNOSTIC METHODS
 Liver Function Test (serum AP, AST, ALT,
GGT and serum cholinesterase levels)
 Enzyme tests indicate liver cell damage
 Bilirubin Test
 Measures bile excretion or retention
 DIAGNOSTIC FINDINGS
 ↓ serum albumin level
 ↑ serum globulin level
 ↑ serum AP, AST, ALT, GGT levels
 ↓ serum cholinesterase levels
 ↑ bilirubin levels
 Prolonged PT
 Ventilation-perfusion imbalance and hypoxia
 MEDICAL MANAGEMENT
 Based on presenting symptoms
 Antacids or histamine-2 antagonists to decrease
gastric distress and minimize possibility of GI
bleeding
 Vitamins and nutritional supplements promote
healing of damaged liver cells and promote client’s
general nutritional status
 Spironolactone to decrease ascites; salt restriction
 MEDICAL MANAGEMENT
 Colchicine (anti-gout) may increase survival time in
clients with mild to moderate cirrhosis
 Angiotensin system inhibitors, statins, diuretics,
immunosuppressants, glitazones have been shown to
possess antifibrotic activity for the treatment of
cirrhosis
 Clients with ESLD and cirrhosis use the herb milk
thistle (Silybum marianum) to treat jaundice and other
symptoms
 Silymarin has anti-inflammatory and antioxidant properties
 Ursodeoxycholic acid improves liver function in
clients with primary biliary cirrhosis
 MEDICAL MANAGEMENT
 Hepatitis-related cirrhosis: interferon for viral and
corticosteroids for autoimmune
 Wilson's disease-caused cirrhosis: copper chelation
therapy
 Portal hypertension: Propranolol to lower BP on portal
system
 Transjugular intrahepatic portosystemic shunting is
occasionally indicated to relieve pressure on the portal
vein in severe complications from portal hypertension
 Alcohol and paracetamol, as well as other potentially
damaging substances, are discouraged
 If complications cannot be controlled or when the liver
ceases functioning, liver transplantation is necessary
 NURSING MANAGEMENT
 Promote rest to permit reestablishment of
liver’s functional ability
 Monitor I&O and weight daily
 Elevate HOB for maximal respiratory efficiency
especially if with marked ascites
 O2 therapy to oxygenate damaged cells and prevent
further destruction
 Increase activity after improvement in nutrition and
strength
 NURSING MANAGEMENT
 Improve nutritional status
 Provide high CHON diet if without ascites, edema, or signs of
impeding hepatic coma
 Administer vit B complex, A, C, and K supplements
 If ascites is present, small, frequent meals to minimize abdominal
pressure
 Consider client’s preferences
 With steatorrhea, administer vit A, D, E, and K
 Administer folic acid and iron to prevent anemia
 Decrease CHON in diet for client’s showing signs of impending or
advancing coma
 Restrict CHON if encephalopathy develops
 Incorporate vegetable protein to meet protein needs and decrease risk
of encephalopathy
 Restrict sodium to prevent ascites
 Avoid consumption of raw shellfish
 NURSING MANAGEMENT
 Provide skin care
 Change positions frequently to prevent pressure
ulcers
 Avoid using irritating soaps and adhesive tapes t
prevent trauma to the skin
 Apply lotion to soothe irritated skin
 Minimize scratching
 NURSING MANAGEMENT
 Reduce risk for injury
 Make sure the side rails are in place and are padded
in case the client becomes restless
 Explain all procedures to the client to prevent
agitation
 Always assist client when getting out of bed
 Evaluate injury properly (internal bleeding tendency)
 Instruct client to use an electric razor, soft-bristled
toothbrush
 Apply pressure to venipuncture sites to minimize
bleeding
 NURSING MANAGEMENT
 Monitor and manage potential complications
 BLEEDING AND HEMORRHAGE
 HEPATIC ENCEPHALOPATHY AND COMA
 May manifest as deteriorating mental status and
dementia or abnormal voluntary and involuntary
movements
 Serum electrolyte levels are carefully monitored and
corrected if abnormal
 O2 is administered if oxygen desaturation occurs
 Monitor for fever and abdominal pain (infection,
bacterial peritonitis)
 NURSING MANAGEMENT
 Monitor and manage potential complications
 Excess fluid volume
 Administer diuretics, limit fluid intake, enhance client
positioning to optimize pulmonary function
 Monitor I&O, daily weight changes, abdominal girth
changes, edema formation
 Monitor for nocturia and oliguria
 NURSING MANAGEMENT
 ENCOURAGE CLIENT TO EXCLUDE
ALCOHOL FROM THE DIET