CIRRHOSIS OF LIVER

CIRRHOSIS OF LIVER

DEFINITION:-

Cirrhosis complication of liver disease which involve loss of liver cells and irreversible scaring of liver cells. It is chronic disease characterized by replacement or degeneration changes in normal liver cells. Tissue with diffuse fibrosis and nodules that disturbs the structure and function of liver. Also scar formation occurs due to destroyed hepatocytes.

CAUSES/ETIOLOGY:-

  • Alcoholism.
  • Hepatitis A,B,C,D.
  • Hepatotoxic drugs.
  • CHF.
  • Biliary obstruction
  • Diabetes
  • Glycogen storage disease
  • Immunological causes


TYPES:-

  1. Post Necrotic Cirrhosis: Due to severe inflammation and massive necrosis of hepatocytes cells.
  2. Alcoholic Cirrhosis: It occurs due to excessive intake of alcohol that leads to accumulation of fat in liver.
  3. Biliary Cirrhosis: Due to severe inflammation and massive necrosis of hepatocytes cells.
  4. Cardiac Cirrhosis: Main cause of this type of Cirrhosis is right side congestive heart failure.


SIGNS/SYMPTOMS:-

1. Early symptoms due to inflammation

  • Fever
  • Pain
  • Anorexia
  • Fatigue
  • Nausea

2. Others symptoms are

  • Oedema
  • Hypoalbuminemia
  • Abdominal distension
  • Increased abdominal girth
  • Spider angioma
  • Increased serum NH3 (ammonia)level
  • Yellowish skin
  • Hepatic encephalopathy
  • Loss of sesory function
  • Difficulty in breathing

3. IF biliary obstruction

  • Absence of urobilinogen in digestive tract
  • Increase serum bilirubin level so appear dark color of urine
  • Jaundice due to accumulation of bilirubin under skin

4. Hormonal disturbances

Reduce androgen and estrogen which produce abnormal menses

  • Amenorrhoea
  • Loss of body Hair
  • Gynecomastia (upper swelling on breast in man)

5. Bleeding disorders

  • reduce absorption of vitamin K and reduce synthesis of prothrombin


PATHOPHYSIOLOGY:-

    Due to any caus like (alcohol abuse, malnutrition, infection, drugs, or biliary obstruction
    ↓
    Destruction of hepatocytes
    ↓
    Fibrosis/scar formation
    ↓
    Obstruction of blood flow
    ↓
    Increase pressure in venous and sinusoidal channels
    ↓
    Fatty infiltration fibrosis/scarring
    ↓
    Portal hypertension


DIAGNOSTIC EVALUATION:-

Serum Examination

  1. Increase SGOT/SGPT level
  2. Low protien level
  3. Increase bilirubin level raised

Others:

  • Liver Function Test (LFT)
  • Aspirate Aminotransferase (AST)
  • AlT-Alanine Transferase
  • LDH-Lactate dehydrogenase
  • USG (for Hepatomegaly)
  • WBC (for determination of infection)
  • RBC (in Anaemia)
  • Liver biopsy-FNAC (Fine Needle Aspiration Cytology)
  • Abdominal paracentesis (for determine pus cells bacterial infection or protein component in accumulated fluid).


COMPLICATIONS:-

  • Coagulations
  • Ascites
  • Peritonitis
  • Portal hypertension


MEDICAL MANAGEMENT:-

Medical management is based on presenting symptoms.

  • Antacids
  • Antiemetics
  • Vitamins and nutritional supplement
  • Balanced diet
  • Potassium sparing diuretics (for ascites), e.g., Spironolactone.
  • Avoid of alcohol.


DIETARY MANAGEMENT:-

  • Provide high caloric diet and low liquid diet (800-1000 ml/day)
  • In Hepatic coma, give low protien and low sodium diet.
  • Provide Albumin containing food.
  • Vitamin A, D, E, K includes with diet to patient.


SURGICAL MANAGEMENT:-

  1. Porta-Caval Shunt (Porta caval anastomosis):-
    A surgical technique in which hepatic portal vein is joined to inferior vena cava.
  2. Splenorenal Shunt (Splenorenal anastomosis):-
    A surgical technique in which spleen vein is joined to the left renal vein. (Mostly for treating portal hypertension).
  3. Liver Transplant (Exchange of liver)


NURSING MANAGEMENT:-

Assessment

  • Assess activity level of patients
  • Assess nutritional level
  • Assess family knowledge level
  • Observation of skin
  • Monitor Complications
  • Assess fluid volume.

Nursing Diagnosis

  • Risk of injury related to coagulopathy.
  • Altered nutrition less than body requirement related to decrease metabolism of fat and protien.
  • Activity intolerance related to fatigue and discomfort.
  • Altered fluid volume related to Oedema.
  • Impaired skin integrity related to jaundice.
  • knowledge deficit related to disease condition.

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