CIRRHOSIS OF LIVER

Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to
chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of
blood through the liver. Scarring also impairs the liver’s ability to -

 control infections
 remove bacteria and toxins from the blood
 process nutrients, hormones, and drugs
 make proteins that regulate blood clotting
 produce bile to help absorb fats—including cholesterol—and fat-soluble
vitamins

TYPES:

a) Cirrhosis of known aetiology

b) Cirrhosis of unknown aetiology

-Laennec’s cirrhosis or portal cirrhosis. It is due to alcoholism.

CAUSES:
1. Chronic viral hepatitis
2. Biliary cirrhosis
3. Bacterial infection
4. Congenital intrahepatic obstruction of the biliary tree
5. Prolonged exposure to unknown toxic agents e.g., some herbal medicines.

PATHOPHYSIOLOGY

Hepatocyte injury with necrosis, fibrosis, regeneration and eventual

degeneration

↓
The diminished parenchymal cell mass causes regeneration of tissue with
nodular areas of proliferating hepatocytes

↓
Hepatocytes respond to injury with deposition of collagen that forms fibrous
connective tissue
 ↓
This scar tissue and nodular areas of regeneration impair the intrahepatic
blood flow

↓
Ongoing necrosis

↓
Failure of hepatocellular function and portal hypertension occur

↓
Ascites, severe cholestasis, encephalopathy (hepatic coma) and GI bleeding

CLINICAL MANIFESTATIONS:

1. Jaundice
2. Anorexia
3. Muscle weakness
4. Poor growth
5. Fatigue
6. Nausea
7. Vomiting
8. Weight loss
9. Abdominal pain
10.Ascites and oedema
11.Gastrointestinal bleeding
12.Anaemia.
13.Dyspnoea and cyanosis may occur especially on exertion.
14.Itching
15.Spiderlike blood vessels on the skin
DIAGNOSTIC EVALUATION

The diagnosis of cirrhosis is based on-

1. The history, especially in regard to prior liver disease, such as hepatitis

2. On physical examination, hepatosplenomegaly will be revealed or a
sudden decrease in liver size.
3. Laboratory evaluation, especially liver function tests, such as bilirubin
and aminotransferases, ammonia, albumin, cholesterol and prothombin
time
4. Liver biopsy for characteristic changes.
Doppler ultrasonography of the liver and spleen is useful to confirm
ascites, to evaluate the blood flow through the liver and spleen, and to
determine the patency and size of the portal vein if liver transplantation
is considered.

THERAPEUTIC MANAGEMENT:
- Liver transplantation has improved the prognosis substantially for many
children with cirrhosis.
- Nutritional support is an important therapy for children with cirrhosis
and malnutrition. Supplements of fat-soluble vitamins are often
required, and mineral supplements may be indicated. In some instances
nutritional in the form of continuous tube feedings or parenteral
nutrition may be necessary.
- Acute haemorrhage is managed with intravenous fluids, and vasopressin
- Ascites can be managed by sodium restriction and diuretics.
- Administering drugs like neomycin and lactulose to limit the formation
and absorption of ammonia which is an endogenous toxin.

NURSING PROCESS:

Assessment:

Obtain complete history about the patient. In addition evaluate the patient’s
condition by performing a physical examination. Pay special attention to the
patient’s ventilation, abdominal size, weight, the presence or absence of
jaundice and other symptoms of the liver disease. Maintain and analyze food
intake and fluid record.

1. Diagnosis: Ineffective breathing related to ascites, liver enlargement.

Nursing intervention:

a) Assist the client to a Fowler’s position.

b) Provide supplemental oxygen if ordered.
c) Observe for increased respiratory distress when the client is
asleep

2. Diagnosis: pain related to pressure on abdominal organs and tissue

damage
Nursing intervention:
a) Administer prescribed analgesics.
b) Position the child in a way that will relieve pressure

3. Diagnosis: Altered nutrition less than body requirements related to

anorexia.
Nursing intervention:
a) Provide small frequent diet
b) In case of nausea and vomiting, tube feeding may be given.
c) Restrict salt intake
d) Give supplementary vitamins B, C and K. Restrict the dietary
proteins to reduce the blood ammonia level.
e) Maintain intake and output

4. Diagnosis: fluid volume deficit related to bleeding and vomiting

Nursing intervention:

a) Provide oral liquids within the fluid restrictions

b) Regulate and maintain intravenous fluid infusions at the
prescribed rate.
c) Blood transfusion is given in case of haematemesis.
5. Diagnosis: fluid volume excess related to oedema, ascitis

Nursing intervention

a) Administer prescribed diuretics

b) Salt restricted diet.

6. Diagnosis: impaired skin integrity related to pruritus.

Nursing intervention:
a) If pruritus exists, avoid drying types of soaps for bathing.
b) Control pruritus by applying calamine lotion

7. Diagnosis: Anxiety related to symptoms, diagnosis

Nursing intervention:
a) Tell the parents about the plan for treatment and the routine of
care.
b) Provide emotional support to the child and parents.
c) Allow the parents to participate in the care of child.
 TEACHING PRACTICE
ON
CIRRHOSIS OF LIVER

SUBMITTED BY:

INDAMANBHA CHYNE

M.Sc. NURSING 1ST YEAR

CHILD HEALTH NURSING

P.I.O.N.

SUBMITTED TO

Mrs. BHIMA UMA MAHESHWARI

HOD

CHILD HEALTH NURSING

P.I.O.N.

SUBMITTED ON: 22/10/09