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 on1. The history, especially in regard to prior liver disease, such as hepatitis

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.
2.

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.
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Diagnosis: Ineffective breathing related to ascites, liver enlargement. Nursing intervention: 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
a)

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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 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 Diagnosis: fluid volume deficit related to bleeding and vomiting

1.

2.

Nursing intervention: a) Provide oral liquids within the fluid restrictions b) Regulate and maintain intravenous fluid infusions at the prescribed rate.

c) 1.

Blood transfusion is given in case of haematemesis.

Diagnosis: fluid volume excess related to oedema, ascitis Nursing intervention

a) Administer prescribed diuretics b) Salt restricted diet.
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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 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.

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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

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