A Reading on

Critical Issues in the Diagnosis and Treatment of Liver

Cirrhosis

In Partial Fulfillment of thr

Requirements on NCM 207 RLE

PRE CLINICAL ROTATION

Submitted to:
Gerald Jar Geronan, RN, RTRP
Clinical Instructor

Submitted by:
Jamacai Z. Iligan, STN
BSN 2A

September 7, 2020
Title: Critical Issues in the Diagnosis and Treatment of Liver Cirrhosis
Bibliography
Nishikawa H & Yukio, O. (2015). Critical Issues in the Diagnosis and Treatment of Liver
Cirrhosis. Mediators of Inflammation, vol. 2015, Article
ID 872152, 9 pages, 2015. https://doi.org/10.1155/2015/872152

Summary
Liver cirrhosis is a condition where in the liver does not function properly due to damage.
There are many factors that may lead the inflammation of the liver and fibrosis these includes
alcoholic and non-alcoholic fatty liver diseases, autoimmune-related liver disease and drug
induced liver disease also there are coinfections that results to higher rates of liver disease.
This is why liver cirrhosis is a worldwide heath problem that is associated with various
complication and high mortality.
Inflammation of the is one of the factors that should looked after when evaluating liver
cirrhosis. This liver infammation is due to activated Kupffer cells and monocytes which will
increase the other pro-inflammatory cytokines resulting systemic inflammations. It is suggested
that when evaluating liver cirrhosis it should be focused on the liver parenchyma and systemic
inflammation because when these two factors are observed this will be able to slow the
progress of liver cirrhosis. It should be done in a non-invasive manner which is through using
serum fibers biomarkers, instead of using liver biopsy which is invasive. Due to the amount of
extracellular matrix build up serum levels of the biomarkers changes the appearance of the new
biomarkers in the serum in the different level of fibrosis in which these serum markers are to
evaluate accurately the degrees of liver fibrosis. Moreover, in relation to imaging methods to
evaluate the early diagnosis of liver cirrhosis, FibroScan and FibroTouch tests.
When assessing the function of the liver and the liver cirrhosis stage it is important to
estimate it accurately through Child-Pugh-Turcotte and Model for End-Stage Liver Disease it is
used to know the strength and the necessity for liver transplant. While the Metavir score system
is also use in staging liver fibrosis. Another step or process to do is the Hepatic Venous
Pressure Gradient measurement, this method is done to predict the risk of variceal bleeding in
cirrhotics since there is increase pressure in the portal vein since blood cannot flow properly. It
may lead to development of large, swollen veins or varices, if bleeding occurs it will be cause of
mortality. In addition, if blood cannot flow properly in the liver it may lead to malnutrition occurs
to almost 80%of the patients who are experiencing liver cirrhosis, due to lack adequate supply
of nutrients it can aggravate variceal bleeding.
In order to treat liver cirrhosis it is advisable to use antiviral therapy to alleviate cirrhotic
progression once liver cirrhosis is detected. In terms of alcoholic liver cirrhosis wherein cutting
off alcohol and physical exercise is one the treatments to be done.
On the other hand, liver cirrhosis may lead to primary liver cancer with this early
interventions are the use of antiviral drugs that may help to prevent cancerization. Also early
diagnosis is one of the main factors to avoid this so every patient with liver cirrhosis is advise to
undergo ultrasound every six months along with CT/MRI scan when there are possible
carcinoma discovered.
Patients with liver cirrhosis should go on a regular check up and laboratory test this is to
monitor disease progression. This also includes the nutrition of the patient should be monitored
to avoid malnutrition. In addition, annual CT or MRI is necessary for cirrhosis progression.
Lastly, it is important to teach patients and their family members because by this it will be able
to help with the recovery and survival of the patient which is called Palliative Care. However,
Palliative Care is not yet advisable since there factors that may create difficulty. Contrary, if liver
cirrhosis is not prevent or got worse it may lead to end-stage liver disease which has a high
degree of mortality.

Reaction.
Upon reading this article, I agree with what this article is trying to imply. As I was reading
this I like how it is suggesting ways to lessen the cost like doing the procedure non-invasive
manner in testing or evaluating liver cirrhosis. These methods are used for detection an
prognosis of the patients with liver cirrhosis. Also I like how it suggested to not use liver biopsy
since there are many factors that may arise that may lead to complications. It also suggests
new ways to treat liver cirrhosis instead of just doing the same procedure so that the results and
the detection can be easily done. Lastly, they did not just talk about the technical or the
mechanism or the treatments and procedure that would help treat the disease but they also
talked about how the patient as well as the family should react or face and if ever this might
happen.
The article was well written it was properly organized that from the introduction of the
disease to the complications and the possible outcome of his disease if treated or not. It gave
facts that was new to me and along with it I was learning with the different terms used and was
able to widen my knowledge about diseases that involves the kidney because before my
knowledge was just if you have a kidney problem you undergo dialysis. But due to this reading I
gained another knowledge about the other ways to treat and detect problems that involves the
kidneys. This is the first time I learned about liver cirrhosis since I did know any disease that
involves the liver except for liver cancer. That is why when I found out that liver cirrhosis may
lead to cancerization it answered my inquiry why a person has liver cancer. I was also able to
understand more about how does a disease in just one organ in the body can lead to so many
complications. Aside from that, I also learned about the different procedures that is done to
diagnose a patient with liver cirrhosis and also what are the ways to treat them. Through
reading this I was looking back to the persons that I met before that has disease in relation to
the liver. My inquiry with regards to why they undergo dialysis or why these person is
experiencing those symptoms.
One of the things that amazed me was the gastroesophageal varices because if this
complication will happen it can be the cause of mortality to the patient and also as I was reading
about this it answered my questions about liver cirrhosis and also understand well the
mechanism of liver cirrhosis and how it would cause an impact into your body once you neglect
to take care of your liver. It was also emphasized in the article how this disease has a great
effect all through out the body. That is why it is also emphasized early detection of liver cirrhosis
and apply antiviral therapy right away once it is detected.
As mentioned above the positive impact of the article is that it did not just tackle about the
disease itself but it talked about the different procedure and treatments. They also added
suggestion on how to improve the quality of care or change the old ways of detecting or treating
the disease. Just like the non-invasive way of evaluating the progression of liver cirrhosis. This
also includes the ways to prevent the complications that may come along the process. Although
there terms that are hard to understand because some of it was technical but the flow of the
article was good and organized It also has a section wherein it talks about what the patient and
the family should do and not just solely depend on the medical workers to treat liver cirrhosis.
As student nurse, I will collaborate to the health care members so I can fully understand the
situation of my patient and also know the different procedure that may patient will undergo so
that I can prepare him or her ahead of time. This will also help me to inform other members of
the health care members about the allergies or contraindications. Also, follow the orders of the
doctor just like in giving medications to the patient. And also I will establish a rapport with my
patient so that this will help to alleviate any anxiety with regards to liver cirrhosis. Just like I will
let the patient understand the disease he or she is going through and let inform about the
different procedures and tests that he will undergo along the way so that the patient will be
aware of what is happening. By this it will not scare or produce anxiety to the patient. Second,
as said in the article it is important that the patient will have adequate amount of nutrition since
the kidney cannot able to function well. Third, I will also inform the family members or the
people around him on what they should do on their part by this they can help and guide the
patient in the rehabilitation process just like emotional and psychological support. Lastly, to
observe and teach the patient to do things on his own just like taking the medicines and what
he or she should do.
All-in-all I was able to gain another knowledge about liver cirrhosis and it made me realize
how a single disease can have a big impact into your whole system. Just like what is written in
the article it is important to detect in advance the onset of any disease not just liver cirrhosis.