Liver cirrhosis

History taking:
Introduction

1. App k hospital anay ki wajah kiya bani?

2. Acah app apni takleef k baray ma mazeed tafseel sa bataya?
3. Chu k batayah app ko pat k kis hisay ma Dard mehsoos horha?
4. Ya dard kis qism ka ha , chuban jaisan
5. Ya dard app ko kab sa hai?
6. Kia ya Dard app k paat k dusray hisay ma b hota ha?
7. Dard kia karnay ya kia khany k bad shuru hota or app is Dard ko kam karnay k lia kia krtay?
8. App na apni takleef k liya kisi doctor ko dekhaya ha ?
9. App nay apni takleef ko kam krnay k lia koi dawai li ya phr kisi dasi nuqsay ka istemaal kia ho?
10.

Signs and symptoms of the disease:

Early stage; some fibrosis (liver compensate still does its work)

 Asymptomatic
 Nonspecific e.g. (Weight loss, weakness, fatigue)

Late stage: Extensive fibrosis (decompensated, liver failure)

 Jaundice and Pruritus(itchy skin)

 Hepatic encephalopathy(confusion, asterixis)
 Easy bruising
 Variceal hemorrhage
 Telangiectasis ( spider angioma)
 Splenomegaly {hypersplenisms(traps blood elements)}
 RBC( anemia)
 WBC( leukopenia)
 Platelets( thrombocytopenia)
 Portal HTN: (ABCDE)
 Ascites
 Bleeding
 Caput medusa
 Diminished liver function
 Enlarge spleen

Medical diagnosis:
 Liver cirrhosis
1. Liver biopsy ( Gold standard)
2. Ultrasound scanning, CT, MRI
3. Upper GI endoscopy
4. Lab Findings
 Elevated Bilirubin
 Serology
 Elevated enzymes
 Thrombocytopenia (Low platelets)

Treatment:

 Liver transplant
 Underlying cause

Pathophysiology:

When the liver comes in contact with viruses (hepatitis C), infections or toxins, inflammatory responses
can occur, that release cytokines and inflammatory mediators. Those lead damage to hepatocytes
causing tissues fibrosis and ultimately lead to liver dysfunction and causing serious complications such as
portal HTN, jaundice, hepatic encephalopathy, caput medusa, Ascites, esophageal varices.

Pharmacological treatment:

 Antacids ( decrease gastric distress and minimize GI bleeding)

 Vitamins and nutritional supplements (heals liver cells and improve nutritional status)
 Potassium sparing diuretics( minimize fluids and electrolytes changes)
 Anti-hypertensive ( decrease portal HTN)
 Steroids and antiviral drugs(reduce liver cell injury)
 Antibiotics ( infections)
 Laxatives(hepatic encephalopathy)
 Life styles changes
 Low sodium diet
 Stop alcohol intake
 Prevents infection with hand hygiene
 Avoids people who are sick

Nursing diagnosis

 Fluid volume excess r/t 3rd spacing of abdominal and peripheral fluid.
 Imbalance nutrition less than body required r/t abdominal distention and decrease appetite.
 Fatigue related to anemia.
 Liver cirrhosis
 Risk of bleeding related to thrombocytopenia.
 Knowledge deficits related to cirrhosis management.

Nursing interventions:

 Restricts sodium to 2g daily by avoiding table salt and to substitute seasoning like herbs, spices
and lemon for flavoring.
 Promoting rest
 Dietary changes that help in building RBCs.
 Teach dietician plan to appealing in patient’s healthy meals high in vitamin A, D, E, K and iron.
 To reduce risk of bleeding teach patient to use soft tooth brush, gentle mouth care after meals
and cautions with all physical activity to avoid injury.
 Provide instructions to patient immediate medical attention if patient has signs of serious
complications such as fever, SOB, dizziness, bloody vomit, red or tarry stool.
 Encourage patient to follow drug regimens.
 Teach adverse effect of alcohol and encourage avoiding alcohol.