LIVER CIRRHOSIS

Pathophysiology:

 Liver Cirrhosis: Chronic liver disease characterized by progressive scarring

(fibrosis) of the liver tissue, leading to impaired liver function and structure.

 Pathogenesis: Repeated liver injury leads to inflammation and fibrosis. Scar

tissue replaces healthy liver tissue, disrupting normal blood flow and liver

function.

 Progression: As fibrosis worsens, the liver's ability to function declines,

leading to portal hypertension, impaired blood flow, and complications such
as ascites, hepatic encephalopathy, and variceal bleeding.
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Causes:

 Chronic alcohol abuse

 Fatty liver

 Chronic viral hepatitis (B, C, etc.)

 Non-alcoholic fatty liver disease (NAFLD) NASH (Non-alcoholic

steatohepatitis) due to increased fat build-up causing liver inflammation.

 Autoimmune hepatitis
 Repeated episodes of heart failure with fluid regurgitation to the liver.
 Genetic disorders

 Biliary obstruction
 Drugs induced liver injury (hepatotoxic drugs)
 Overdose of acetaminophen, NSAIDS, Isoniazid
 Production of acetaldehyde (reactive metabolite)
Signs and Symptoms:

 Fatigue

 Jaundice

 Abdominal swelling (ascites)

 Easy bruising or bleeding

 Confusion (hepatic encephalopathy)

 Spider-like blood vessels on skin (spider angiomas)

 Weight loss

 Hepatomegaly/ splenomegaly

 Collateral veins visible on abdominal wall

 Edema of lower part of body

 Esophageal varices

 Hemorrhoids
 Diagnostic Tests:

 Liver function tests (ALT, AST, bilirubin, albumin)

 Imaging studies (ultrasound, CT scan, MRI)

 Liver biopsy

 Endoscopy (to check for varices)

 Blood tests for viral hepatitis markers

Non-pharmacological Management:

 Dietary changes (low-sodium diet for ascites)

 Alcohol cessation

 Management of underlying causes (viral hepatitis treatment, etc.)

 Regular monitoring and follow-up

Pharmacological Treatment (Four Drugs):

1. Ursodeoxycholic Acid (UDCA) - Mechanism: Reduces bile acid toxicity.

Side effects: Diarrhea, elevated liver enzymes. Nursing interventions:

Monitor liver function tests, educate on proper administration.

2. Lactulose - Mechanism: Reduces ammonia levels in hepatic

encephalopathy. Side effects: Diarrhea, electrolyte imbalances. Nursing

interventions: Monitor mental status, ensure adequate fluid intake.

3. Propranolol - Mechanism: Beta-blocker to reduce portal hypertension. Side

effects: Hypotension, bradycardia. Nursing interventions: Monitor blood

pressure, heart rate.

4. Spironolactone - Mechanism: Diuretic for ascites. Side effects:

Hyperkalemia, dehydration. Nursing interventions: Monitor potassium

levels, assess for signs of dehydration.

Surgical Treatment:

 Liver transplant: Considered in advanced cases where the liver is severely

damaged and non-responsive to other treatments.

Priority Nursing Diagnoses:

1. Risk for Infection related to compromised liver function (evidence:

elevated bilirubin, decreased albumin levels).

2. Fluid Volume Excess related to impaired liver function causing ascites

(evidence: abdominal distension, weight gain).

3. Risk for Impaired Skin Integrity related to jaundice and poor perfusion

(evidence: yellowing of skin, poor wound healing).

Priority Nursing Interventions for Each Diagnosis:

1. Risk for Infection:

 Monitor vital signs and laboratory results.

 Promote good hygiene practices.

 Educate on signs of infection and when to seek medical help.

2. Fluid Volume Excess:

 Monitor daily weights and abdominal girth.

 Implement a low-sodium diet as prescribed.

 Administer diuretics as prescribed and monitor response.

3. Risk for Impaired Skin Integrity:

 Keep skin clean and dry.

 Use barrier creams to protect skin.

 Reposition regularly to relieve pressure on vulnerable areas.