• Subject: Adult Health Nursing

• Topic: Cirrhosis of liver

 Objectives
• At the end of this presentation the student will be
able to:
• Define cirrhosis of liver
• Describe Pathophysiology of cirrhosis of liver
• Identify types of cirrhosis of liver.
• Enlist signs, symptoms and causes of cirrhosis of
liver.
• Discuss medical diagnosis and treatment cirrhosis of
liver
• Make nursing diagnosis and nursing intervention for
cirrhosis of liver.
 Liver Cirrhosis
• Cirrhosis 
It is a chronic liver disease
characterized by scarring of the liver that
involves the formation of fibrous (scar) tissue
associated with the destruction of the normal
parenchymal cells of the organ.
• It is the result of long-standing injury most
commonly due to alcohol in excess but there
are a number of other important causes .
 Cont….
• The destruction of the
normal structure and
the loss of liver cells
prevents the liver from
functioning normally.
 Pathophysiology
• Cirrhosis is often caused by
hepatitis and fatty liver ,
independent of the cause. If the
cause is removed at this stage, the
changes are still fully reversible.
• The Pathophysiology of cirrhosis is
the development of scar tissue
that replaces normal parenchyma,
blocking the portal flow of blood
through the organ and disturbing
normal function.
 Types of cirrhosis
 The major types of cirrhosis based on
pathological classification are:
• Alcoholic cirrhosis (alcohol intake)
• Postnecrotic cirrhosis (hepatitis)
• Biliary cirrhosis (biliary obstruction)
• Cardiac cirrhosis (right sided heart failure) and
• Nonspecific metabolic cirrhosis (GI diseases).
 Etiology
• Hepatitis C infection (long-term infection).
• Long-term alcohol abuse. 
• Autoimmune inflammation of the liver.
• Disorders of the drainage system of the liver
(the biliary system), such as primary biliary
cirrhosis and primary cholangitis.
 Cont…
• Hepatitis B (long-term infection).
• Hepatotoxic drugs or toxins.
• Metabolic disorders of iron.
(hemochromatosis).
• Nonalcoholic fatty liver disease (NAFLD).
• Hemochromatosis=inherited disorders characterized by high absorption of iron by
the intestinsl tract , resulying in excessive storage of iron particularly in the
liver,skin,pancrease,heart,joints and testes….
 Clinical Manifestation
• Peripheral edema.
• Nausea and vomiting.
• Constipation & diarrhea.
• Pain and fever.
• Clubbing.=occur due to oxygen
• dificiency
• An enlarged liver or spleen.
• Acities.=fluid in peritonial cavity
• Red spider-like blood vessels on
the skin
• Jaundice.
 Diagnosis
• Complete blood count test (CBC).
• Liver function tests including alkaline phospatase,
serum glutamic pyruvic transaminase (SGPT).
• Serum albumin.
• Liver biopsy.
• Liver scan.
• Upper GI barium swallow.
• Computed tomography (CT) of the abdomen
• Magnetic resonance imaging (MRI) of the abdomen
• Ultrasound of the abdomen.
 Treatment
 All patients with cirrhosis can benefit from certain
lifestyle changes, including:
• Stop drinking alcohol.
• Limit salt in the diet.
• Get vaccinated for influenza, hepatitis A and hepatitis
B, and pneumococcal pneumonia (if recommended by
doctor).
• Generally, liver damage from cirrhosis cannot be
reversed, but treatment could stop or delay further
progression and reduce complications.
 Cont…
• A healthy diet is encouraged, as cirrhosis may be an
energy-consuming process.
• Antibiotics will be prescribed for infections, and various
medications can help with itching.
• Laxatives, such as lactulose, decrease risk of
constipation.
• Alcoholic cirrhosis caused by alcohol abuse is treated by
abstaining from alcohol.
 Cont…
• Treatment for hepatic
cirrhosis involves
medications used to treat
the different types of
hepatitis, such as interferon
for viral hepatitis and
corticosteroids for
autoimmune hepatitis.
• Liver transplant.
 Complications
• Liver failure.
• Spleenomegaly.
• Ascites and bacterial peritonitis.
• Portal hypertension
• Kidney failure.
• Hepatocellular carcinoma.
• Mental confusion.
• Change in the level of consciousness.
• Coma.
 Nursing diagnosis
• Acute pain related to liver enlargement secondary to
ascites as evidenced by facial grimace.
• Activity intolerance related to fatigue and discomfort.
• Imbalanced nutrition, less than body requirements,
related to chronic gastritis, decreased GI motility, and
anorexia.
• Altered breathing pattern r/t decreased lung
expansion secondary to intra-abdominal fluid
collection (ascites).
 Cont….
• Risk for injury and bleeding related to altered clotting
mechanisms.
• Fluid volume excess R/T ascites and edema
formation.
• Altered coping skill related to disease.
 Nursing interventions
• Provide comfort measures such as back rubbing
&changing position to relieve pain
• Teach the patient relaxation techniques like deep
breathing
• Provide quiet and calm environment.
• Give analgesics to relieve form pain and fever.
• Evaluate pt’s current activity tolerance and adjust
activity and reduce intensity of task that may cause
undesired physiological changes.
• Help and encourage patients to eat, e. Feed the patient
when fatigue or let someone nearby to help patients.
 Cont…
• Keep head of bed elevated to facilitates breathing by
reducing pressure on the diaphragm
• Restrict intake of caffeine, gas-producing or spicy and
excessively hot or cold foods to aids in reducing gastric
irritation &abdominal discomfort that may impair oral
intake /digestion.
• Protect pt. from bleeding, monitor urine, stool, gums,
skin for signs of bleeding/ bruising
• Teach pt. to use soft toothbrush,avoid constipation
• Administer Vit. K as ordered.
 References
• Garcia-Tsao G, Lim JK; Members of Veterans Affairs
Hepatitis C Resource Center Program. Management
and treatment of patients with cirrhosis and portal
hypertension:
• Garcia-Tsao G. Cirrhosis and its sequelae. In:
Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed.
Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.
• Mehta G, Rothstein KD. Health maintenance issues in
cirrhosis. Med Clin North Am. 2009;93:901-915