The document describes liver cirrhosis as a chronic disease resulting from long-term liver injury that causes cell destruction and scarring of the liver tissue, impairing blood flow and leading to hepatic insufficiency. Common causes of cirrhosis include alcohol intake, viral hepatitis, and metabolic diseases. The progression of cirrhosis can cause complications like ascites, jaundice, bleeding, and liver failure as healthy liver tissue is replaced by scar tissue.

1. C-2-5

2.  Liver is a largest gland in body.
 It has 4 lobes; right,left, caudate,and quadrant.
 It is located at right side of the abdomen, inferior to
the diaphragm and anterior to the stomach.
 Functions:
 Carbohydrate, protein and fat metabolism.
 Breakdown of red blood cell.
 Defence against microbes.
 Detoxification of drugs and toxics.
 Inactivation of hormones.
 Secretion of bile.
 Storage.

3.  Livercirrhosis results of long-term injury caused
by variety agents.
 Definition:
A chronic disease that causes cell destruction and
fibrosis(scarring)of hepatic tissue
o Fibrosis alters normal liver structure and
vasculature, impairing blood and lymph
flow, resulting in hepatic insufficiency and
hypertension in the portal vein.
o Progressive and irreversible.

4. Alcohol intake
Obstruction and inflammation of
biliary tract
viral hepatitis
Heart failure (right side)
Metabolic disease

5. Inflamation and destroyed a liver
tissue
Replaced fibrous tissue
There is hyperplasia of Hepatocyte
adjacent to damage area to
compensate for destroyed cell

6. Formation of nodule consisting of hepayocyte
confined within sheets of fibrous tissue
Can cause :
Early- liver enlargement, tendernest pain
in RUQ ,weight loss,fatigue
anorexia,diarrea,constipation
Progress –to ompaire metabolism cause
bleeding, ascites,jaundise
Condition progress portal hypertension
develop, leading to congestion in the organ drained
by the tributanes of the portal vein to ascites and
develop of oesophageal varices

7. Liver failure may occur when hyperplasia
unable to keep pace with the cell destruction
and increase risk liver cancer
Hypertention may acoccur when abnormal
nodule encircled conective tissue
Fibrous connective tissue constrictve

8. Disturb blood and bile flow within liver lobule
Blood no longer flows freely throw the liver to inferior
vena cava
Restrict blood flow lad to portal hypertension ,increase
presssure in the portal venous system

9. Alcoholic cirrhosis
Usually occur after years of drinking too
much.Alcohol may cause swelling and
inflammation in the liver.Also may cause
malnutrition.

10. Biliary cirrhosis
Occur due to obtruction to the flow of bile duct
either within the liver or outside the liver.Primary
biliary cirrhosis is a condition where small and
medium sized bile duct within the liver are
inflamed undergo destruction and scarring.Thus
bile produced by the liver cannnot reach the
intestine lead to accumulation of bile in the
liver,resulting in liver damaged.

11.  Cardiac cirrhosis
Liver dysfunction due to venous congestion
usually cardiac dysfunction for example right
heart failure.When severe and longstanding
hepatic congestive can lead to fibrosis.Increase
pressure in the sublobular branches of the
hepatic vein cause an engorgement of venous
blood being dammed back in the inferior vena
cava and hepatic veins.

12. Posthepatic cirrhoss
Is characterized by scarring following chronic
destructive inflammationof the liver parenchyma
that slowly spreads from the portal regions
throughout the lobe of the portal region.
Metabolic cirrhosis
Associated with metabolic disease such as
hemochromatasis and wilson’s disease.

13.  In early stage, the patient may experience only
vague sign and symptoms , but typically he
complains of abdominal pain, diarrhea, fatigue,
nausea and vomiting.
 Later, as the disease progresses, he may complains
of chronic dyspepsia, constipation, pruritus,(high
serum bilirubin produce) and weight loss. He also
may report may report tendency for easy
bleeding, such as easy bruising and bleeding gum

14. Liver function studies- ALT,AST, alkaline
phosphatase,GGT. All may elevated in
cirrhosis Is characterized by scarring following chronic
Liver biopsy- not necessary for cirrhosis but
destructive inflammationof the liver
parenchyma that slowly spreads from the
can be determine the extent of the nature of
portal regions throughout the lobe and
portal region.
the liver damage.
Esophagascopy – to identify presence of
esophageal varices.

15.  Abdomen ultarsound to evaluate liver size,detect
ascites and liver nodules.
 CBC with platelet count- low RBC,HCT and Hb
demonstrate anemia related to bone marrow
suppression.
-increase RBC destruction causes platelet low due
to spleenomegaly.

16. TREATMENT
Dietary and fluid management
1. Restrict fluid and sodium based on diuretic
therapy, urine output, electrolytes values to
decrease fluid retention in abdomen and prevent
hypernatremia.
2. Consume protein at least 75-100 grams per
day because accumulation of abdomen fluid rich
in protein will lead to hypoalbunemia.
3. Increase carbohydrates intake and consume
moderate amount of fats or administer total
parenteral nutrition due to loss in body weight
resulted from impaired metabolism.

17.  4.Increase intake of vitamin and mineral
supplements. For examples, vitamin
A, B, D, E, K and Mg due to the failure of
liver to store vitamins and lost of these
vitamins and minerals resulted from diarrhea.

18. Complication management
 1. Perform paracentesis to remove fluid form the
abdomen thus prevent ascites and associated
respiratory distress. It is able to remove 5 or more
liters of fluid.
 2. For bleeding esophageal varices:
 Perform blood transfusion, fresh frozen plasma
transfusion, infuse fluids to restore hemodynamic
stability after a severe bleeding.
 Administer vasoconstrictive medications such as
somatotastin, octreotide and vasopressin to control
bleeding.
 Perform upper endoscopy such as variceal ligation or
endoscopic sclerosis to treat varices with banding.

19.  Perform ballon tamponade if bleeding not
controlled or endoscopy unavailable as short term
measure to control bleeding.
3. Perform insertion of transjugular intrahepatic
portosystmic shunt ( TIPS ):
 Using a stent to channel blood between portal and
hepatic vein and bypassing liver due to
obstruction of blood through liver.
 It is a short term measure to control portal
hypertension

20. Surgery
Liver transplant indicated when:
 Bilirubin increases
 Albumin level decreases
 Problems with complication increases and
patient responds poorly to treatment
 Contraindicated in maglinant
case, alcohol or drugs abused case.

21.  Diuretics
-Can be given to cirrhosis patients who are also
affected by ascites and edema. The diuretics work to
remove extra fluids from the body.
-example:-furosemide(lasix)
 Beta-Blockers
-Doctors may recommend beta-blockers to reduce or
eliminate bleeding in the gastrointestinal tract
-Prevent esophageal from rebleeding
-example:-beta blocker nadolol(corgard) with
isosorbide mononitrate

22. Liver Cirrhosis

23. Activity intolerance related to fatigue, general debility and
discomfort.
1) Assess the condition and ability of patient to perform work to
plan next nursing intervention.
2) Encourage alternating periods of rest and ambulation to promote
rest and avoids patient fatigue.
3) Elevate the leg with pillow to mobilize edema and ascites
4) Encourage and assist patient with gradually increasing periods of
exercise to avoid patient fall and fatigue.
5) Put the call bell and cardiac table near to patient’s bed so that
patient able can get the things easily.

24. Altered nutrition: Less than body requirements related
to anorexia and GI disturbances
1) Assess nutrition level of the patient from intake and output
chart to perform next intervention.
2) Encourage patient to eat high calorie, moderate protein meal
due to impaired protein metabolism.
3) Suggest small, frequent feeding and attractive meal to increase
patient’s appetite.
4) Encourage oral hygiene before meal to increase patient’s
appetite.
5) Administration of medication antiemetic such as maxalon as
doctor order to prevent nausea and vomiting.
6) Daily weight the patient with same weighing scale, same cloth,
same time to identify the effectiveness of the treatment.
7) Provide IV therapy such as total parental nutrition (TPN) as
doctor prescribed to maintain the nutrition need the by
patient.

25. Impaired skin integrity related edema, jaundice and
compromised immunologic status.
1)Note and record degree of jaundice of skin and sclerae and
scratches on the body so that next intervention can be
planned.
2)Encourage frequent skin care, bathing without soap and
massage with lotion to moisture the skin
3)Advise patient to keep fingernails short to prevent injury to
the skin.
4)Perform any procedure gently to prevent the skin from
injury.
5)Elevate the leg to reduce the edema and promote venous
return.

26. 1)Observe
Risk for injury related to altered clotting mechanisms
1)Observe stool and emesis about colour, consistency, amount and
test each one for occult blood.
2)Be alert for symptoms of anxiety, epigastric
fullness, weakness, restless which may indicate GI bleeding.
3)Observe for internal bleeding such as
eechymosis,epistaxis,petechiae and bleeding gums.
4)Stay with patient and give pressure at the bleeding sites during
episodes of bleeding to stop the bleeding.
5)Institute and teach measures to prevent trauma such as maintain
safe environment,gentle blowing of nose and use soft tooth brush
to prevent bleeding from occur.
6)Administer vit K(Aqua Mephyton) as doctor prescribed to
increase clotting factor.

27. Altered thought process related to deterioration of liver
function and increased serum ammonia
1)Restrict high protein load while serum ammonia is high to
prevent hepatic encephalopathy
2)Monitor ammonia level by the urine test to know the
effectiveness of treatment
3)Protect from sepsis through good hand ashing and
management from infection because the liver cannot
function well.
4)Monitor fluid intake and output and serum electrolyte level
to prevent dehydration and hypokalemia may occur with the
use of diuretics which may precipitate hepatic coma