1. GI: Cirrhosis
Marnie Quick, RN, MSN, CNRN

2. Normal Liver

5. Label:

6. Answers from previous slide
 A. Liver
 B. Hepatic vein- blood from liver
 C. Hepatic artery- oxygenated blood to liver
 D. Portal vein- partly O2 blood to liver
 E. Common bile duct
 F. Stomach
 G. Cystic duct
 H. Gallbladder

7. Liver

8.  Symptoms of liver
failure appear when
80% liver destroyed
 Liver can regenerate
itself if adequate
nutrition and no
alcohol

9. Liver functions
 1. Metabolic functions
 CHO- liver removes glucose from blood, stores it as
glycogen, breaks it down to release glucose PRN
 Protein- converts ammonia to urea**
 Protein (food/blood) is 1st
broken down by bacteria in GI to
form ammonia. Ammonia to liver which converts to urea.
 Fat- ketogenesis. (see next slide- bile)
 Steriod- aldosterone metabolism (liver damage= inc
levels aldosterone causing Na & H2O retention)

10. 2. Bile synthesis & secretion-
Bile aids digestion/absorption fats in small intestine.
Indirect bilirubin broken down & excreted stool
3. Storage- Vitamin A, all B’s, D, E, and K
4. Regulates blood coagulation**-Forms prothrombin,
fibrinogen, heparin
If decrease Vit K & fibrinogen= increase fibrinolysis, &
decrease platelets> hemorrhage
5. Detoxification** -Rids body of endogenous waste- drugs,
bacteria, etc
6. Heat production
7. Phagocyte action- breakdown old RBC, WBC, bacteria

12. Cirrhosis of the liver:
Etiology/pathophysiology
 End stage of chronic liver disease
 Functional liver tissue destroyed and replaced by
fibrous scar tissue
 Metabolic functions are lost; blood and bile flow
in liver is disrupted, portal hypertension develops
 Types: Alcoholic/nutritional (common); biliary
(chronic biliary obstruction); postnecrotic
(hepatitis B or C; toxic substances); cardiac

14. Stages of alcohol-induced liver damage

15. Cirrhosis

16. Alcoholic/nutritional cirrhosis
 Most common cause of cirrhosis with resultant
lack of nutrition
 Stage 1: metabolic changes affect fatty
metabolism, fat accumulates in liver. In this stage
abstinence from alcohol could allow liver to heal
 Stage 2: With continued use of alcohol,
inflammatory cells infiltrate the liver causing
necrosis, fibrosis and destruction of liver
 Stage 3: regenerative nodules form- liver shrinks

18. Cirrhosis of liver: Complication & treatment
Portal hypertension
 Fibrous connective tissue in liver disrupt blood
and bile flow. Portal and hepatic veins become
compressed.
 With backup of blood have acites, splenomegaly,
peripheral edema, increase blood cell destruction-
anemia, low WBC and low platelets
 Treatment: medication to control hypertension,
diuretics to decrease fluid retention/acites and
TIPS procedure to increase blood flow

19. TIPS procedure- Note shunt that will divert
blood- relieving hypertension & esophegeal
varcies

20. Cirrhosis: complication & treatment
Esophageal varices
 As a result of portal hypertension, veins in
esophagus, rectum and abdomen become
engorged/congested resulting in esophageal and
gastric varices (major concern- can bleed out)
 60% esophageal varices occur with cirrhosis
 Treat-
 Medications: vasopressin (control bleeding), beta
blockers (prevent bleeding), blood replace, Vit K
 Surgery: shunt (TIPS), ligation varices, banding
 Sengstaken-Blakemeore tube (tamponade bleeding)

22. Esophageal varices

23. Sengstaken Blackmore tube:
Inflate gastric balloon; Esophageal balloon; and third one to
aspirate stomach

25. Cirrhosis: Complications and treatment
Splenomegaly, acites and peripheral edema
 Spleen enlarges from blood shunted from portal
hypertension. Blood cells destroyed
 As liver impairment of synthesis of albumin
occurs have accumulation plasma-rich fluid in
abd cavity- ascites (abd distention & wt gain)
 Treat ascites- diuretics (aldactone), paracentesis,
diet (hi CHO, low fat, low Na

26. Ascites with dilated veins

27. Ascites

28. Cirrhosis: Complications & treatment
Hepatic encephalopathy
 Protein (from food or blood in GI) is broken
down (with the aid of bacteria) in GI to ammonia
 Liver then converts ammonia to urea and is
excreted by kidneys
 With liver failure have accumulation of ammonia
in blood. Ammonia then enters brain and
interferes with function of brain- encephalopathy

29. Hepatic encephalopathy-- continued
 Stages: 1. personality changes, irritability
2. hyperreflexia (liver flap-asterixis) violent/abusive
behavior 3. coma
 Treat:
 Enemas decrease ammonia absorption
 Lactulose- a laxative that decreases ammonia by
decreasing the bacteria in bowel that normally
converts protein to ammonia. Causes 3-4 stools/day
 Neomycin- intestinal antiseptic to decrease bacteria
 Decrease protein intake

30. Asterixis- liver flap

31. Liver Failure

33. Cirrhosis:
Therapeutic intervention
 Diagnostic tests-
 Liver function test ALT, AST- not as high as
hepatitis;
 CBC platelets (anemia, thrombocytopenia)
 Coagulation studies (lack Vit K- prolonged PT)
 Bilirubin (elevated); ammonia (elevated)
 Serum albumin (hypoalbuminemia)
 Abdominal ultrasound (liver size/nodular, ascitis)
 Esophagoscopy- varices
 Liver biopsy(p 590) not done if bleeding time
elevated

34. Liver biopsy

35. Cirrhosis
Therapeutic Interventions cont
 Medications:
 Avoid *drugs metabolized by the liver and drugs toxic to liver-
sedatives, hynotics, actaminophen, and alcohol.
 Diuretics to reduce ascites
 Lactulose (laxative) and neomycin (antibiotic) to dec ammonia-
hepatic encephalopathy
 Vit K to reduce risk bleeding
 Beta-blockers to prevent esophegeal varices from rebleeding
 Ferrous sulfate and folic acid to treat anemia
 Antacids decrease acute gastritis

36. Cirrhosis:
Therapeutic interventions cont
 Dietary and fluid
 Restricted fluid/Na intake based on response to
diuretic therapy, urine output and electrolyte values
 Hi calories; Hi CHO; low fat
 Surgery
 Surgery to treat complications
 Liver transplant (Lewis p 1087)

37. Liver transplant

38. Cirrhosis:
Nursing Assessment specific to Cirrhosis
 Health history
 Current symptoms, altered bowel; excess bleeding;
abdominal distention; jaundice; pruritus; history liver
or gallbladder disease; alchohol history
 Physical assessment
 VS; mental status, color skin; peripheral pulses and
edema; abd assessment; bowel sounds; abd girth;
tenderness and liver size

39. Cirrhosis:
Pertinent Nursing problems/Care
 Health promotion
 Patient family teaching guides
 Acute intervention
 Ambulatory home care
 Imbalance nutrition less than body reequirements
 Dysfunctional family process: alcoholism
 Excess fluid volume
 Potential complication: hemorrhage; hepatic
encephalopathy