- Chronic, progressive disease characterized by inflammation, fibrosis, and degeneration of the liver cells
- Destroyed liver cells are replaced by scar tissues resulting to malfunction of liver
- Occurs more in men than women. Ages 40-60
- Types:
- Laenec’s cirrhosis – alcohol and malnuttrition
- Post necrotic – viral hepatitis
- Post billary obstruction- bile reflux
- Clinical manifestation
- Fatigue, anorexia, n&v, indigestion, weight loss, flatulence
- Hepatomegaly, pain in RUQ, hard nodular liver
- Increase abdominal girth:ascites,
- Changes in mood, alertness and mental ability
- Gynecomastia, decrease pubic hair in males
- Amenorrhea in females
- Jaundice
- Easy bruising and bleeding
- 
Muscle atrophy
- Anemia
- Asterixis – liver flap. Primary concern
- Hypercholesterolemia
- Palmar erythema
- Pruritus – deposition of bile salts in the skin
- Portal hypertesion resulting to esophageal varices
- Caput medusa – dilated abdominal veins due to congestion of superficial vein shunting to umbilical area
- Diagnostics:
- AST, ALT, LDH, Bilirubin – increase
- Urobilirubin in the urine
- Prolonged PT
- Decrease serum albumin, fibrinogen, platelets
- Cholangiopancreatography reveals common bile duct obstruction
- Biopsy confirms cirrrhosis
- Ultrasound shows liver damage
- Management
- Potassium sparing diuretics
- Salt poor albumin to restore plasma volume
- Vitamin K to bring Prothrombin time close to normal
- Vitamin B complex
- Lactulose to decrease serum ammonia level and improve encephalopathy
- Propanolol to decrease portal pressure in cases of esophageal varices
- Antiemetics but cautious in usage for it requires liver for dtoxification
- Paracentesis for pt with ascites
- Leveen shunt for ascites
- Sengstaken- blakemore tube for esophageal verices
- Nursing management:
- Encourage small frequent meal
- Low Na for ascites
- High calorie, low fat, low protein diet
- ADEK and folic acid supplements
- Prevent infection- use electronic razors
- Prevent bleeding and assess for esophageal varices
- Administer diuretics
- Measure abdominal girth daily
- Avoidance of alcohol
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