Transcript uploads/5/1/50hosisx

DEFINITION
Cirrhosis is defined as the histological
development of regenerative nodules
surrounded by fibrous bands in response to
chronic liver injury, which leads to portal
hypertension and end-stage liver disease.
or
Cirrhosis is a diffuse process characterized by
tissue fibrosis and the conversion of normal liver
architecture into structurally abnormal nodules.
(Pinzani et al., 2014).
INCIDENCE
• Cirrhosis is the seventh leading cause of diseaserelated death in the United States. It is the third
most common cause of death in adults between
the ages of 45 and 65. It is twice as common in
men as in women. The disease occurs in more
than half of all malnourished chronic alcoholics,
and kills about 25,000 people a year. In Asia and
Africa, however, most deaths from cirrhosis are
due to chronic hepatitis B.
(Haqqert et al., 2011)
CAUSES
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Alcohol
Hepatitis B
Hepatitis C
Non alcoholic fatty liver disease
RISK FACTORS
• Autoimmune diseases that attack the bile ducts or liver cells
• Severe reactions to prescription drugs
• Prolonged exposure to environmental toxins
• Infections from bacteria and parasites usually found in the tropics
or Asia
• Repeated episodes of heart failure with liver congestion.
• Certain inherited diseases, including:
• Hemochromatosis, in which too much iron builds up in the liver
and other organs
• Wilson's disease, which produces abnormal concentrations of
copper
• Alpha-1-antitrypsin deficiency, which is the absence of a
particular enzyme in the liver
(Pinzani et al., 2011)
SIGN AND SYMPTOMS
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Fatigue
Loss of appetite
Nausea
Weakness
Weight loss
Fluid accumulation in the legs (edema) and abdomen
(ascites)
Increased bleeding and bruising
Jaundice, a yellowing of the skin and eyes
Itching
Confusion
CONT....
• Increased sensitivity to drugs
• Personality and behavioral changes, including confusion,
neglect of appearance, forgetfulness, trouble concentrating
and changes in sleep habits
• Loss of consciousness
• Coma
(Belvoir., 2007)
Diagnostic test for Identifying
cirrhosis
• Physical exam. a cirrhotic liver is enlarged and irregular
instead of smooth.
• Blood tests:
 CBC
 LFT
The following findings are typical in cirrhosis:
 Thrombocytopenia – Low platelet counts
 Aminotransferases - AST (aspartate aminotransferase) and
ALT(Alanine transaminase) are moderately elevated,
with AST > ALT.
 Alkaline phosphatase - slightly elevated
CONT….
 Gamma- glutamyl transferase – correlates with AP levels.
Typically much higher in chronic liver disease from alcohol.
 Bilirubin - Levels normal when compensated but may elevate
as cirrhosis progresses.
 Albumin - levels fall as the synthetic function of the liver
declines with worsening cirrhosis since albumin is exclusively
synthesized in the liver
 Prothrombin time - increases since the liver synthesizes
clotting factors.
 Globulins - increased due to shunting of bacterial antigens
away from the liver to lymphoid tissue.
 Serum sodium - hyponatremia due to inability to excrete
free water resulting from high levels
of ADH and aldosterone.
CONT...
• Other tests.
 CT scan
 Ultrasound
• Biopsy.
A liver biopsy is the definitive test to diagnose
cirrhosis
(Mahl &Grady., 2006)
Special diet for cirrhosis
• A balanced diet.
• Salt restriction if fluid retention is present.
• Diet low in sodium, high carbohydrates and
vitamins
Patient Education:
• Avoid drugs (including alcohol) that cause liver
damage.
• Avoid non-steroidal anti-inflammatory drugs
(NSAIDs, for example, ibuprofen).
(L Dan,F Antony,L carol., 2013)
Expected duration
• Cirrhosis is usually a progressive disease.
Although it usually cannot be reversed, the
liver damage can be halted or slowed down
with treatment or changes in behaviour in
many cases.
Treatment
Life style stages
Stop drinking alcohol. You need to quit completely.
• Talk to your doctor about all of the medicines you take,
including non-prescription drugs such as acetaminophen
(for example, Tylenol), aspirin, ibuprofen (for example,
Advil or Motrin), and naproxen (Aleve). These could
increase the risk of liver damage and bleeding.
• Get immunized (if you have not already) against hepatitis
A and hepatitis B, influenza, and pneumococcus.
• Begin following a low-sodium diet if you have fluid build
up (ascites). Reducing your sodium intake can help
prevent fluid build up in your belly and chest.
Drugs
• Iron supplements, diuretics, and antibiotics may be used for
anemia, fluid retention, and ammonia accumulation
associated with cirrhosis.
• Vasoconstrictors are sometimes needed to stop internal
bleeding and antiemetic may be prescribed to control
nausea.
• Laxatives help the body absorb toxins and accelerate their
removal from the digestive tract.
• Beta blockers may be prescribed to control cirrhosis induced
portal hypertension. Because the diseased liver can no
longer efficiently neutralize harmful substances, medications
must be given with caution. Interferon medicines may be
used by patients with chronic hepatitis B and hepatitis C to
prevent post hepatic cirrhosis.
Surgical management
• Liver transplantation
In this operation ,the diseased liver is
removed and replace with a healthy liver from
an organ donor.
Follow up
• Regular follow ups are required and in severe
cases hospitalization is needed.
Prognosis:
Recovery depends on the cause of your
cirrhosis and whether you are able to remove
or stop the cause. complete recovery is not
possible.
(L Dan,F Antony,L carol., 2013)
Prognosis
• Cirrhosis-related liver damage cannot be reversed, but
further damage can be prevented by patients who:
• eat properly
• get enough rest
• do not consume alcohol
• remain free of infection
• If the underlying cause of cirrhosis cannot be corrected or
removed, scarring will continue. The liver will fail, and the
patient will probably die within five years. Patients who
stop drinking after being diagnosed with cirrhosis can
increase their likelihood of living more than a few years
from 40% up to 70%.
(L Dan,F Antony,L carol., 2013)
NURSING DIAGNOSIS
1.Imbalanced nutrition related to indigestion or
nausea and vomiting.
• Measure dietary intake by calorie count.
• Compare changes in fluid status and weight
history.
• Give small and frequent meals.
• Encourage frequent mouth care.
• Recommend cessation of smoking.
• Monitor laboratory studies like serum glucose
and total proteins.
CONT....
2.Ineffective breathing pattern related to ascites or
accumulated secretions.
• Monitor respiratory rate and depth.
• Keep head of bed elevated because it facilitates the
breathing with reducing pressure on diaphragm.
• Encourage frequent repositioning, deep breathing
exercises and coughing exercises that aids in lung
expansion and removes secretions.
• Monitor temperature and check for chills, coughing
and colour of secretions that are very helpful to check
the infection especially pneumonia.
Conti...
3.Excessive fluid volume related to compromised
regulatory mechanism or excess sodium fluid intake.
• Monitor daily weight and blood pressure.
• Assess respiratory status may be indicative of
pulmonary congestion.
• Monitor for cardiac dysrythmia and auscultation of
heart sounds may be caused by electrolyte imbalance
and heart failure.
• Restrict sodium and fluids as indicated.
• Provide frequent mouth care and encourage bed rest.
TOTAL PARENTERAL NUTRITION
Total Parenteral Nutrition will help mother
and child to get nutrition through vein.
Physicians select the correct amount of
calories and TPN solution. They can also eat
and drink in between the TPN therapy.
(Wimore & Groff., 1999)
GENERAL NURSING CARE
• Check vital signs and determine body weight.
• Monitor laboratory results and abnormal findings
especially electrolytes, proteins and glucose.
• Measure intake and output.
• Monitor temperature changes for possible infection
.Use aseptic techniques while dealing with the client.
• Check blood glucose level periodically.
• Monitor the flow rate of TPN. Start with 60 to 80ml
per hour and increases the rate slowly.
• Refrigerate TPN solution while not in use.
CLIENT TEACHING

Provide emotional support to client and
family before and during TPN therapy
 Instruct the client to notify health care
provider immediately if he is facing any
discomfort.
 Keep client informed about the
effectiveness of TPN.
INDICATIONS
• It is very useful in premature infants with
respiratory distress syndrome.
• Children with diarrhoea.
• Patients with short bowel syndrome and renal
failure.
• Useful in acutely and chronically ill patients.
(Wimore & Groff., 1999)
RISKS
• Infection is a common and major risk in IV infusion.
approximately 15% cases occurs with infections and
death usually results from septic shock.
• Hunger is very common because the patients are
being fed intravenously so the brain usually take
impulses from mouth, stomach and blood regarding
the conscious feeling of hunger.
• Fatty liver and liver failure occurs after a long enough
use. This pathogenesis happens due to more calories.
(Wimore & Groff., 1999)
References
• Haggert, Maureen, Rebecca J. Frey, and Laura Jean Cataldo.
"Cirrhosis." The Gale Encyclopedia of Medicine. Ed. Laurie J.
Fundukian. 4th ed. Vol. 2. Detroit: Gale, 2011. 1031-1035.
Gale Virtual Reference Library. Web. 23 Mar. 2015.
• Longo Dan L ,Fauci Antony S, Langford Carol A. Harrisson’s
gastroenterology and hepatology(2013) 2nd edition
• Thomas Mahl .John O’grady. Fast Facts:Liver
disorders(2006) pages 71 to 79 ,29,39,98 to 100.
• Pinzani, Massimo., Rosselli., Matteo., Zuckermann., Mi
chelle. (2011). Liver cirrhosis. Best Practice & Research,
25.2, 281-90.
CONT....
• http://nurseslabs.com/8-liver-cirrhosisnursing-care-plans/-plans
• http://europepmc.org/abstract/med/6773167
• Wimore,D.W & Groff, D.B.(1999). Total
parenteral nutrition in infants with
catastrophic gastrointestinal anomalies,
Paediatrics Surgical, 181-9.