Presentation On Cirrhosis of Liver

Cirrhosis of liver
Anatomy of liver
 Largest solid gland and internal organ
in the body.
 Weight - 1 to 2.3 kg.
 Location - in upper part of abdominal

cavity just below the diaphragm.
 occupies - whole of the right

hypochondrium, greater part of
epigastrium with extension in to left
hypochondrium
Four lobes
• Right lobe (largest)

• Left lobe
• Caudate lobe
• Quadrate lobe
Blood supply
• 75% from nutrient rich , oxygen poor portal vein .
• 5% from nutrient poor oxygen rich hepatic artery .
Liver lobule
• Functional unit of liver
• Hexagonal liver lobule made of hepatocytes .
• Each liver lobule surrounded by six portal triads on each
point with lobes central vein in centre.
Physiology of liver
• The liver regulates most chemical levels in the blood and
excretes a product called bile .
• This helps carry away waste products from the liver . All the
blood leaving the stomach and intestines passes through the
liver .
• The liver processes this blood and breaks down , balance , and
creates the nutrients and also metabolized drugs in to forms
that are easier to use for the rest of the body or that are non
toxic .
Some of the more well – known functions includes
the following
• Production of bile , which helps carry away waste and break

down fats in the small intestine during digestion.
• Production of certain proteins for blood plasma .
• Regulation of blood levels of amino acids , which form the

building blocks of proteins.
• Clearance of bilirubin also from red blood cells .if there is an

accumulation of bilirubin , the skin and eyes tuns yellow.
About the disease
Introduction
Liver cirrhosis is the severe scarring of liver and poor liver
function at last stage of chronic liver disease scarring is
most often caused by prolonged exposure is toxins e.g.
alcohol or viral infection , scarring leads to altered liver
functions.
Definition
Cirrhosis is complication of liver disease which involves loss of liver cells
and irreversible scaring of liver cells . It is a chronic disease characterized
by replacement or degenerative changes in normal liver cells . Tissue with
diffuse fibrosis and nodules that disturbs the structure and function of
liver . Also scar formation occurs due to destroyed hepatocytes.
Classification of cirrhosis of liver
1. Post necrotic cirrhosis : due to severe inflammation
and massive necrosis of hepatocytes cells .
2. Alcoholic cirrhosis : it occurs due to excessive intake of

alcohol that leads to accumulation of fat in liver .
3. Biliary cirrhosis : due to biliary obstruction for long time

cholestasis.
4. cardiac cirrhosis : main cause of this type of cirrhosis is

right side congestive heart failure.
stages
Of
Liver
cirrhosis
Causes
• Chronic congestive heart failure .
• Non - alcoholic fatty liver disease.
• Long – term heavy drinking of alcohol
• Chronic viral hepatitis types B ,C and D.
• Haemochromatosis
• wilson’s disease
• Toxic hepatitis
Risk factors
• Too much of alcohol consumption.
• Uncontrolled diet and obese.
• Chronic hepatitis .
Clinical manifestation
Early symptoms due to inflammation :
• Fever
• Pain
• Anorexia
• Fatigue
• Nausea
Others symptoms are :

• Oedema
• Ascites
• hypoalbuminemia
• Abdominal distension
• Yellowish skin
If biliary obstruction :
• Absence of urobilinogen in digestive tract
• Increase serum bilirubin level so appear dark colour of urine .
• Jaundice due to accumulation of bilirubin under skin.
Hormonal disturbances:
• Amenorrhoea
• Loss of body hair
Bleeding disorders :
• Reduce absorption of vit k and reduce synthesis.
Diagnostic test
• Serum examination
Increase SGOT/SGPT level
Increases bilirubin level raised
Low protein level
• Liver function test (LFT)

• Aspirate aminotransferase (AST)
• ALT – alanine transferase
• LDH – lactate dehydrogenase
• USG – (for hepatomegaly )
• WBS (for determination of infection )
• RBC – (in anaemia)
• Liver biopsy
• Abdominal paracentesis
Complication
• Coagulopathies
• Ascites
• Portal hypertension
• peritonitis
pathophysiology
Due to any cause like ( alcohol abuse malnutrition , infection , drugs
or biliary obstruction )
Destruction of hepatocytes
Fibrosis / scar formation
Obstruction of blood flow
Increase pressure in venous and

sinusoidal channels
Fatty infiltration fibrosis / scaring
Portal hypertension
Medical management
• Vitamin and mineral supplements may be necessary , these promote
healing of damaged liver cells and improve nutritional status .
• Potassium – sparing diuretics (spironolactone) may be indicated for

the treatment of fluid retention in the legs (oedema) or abdomen
(ascites).
• Oral antibiotics may be prescribed to prevent or treat infection that

result from poor liver function . Severe infection with ascites will
required intravenous (IV) antibiotics.
• Laxatives (lactulose) to prevent constipation and to
reduce chances of poisonous substances from the bowel
bypassing liver and reaching the brain, causing
drowsiness , confusion and coma.
Dietary management
• Provide high caloric diet and low liquid diet
( 800 – 10000 ml/day )
• In hepatic coma , give low protein and low
sodium diet .
• Provide albumin containing food .
• Vitamin A ,D ,E ,K includes with diet to patient .
Surgical management
Porta - caval shunt (porta caval anastomosis)
A surgical technique in which hepatic portal vein is
joined to inferior vena cava .
Splenorenal shunt ( splenorenal anastomosis)
A surgical technique is which spleen vein is joined
to the left renal vein . ( mostly for treating portal
hyper tension ).
Liver transplantation : ( exchange of liver )

Nursing management
 Assessment of the patient is focuses on the appearance of symptoms
and the history of factors that precipitate the cirrhosis such as long –
term alcohol abuse , dietary intake and changes in the physical and
mental status of the patient .
 Assess and record the history of alcohol use .
 Monitor client for bleeding gums , purpura , Haematuria and

hematemesis .
 Monitor vital signs intake and out put and electrolyte levels to
determine fluid volume status .
 Assess fluid retention.

 The nurses assesses nutritional status by checking daily
weights and monitoring of plasma proteins transferrin and
creatinine levels .
 Assess the patients for presence of esophageal varices ,

stomach irritation or ulceration duodenal ulceration or
bleeding .
 The nurse assesses the patients mental status through the

interview and other interactions with the patient ; orientation
to person to person , place and time is noted .
 Observe closely for signs of behavioural or personality changes

.
Nursing diagnosis
 fluid volume related to compromised regulatory mechanism excess
sodium / fluid intake secondary to cirrhosis of liver as evidenced by
pallor , weight gain weak in appearance , jaundice , abdominal
distention and oedema.
 Impaired skin integrity related to altered circulation metabolic state

secondary to accumulation of bile as evidenced by poor skin turgor
skeletal prominence dry and scaly skin .
 Imbalanced nutrition less than body requirements related to

inadequate diet / digest nutrients , nausea , vomiting as evidenced
by refused to eat , weight loss , poor muscle toon .
 Risk for injury and bleeding related to abnormal
blood profile altered clotting mechanism portal
hypertension development of esophageal varices
 Knowledge deficit related to condition prognosis

treatment self care and discharge needs.
Health education
During hospital stay
 Low sodium diet (to prevent further fluid retention .
 Balance diet
 Avoid raw shellfish
 Do not share needles, razors , tooth brushes , or
other personal items with others .
 Avoid infection
 Maintain personal hygiene .
 Immunization ; influenza, hepatitis A , hepatitis B ,
pneumococcal .
During discharge
 Prevent further damage to liver
 Avoid alcohol
 No acetaminophen , NSAIDs , aspirin .
 Talk to health care provider before taking any
medication (prescription or OTC)
 Practice safe sex
 Use clean needles for tattoos or piercings.
 Take full rest and sleep.
Self evaluation
• When I was working on this presentation ,
learned many things about disease condition, risk
factors, sign & symptoms, complication as well as
treatment .I also learned about classification and
stages of cirrhosis of liver and their
medical ,dietary and surgical management etc.

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Cirrhosis of liver

 Weight - 1 to 2.3 kg.

 Location - in upper part of abdominal

 occupies - whole of the right

• Right lobe (largest)

• Production of bile , which helps carry away waste and break

• Production of certain proteins for blood plasma .

• Regulation of blood levels of amino acids , which form the

• Clearance of bilirubin also from red blood cells .if there is an

2. Alcoholic cirrhosis : it occurs due to excessive intake of

3. Biliary cirrhosis : due to biliary obstruction for long time

4. cardiac cirrhosis : main cause of this type of cirrhosis is

• Uncontrolled diet and obese.

Others symptoms are :

• Liver function test (LFT)

Fibrosis / scar formation

Obstruction of blood flow

Increase pressure in venous and

Fatty infiltration fibrosis / scaring

• Potassium – sparing diuretics (spironolactone) may be indicated for

• Oral antibiotics may be prescribed to prevent or treat infection that

Liver transplantation : ( exchange of liver )

 Assess and record the history of alcohol use .

 Monitor client for bleeding gums , purpura , Haematuria and

 Assess fluid retention.

 Assess the patients for presence of esophageal varices ,

 The nurse assesses the patients mental status through the

 Observe closely for signs of behavioural or personality changes

 Impaired skin integrity related to altered circulation metabolic state

 Imbalanced nutrition less than body requirements related to

 Knowledge deficit related to condition prognosis

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