CIRRHOSIS OF LIVER

Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to
chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of
blood through the liver. Scarring also impairs the liver’s ability to -
• control infections
• remove bacteria and toxins from the blood
• process nutrients, hormones, and drugs
• make proteins that regulate blood clotting
• produce bile to help absorb fats—including cholesterol—and
fat-soluble vitamins
TYPES:
a) Cirrhosis of known aetiology

b) Cirrhosis of unknown aetiology

-Laennec’s cirrhosis or portal cirrhosis. It is due to
alcoholism.

CAUSES:
1. Chronic viral hepatitis
2. Biliary cirrhosis
3. Bacterial infection
4. Congenital intrahepatic obstruction of the biliary tree
5. Prolonged exposure to unknown toxic agents e.g., some herbal
medicines.

PATHOPHYSIOLOGY
Hepatocyte injury with necrosis, fibrosis, regeneration and
eventual degeneration
↓
The diminished parenchymal cell mass causes regeneration of
tissue with nodular areas of proliferating
hepatocytes
↓
Hepatocytes respond to injury with deposition of collagen that
forms fibrous connective tissue
↓
 This scar tissue and nodular areas of regeneration impair the
intrahepatic blood flow
↓
Ongoing necrosis
↓
Failure of hepatocellular function and portal
hypertension occur
↓
Ascites, severe cholestasis, encephalopathy (hepatic coma)
and GI bleeding

CLINICAL MANIFESTATIONS:
1. Jaundice
2. Anorexia
3. Muscle weakness
4. Poor growth
5. Fatigue
6. Nausea
7. Vomiting
8. Weight loss
9. Abdominal pain
10.Ascites and oedema
11.Gastrointestinal bleeding
12.Anaemia.
13.Dyspnoea and cyanosis may occur especially on exertion.
14.Itching
15.Spiderlike blood vessels on the skin

DIAGNOSTIC EVALUATION

The diagnosis of cirrhosis is based on-

1. The history, especially in regard to prior liver disease,

such as hepatitis
 2. On physical examination, hepatosplenomegaly will be
revealed or a sudden decrease in liver size.
3. Laboratory evaluation, especially liver function tests, such
as bilirubin and aminotransferases, ammonia, albumin,
cholesterol and prothombin time
4. Liver biopsy for characteristic changes.
Doppler ultrasonography of the liver and spleen is
useful to confirm ascites, to evaluate the blood flow
through the liver and spleen, and to determine the
patency and size of the portal vein if liver transplantation
is considered.

THERAPEUTIC MANAGEMENT:
– Liver transplantation has improved the prognosis
substantially for many children with cirrhosis.
– Nutritional support is an important therapy for children
with cirrhosis and malnutrition. Supplements of fat-soluble
vitamins are often required, and mineral supplements may
be indicated. In some instances nutritional in the form of
continuous tube feedings or parenteral nutrition may be
necessary.
– Acute haemorrhage is managed with intravenous fluids,
and vasopressin
– Ascites can be managed by sodium restriction and
diuretics.
– Administering drugs like neomycin and lactulose to limit
the formation and absorption of ammonia which is an
endogenous toxin.

NURSING PROCESS:

Assessment:

Obtain complete history about the patient. In addition evaluate

the patient’s condition by performing a physical examination.
Pay special attention to the patient’s ventilation, abdominal
size, weight, the presence or absence of jaundice and other
symptoms of the liver disease. Maintain and analyze food
intake and fluid record.

1. Diagnosis: Ineffective breathing related to ascites, liver

enlargement.

Nursing intervention:

a) Assist the client to a Fowler’s position.

b) Provide supplemental oxygen if ordered.
c) Observe for increased respiratory distress when the
client is asleep

1. Diagnosis: pain related to pressure on abdominal organs

and tissue damage
Nursing intervention:
a) Administer prescribed analgesics.
b) Position the child in a way that will relieve pressure

1. Diagnosis: Altered nutrition less than body requirements

related to anorexia.
Nursing intervention:
a) Provide small frequent diet
b) In case of nausea and vomiting, tube feeding may be
given.
c) Restrict salt intake
d) Give supplementary vitamins B, C and K. Restrict the
dietary proteins to reduce the blood ammonia level.
e) Maintain intake and output

2. Diagnosis: fluid volume deficit related to bleeding and

vomiting

Nursing intervention:

a) Provide oral liquids within the fluid restrictions

b) Regulate and maintain intravenous fluid infusions at
the prescribed rate.
 c) Blood transfusion is given in case of haematemesis.

1. Diagnosis: fluid volume excess related to oedema, ascitis

Nursing intervention

a) Administer prescribed diuretics

b) Salt restricted diet.

1. Diagnosis: impaired skin integrity related to pruritus.

Nursing intervention:
a) If pruritus exists, avoid drying types of soaps for
bathing.
b) Control pruritus by applying calamine lotion

1. Diagnosis: Anxiety related to symptoms, diagnosis

Nursing intervention:
a) Tell the parents about the plan for treatment and the
routine of care.
b) Provide emotional support to the child and parents.
c) Allow the parents to participate in the care of child.
 TEACHING
PRACTICE
ON
CIRRHOSIS OF
LIVER

SUBMITTED BY:

INDAMANBHA CHYNE

M.Sc. NURSING 1ST YEAR

CHILD HEALTH NURSING

P.I.O.N.

SUBMITTED TO

Mrs. BHIMA UMA MAHESHWARI

HOD

CHILD HEALTH NURSING

P.I.O.N.
SUBMITTED ON: 22/10/09