Definition

Is a chronic disease characterized by

scaring and necrotic tissue replaced
by fibrotic tissue . Resulting in
hepatic insufficiency and portal
hypertension

Causes
Chronic alcoholism
Bilharzias
Mal nutrition
Viral hepatitis
Toxic drugs
Chronic biliary obstruction

Pathophysiology
When normal liver cells replaced by
fibrous cells ,normal liver structure and
function altered resulting in portal hyper
tension , a cities ,esophageal varices and
hepatic encephalopathy
The progress of liver cirrhosis is slowly ,
for that reason P may come late with
complication of liver cirrhosis

Clinical feature
Onset slowly may take years
Early complain include fatigue , anorexia ,
edema, epistaxis , gums bleeding, jaundice
and weight loss
Later complains occurs due to chronic
failure of the liver and obstruction of portal
circulation which include constipation,
esophageal varices , ascites , splenomegaly,
pancytopenia , low albumin, DLOC and
bleeding

Diagnostic test
LFT , liver scan
Liver biopsy to detect destruction and
fibrosis of liver tissue
Abd U\S ,
Esophagoscopy to assess varices
Paracentesis to examine ascitic fluid
CBC and electrolyte

Management
Stop alcohol and toxic drugs
Correct nutritional status by vitamins,
nutritional supplements high calorie and
low protein
Treat ascites and fluid over load by the
following
1-dialy weight and assess abd girth
2- restrict sodium and water intake
3-bed rest to aid diuresis
4-duretic therapy like Spiro lactone

Con=4-abdominal paracentesis
5- administer albumin to maintain osmotic
pressure
Treatment of other problems associated
with liver failure such as anti emetic ,
lactulose, and streptomycin for hepatic
encephalopathy
Sclerotherapy and singestaken tube for
esophageal varices
Liver transplantation

Complication
Hyponatremia and water
retention
Bleeding
Esophageal varices
Co- agulapatheis
Hepatic failure
Hepatic encephalopathy
Portal hypertension
Ascetics

Nursing care for P with

Obtain history of
L chief
C complains
and risk factors
Perform abdominal examination
and assessing for ascities
Assess for bleeding
Assess weight and abdominal girth
daily
Assess mental status
Assess fluid and nutritional status
Assess P knowledge

Nursing diagnosis
Activity intolerance R\L to disease
process and low energy
Goal =- promoting activity tolerance
N-implementation=Assess activity tolerance
Provide high caloric diet
Bed rest and assist patient in daily
activity
Administer vitamin supplements
Reassess activity tolerance

Altered nutrition less than body

requirement R\L to anorexia and GIT
disturbance
Goal =- improving nutritional status
Impaired skin integrity R\L to
edema and jaundice
Goal =- maintaining skin integrity
Risk for bleeding R\L to altered
clotting mechanism
Goal=- prevent bleeding

Impaired level of consciousness R\L

to deterioration of liver function
and increase serum ammonia
Goal =- improve level of
consciousness
Risk for infection R\L to low
immune
Risk for collaborative problems or
complication such as ..
Knowledge deficit R\L to disease ,
drugs, complication and follow up