Cirrhosis or Liver Cirrhosis is the occurrence of scar tissue, nodulations and fibrosis of the liver. It is a chronic, progressive, and irreversible disorder of the liver. Cirrhosis is commonly caused by chronic infection with Hepatitis B and C, obstructed bile flow, and alcohol (toxins or hepatotoxic drug).

Pathophysiology of Liver Cirrhosis

With underlying causes, an increase in triglyceride or fatty acid production occurs. This can lead to fatty liver and the development of fibrosis and nodulation of the liver. With the formation of fibrosis and nodulations, cirrhosis occurs.

Signs and Symptoms of Liver Cirrhosis

  1. Gastritis – Due to the engorged vein in the gastrointestinal tract. It impairs the bile synthesis and fat metabolism.
  2. Anemia, Leukopenia – Destruction of the blood cells by the enlarged spleen.
  3. Asterixis or Hepatic Encephalopathy – Asterixis is the flapping or tremors of the hand when the arm is extended. It is due to the increase in ammonia absorption and increased in neurotoxins in the blood.
  4. Malnutrition or Muscle-wasting – It is due to the impaired fat or nutrient metabolism.
  5. Bleeding or Bruising – Impaired vitamin K synthesis. There is decreased platelets due to the destruction by the enlarged spleen.
  6. Jaundice – Due to impaired bilirubin metabolism and excretion.
  7. Edema, Ascites
  8. Esophageal varices
  9. Gynecomastia, Impotence, and Infertility – It is due to altered sex hormone metabolism.

Complications of Cirrhosis

Hepatic Encephalopathy

An increase in proteins would increase ammonia in the blood and is neurotoxic.

Signs and Symptoms of Hepatic Encephalopathy
  1. Asterixis
  2. Changes in personality and mentation
  3. Agitation, Confusion, Drowsiness
  4. Slurred speech
  5. Deep coma (Last stage)
Management of Hepatic Encephalopathy
  • Low protein diet to decrease ammonia formation.
  • Medications like lactulose and neomycin.
  • Administer enema.
  • Increase acidity of colonic contents.
  • Decrease ammonia formation.

Esophageal Varices

Engorgement of esophageal veins can lead to rupture and hemorrhage.

Management of Esophageal Varices
  1. Lavage with normal saline solution
  2. Endoscopy for ligation
  3. Medications like Somatostatin, Octreotide, and Vasopressin
  4. Inject vitamin K
  5. Balloon tamponade

Hepatorenal Syndrome

Acute Renal Failure, Oliguria, and Hypotension may occur.

Management for Hepatorenal Syndrome

Same with management for Acute Renal Failure.

Hemorrhoids

Vasodilation of rectal veins.

Signs and Symptoms of Hemorrhoids
  1. Pain
  2. Rectal bleeding
  3. Feeling of rectal fullness
Diagnostic Exam for Hemorrhoids
  1. Liver Function Test
    • Alanine Amino Transferase (ALT)
    • Aspartate Amino Transferase (AST)
    • Alkaline Phosphatase
    • Gamma Glutamic Transferase
  2. Prolonged Prothrombin Time
  3. Increased Serum Biliburin
  4. Abdominal Ultrasound
  5. CT Scan
  6. Esophagoscopy
  7. Liver Biopsy (Confirmatory)
Management for Hemorrhoids
  1. Diuretics like Spironolactone
  2. Lactulose and Neomycin
  3. Nadolol
  4. Oxazepam
  5. Ferrous Sulfate
  6. Vitamin K

Nursing Diagnosis for Liver Cirrhosis

Excess Fluid Volume

  1. Assess weight, abdominal girth, central venous pressure, and input/output.
  2. Decrease fluid intake

Disturbed Thought Process

  1. Assess levels of consciousness and neurologic status
  2. Decrease protein diet

Ineffective Protection related to Decreased Coagulation Factor, Vitamin K, and Platelets

  1. Monitor for signs of bleeding
  2. Inject vitamin K when needed

Imbalanced Nutrition: Less Than Body Requirements

  1. Increase caloric intake: Increase Carbohydrate and fiber/roughage. Decrease Protein and Sodium.