- Is a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissue.
- Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein.
- Complications include hyponatremia, water retention, bleeding esophageal varices, coagulopathy, spontaneous bacterial peritonitis, and hepatic encephalopathy.
Three major forms:
1. Laennec’s (alcohol induced) Cirrhosis
- Fibrosis occurs mainly around central veins and portal areas.
- This is the most common form of cirrhosis and results from chronic alcoholism and malnutrition.
2. Postnecrotic (micronodular) Cirrhosis
- Consist of broad bands of scar tissue and results from previous acute viral hepatitis or drug-induced massive hepatic necrosis.
3. Biliary Cirrhosis
- Consist of Scarring of bile ducts and lobes of the liver and results from chronic biliary obstruction and infection (cholangitis), and is much rarer than the preceding forms.
- Early complaints including fatigue, anorexia, edema of the ankles in the evening, epistaxis, bleeding gums, and weight loss.
- In later disease:
- Chronic dyspepsia, constipation and diarrhea.
- Esophageal varices; dilated cutaneous veins around umbilicus (caput medusa); internal hemorrhoids, ascites, splenomegaly.
- Fatigue, weakness, and wasting caused by anemia and poor nutrition.
- Deterioration of mental function.
- Estrogen-androgen imbalance causing spider angioma and palmar erythema; menstrual irregularities in women; testicular and prostatic atrophy, gynecomastia, loss of libido, and impotence in men.
- Bleeding tendencies and hemorrhage.
- Enlarged, nodular liver.
- Elevated serum liver enzyme levels, reduced serum albumin.
- Liver biopsy detects cell destruction and fibrosis of hepatic disease.
- Liver scan shows abnormal thickening and a liver mass.
- CT scan determines the size of the liver and its irregular nodular surface.
- Esophagoscopy determines the presence of esophageal varices.
- Percutaneous transhepatic cholangiography differentiates extrahepatic from intrahepatic obstructive jaundice.
- Paracentesis examines ascitic fluid for cell, protein, and bacteria counts.
- Provide asymptomatic relief measures such as pain medications and antiemetics.
- Diuretic therapy, frequently with spironolactone, a potassium-sparing diuretic that inhibits the action of aldosteroe on the kidneys.
- I.V albumin to maintain osmotic pressure and reduce ascites.
- Administration of lactulose or neomycin through a nasogastric tube or retention enema to reduce ammonia levels during periods of hepatic encephalopathy.
- Transjugular intrahepatic portosystemic shunt may be performed in patients whose ascites prove resistant. This percutaneous procedure creates a shunt from the portal to systemic cisculation to reduce portal pressure and relieve ascites.
- Orthotopic liver transplantation may be necessary.
- Observe stools and emesis for color, consistency, and amount, and test each one for occult blood.
- Monitor fluid intake and output and serum electrolyte levels to prevent dehydration and hypokalemia, which may precipitate hepatic encephalopathy.
- Maintain some periods of rest with legs elevated to mobilize edema and ascites. Alternate rest periods with ambulation.
- Encourage and assist with gradually increasing periods of exercise.
- Encourage the patient to eat high-calorie, moderate protein meals and supplementary feedings. Suggest small, frequent feedings.
- Encourage oral hygiene before meals.
- Administer or teach self-administration of medications for nausea, vomiting, diarrhea or constipation.
- Encourage frequent skin care, bathing with soap, and massage with emollient lotions.
- Keep the patient’s finger nails short to prevent scratching from pruritus.
- Keep the patient quiet and limit activity if signs of bleeding are evident.
- Encourage the patient to eat foods high vitamin C content.
- Use small gauge needles for injections and maintain pressure over injection site until bleeding stops.
- Protect from sepsis through good handwashing and prompt recognition and management of infection.
- Pad side rails and provide careful nursing surveillance to ensure the patient’s safety.
- Stress the importance of giving up alcohol completely.
- Involve the person closest to the patient, because recovery usually is not easy and relapses are common.