OUTLINES:

1-Introduction2-Definition

3-Causes4-Signs and Symptoms

5-Complications6-Nursing Care Plan

* Assessment* Intervention

* Health Teaching7-Summary

8-References

Introduction:The liver weighs about 3 pounds and is the largest solid organ in the body. It performs many important functions, such as:

-Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function

-Storing excess nutrients and returning some of the nutrients to the bloodstream

-Manufacturing bile, a substance needed to help digest food

-Helping the body store sugar (glucose) in the form of glycogen

-Ridding the body of harmful substances in the bloodstream, including drugs and alcohol

-Breaking down saturated fat and producing cholesterol

Definition:

Is a chronic disease characterized by scaring and necrotic tissue replaced by fibrotic tissue . Resulting in hepatic insufficiency and portal hypertension

Causes:Cirrhosis is caused by scar tissue that forms in your liver in response to damage occurring over many years. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As the scar tissue builds up, liver function worsens. In advanced cirrhosis, the liver no longer works very well.Some of the causes of cirrhosis are inherited or thought to be inherited:

-Iron buildup in the body (hemochromatosis)-Cystic fibrosis

-Copper accumulated in the liver (Wilson's disease)-Poorly formed bile ducts (biliary atresia)

-Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)

-Genetic digestive disorder (Alagille syndrome)-Liver disease caused by your body's immune system

(autoimmune hepatitis)

Causes (Cont):Others occur later in life:

-Chronic alcohol abuse-Hepatitis C-Hepatitis B

-Fat accumulating in the liver (nonalcoholic fatty liver disease)

-Destruction of the bile ducts (primary biliary cirrhosis)

-Hardening and scarring of the bile ducts (primary sclerosing cholangitis)

-Infection by a parasite common in developing countries

(schistosomiasis)

Some people may have more than one cause for cirrhosis, such as alcohol abuse and viral hepatitis. If doctors cannot find a cause for your condition, it's called cryptogenic cirrhosis. Up to 20 percent of people with cirrhosis have cryptogenic cirrhosis.

Signs & Symptoms :Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

-Fatigue-Bleeding easily

-Bruising easily-Itchy skin

-Yellow discoloration in the skin and eyes (jaundice)

-Fluid accumulation in your abdomen (ascites)

-Loss of appetite-Nausea

-Swelling in your legs-Weight loss

-Confusion, drowsiness and slurred speech (hepatic encephalopathy)

-Spider-like blood vessels on your skin

Complications:

Complications related to blood flow:

1-High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.

2-Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.

3-Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis .

4-Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra load, these smaller veins can burst, causing serious bleeding. High blood pressure also may cause enlarged veins (varices) and lead to life-threatening bleeding in the esophagus (esophageal varices) or the stomach (gastric varices). If the liver can't make enough clotting factors, this also can contribute to continued bleeding.

Complications (Cont):

Other complications:1-Infections. If you have cirrhosis, your body may have

difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.

2-Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.

3-Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.

4-Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.

5-Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.

Assessment

Interventions

Health Teaching

Assessment:Obtain history of chief 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

Interventions:Stop alcohol and toxic drugs Correct nutritional status by vitamins, nutritional supplements high calorie and low protein Treat ascities 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 duresis 4-duretic therapy like spirolactone

Interventions (Cont):Treatment of other problems associated with liver failure such as anti emetic , lactulose, and streptomycin for hepatic encephalopathySclero therapy and singes taken tube for esophageal varices Liver transplantation (By Doctor)If patient in a late stage , identify those patient at risk because they are more liable for infections , bleeding than others

Health Teaching:Drink alcohol in moderation, if at all.

Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.

Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.

Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.

Summary:

Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis

is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar

tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-

threatening.

References:1-http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/

2-http://www.slideshare.org/clinical-cirrhosis/