CIRRHOSIS OF LIVER

                                 CIRRHOSIS OF LIVER

What is liver cirrhosis?

It is repeated destruction of hepatic cells causing formation of scar tissues.

Definition:

A chronic progressive disease of liver characterized by diffused damage to cells with fibrosis & nodular regeneration.

Etiology & Risk factors:

• Alcohol consumption
• Hepatits C
• Exposure to drugs or toxins
• Steatohepatitis
• Autoimmune hepatitis
• Cystic fibrosis
• Metabolic disorders 
• Genetic causes
• Biliary disease
• Primary hemochromatosid
• Cryptogenic cirrhosis
• Vascular abnormalities
• Primary sclerosing cholangitis

Types:

Alcoholic Cirrhosis: Scar tissue characteristically surrounds the portal area.

Post necrotic Cirrhosis: There are broad scar tissue bands due to late results of acute viral hepatitis, postinfection with industrial chemicals.

Biliary Cirrhosis: Scaring occurs around bile duct in liver, results from Chronic biliary obstruction & infection.

Cardiac Cirrhosis: Associated with long term right sided heart failure.

Classification:

Micronodular Cirrhosis: Small nodules generally uniform & less than 3 mm & is associated with:

• Alcoholic hepatitis
• Haemochromatosis
• Drugs
• Chronic biliary disease

Macronodular Cirrhosis: Nodules are larger than 3 mm. these are associated with:

• Chronic viral hepatitis
• Autoimmune
• Long duration of any of etiological factors

Mixed: Nodularity with variably sized nodules.

Pathophysiology:

Hepatocytes are injured due to etiological factors secret paracrine factors & activate stellatate cells & loose vitamin A & proliferate resulting in collagen production causing fubrosis & scar tissue & compress the central vein.

Sign & Symptoms:

• Initially asymptomatic
• Weakness
• Muscle cramps
• Weight loss
• Anorexia
• Nausea & vomiting
• Ascites
• Pale, clay colored stool
• Abdominal pain
• Portal hypertension
• Pruritis
• Ecchymosis
• Coagulation defects
• Nosebleeds, bleeding gums
• Amenorrhea
• Impotence
• Jaundice
• Hepatomegaly
• Dilated venous pattern over abdomen
• Palmar erythema
• Dyspnea
• Encephalopathy

Medical & Nursing Management:

• Low sodium diet with adequate calorie intake
• Restrict fluid intake in case of hyponatremia or fluid overload
• Administer multivitamins
• Diurestics: furosemide, spironolactone
• Paracentesis to remove ascitic fluid
• Administer lactulose to promote ammonia removal from gut
• Antibiotics: neomycin sulfate, metronidazole
• Shunt placement: Peritoneovenous shunt, portocaval shunt, transjugular intrahepatic shunt
• Gastric lavage
• Balloon temponade to control oesophageal varices bleeding
• Administer blood products if needed
• Sclerotherapy
• Vaccine for influenza & hepatitis B
• Elevate head 30 degrees to ease breathing
• Weight patient daily
• Elevatye feet to decrease peripheral edema
• Monotor level of consciousness, orientation, recent & remote memory, behaviour, mood.

Distinctive facts:

• Ix: AST, LDH, ALt levels- elevated, Liver biopsy, USG, CT scan, Serum protein, albumin, WBC- low
• Special signs: Muehrcke's nails & terry's nails spider angioma caput medusae
• Liver transplant is a surgical option
• NSAIDs & Aspirin to be avoided
• 3000 cal/day
• Hepatotoxins are to be removed
• Hepatocellular carcinoma & encephalopathy are most common complications

Prognosis:

As cirrhosis progresses, the patient may develop encephalopathy & coma. Survival from liver transplantation is now around 80%. Alcoholic cirrhosis has a worse prognosis. Mortality of 34–66%