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%
