Cirrhosis of liver

Divan masih post basic B.sc nursing

1. Causes and predisposing factors of cirrhosis of liver Chronic alcoholism Chronic viral hepatitis type A,B,C . Wilson’s disease ( Wilson's disease  is a genetic  disorder  in which copper builds up in the body.  ) Chronic congestive heart failure.

2. Predisposing factors Non necrotic liver disease . Gall bladder stone and surgery . Blockage in the bile ducts . Glycogen storage disease . Alpha 1 antitrypsin deficiency . Autoimmune hepatitis . Cystic fibrosis.

3. spider angioma Asterixis   Jaundice

4. Purpura   Petechiae Caput medusae

5. COMPLICATIONS Portal hypertension and esophageal varices. Peripheral edema and ascites. Hepatic encephalopathy. Hepatorenal syndrome

6. MANAGEMENT Medical management surgical management nursing management ` (All medications )

7. Management of ascites MEDICAL MANAGEMENT D iuretic Spironolactone Amiloride Triamterene Furosemide SURGICAL MANAGEMENT Paracentesis peritoneovenous shunt

8. Management of esophageal varices Medical management Beta blockers Vasopressin   Surgical management E ndoscopic sclerotherapy Balloon tamponade Sandostatin  ( octreotide )   Transjugular intrahepatic portosystemic shunt  (TIPS) 

9. Drug’s name Mechanism of actions Vasopressin  ( ADH ) Its two primary functions are to retain water in the body and to constrict blood vessels. Propranolol   Reduction of portal venous pressure, reduction of esophageal varices bleeding. Lactulose Acidifications of feces in bowel and trapping of ammonia, causing its eliminations in feces. Neomycin Decrease in bacteria flora, decreasing formation of ammonia .

10. Drug’s name Mechanism of actions Triamterene   is a potassium-sparing diuretic inhibits reabsorption of sodium and secretion of potassium. Magnesium sulphate Magnesium replacement, hypomagnesemia occurs with liver dysfunction . Vitamin K Plays a key role in helping the blood clot, preventing excessive bleeding .

11. Drug’s name Mechanism of actions Cimetidine Decrease gastric acidity Spironolactone   Blocking of action of aldosterone, potassium sparing . Amiloride   Eliminate sodium (salt) and water from the body while retaining potassium. Chlorothiazide Decrease reabsorption of sodium and water . Furosemide To prevent reabsorption of sodium and water.

12. Management of hepatic encephalopathy Antibiotics Lactulose/ lactitol Diet (high protein diet )   Phosphate   enema.

13. Other preventives measures Get vaccination for influenza and hepatitis A,B. A dministration of B- complex vitamins . Vitamin K Rest. A voidance of alcohol and aspirin

14. BIBLIOGRAPHY Lewis S L,Heilkemper , M,Dirksen SR. Medical S urgical Nursing . 1 st ed. Canada: Ann M illar; 2006.p 1126-30. Smeltzer C .Suzanne ,Bare G.Brenda,Hinkle L .Janice , C heever H Kerry. Brunner and S uddarth’s “Text book of M edical S urgical Nursing. 23 rd .New Dehli:Wolters Kluwer; 2014.p 1366-75.

15. Smeltzer C . Suzanne, Bare, G B renda , H inkle L . Janice , C heever H. Kerry. Brunner and S uddarth’s , T extbook of Medical and Surgical Nursing. 12 th ed . New Delhi: wolters Kluwer; 2010. P 1116 - 46 Black m. J oyce H awk’s H okkanson J ane. M edical and Surgical Nursing. 7 th ed. USA: Barbara Cullen; 2001. p 1135-49