cirrhosis of liver (liver fibrosis).pptx

Cirrhosis is a chronic condition characterized by replacement of normal liver tissue with diffuse fibrosis that disrupt the structure and function of the liver
Cirrhosis is a chronic, degenerative disease in which normal liver cells are damaged and are then replaced by fibrous tissue and blocking the flow of blood through the liver.
ALCOHOLIC CIRRHOSIS : the scar tissue characteristically surrounds the portal areas. This is most frequently caused by chronic alcoholism and is the most common type of cirrhosis
POST NECROTIC CIRRHOSIS : there are broad bands of scar tissue. This is a late result of a previous bout of acute viral hepatitis
BILIARY CIRRHOSIS : scaring occur in the liver around the bile ducts. This type of cirrhosis usually result from chronic biliary obstruction and infection
Heavy alcohol consumption
Chronic hepatitis C, B, D and viral
Trauma of the liver
Obesity
Cystic fibrosis
Autoimmune hepatitis
Blocked bile duct
Wilson’s disease
Congestive heart failure
Non-alcoholic fatty liver
Biliary atresia
Gallbladder surgery
Glycogen storage disease
Galactosemia
Loss of appetite
Weight loss
Enlarged liver
Vascular spider
Nausea, Vomiting
Mild fever
Abdominal pain
Abnormal pigmentation
Ankle edema
Nail changes
Vitamin deficiency
Intense itching
Morning indigestion
Lack of energy, tiredness
Anemia
Ankle edema
Nail changes
Vitamin deficiency
Intense itching
Morning indigestion
Lack of energy, tiredness
Anemia

1. CIRRHOSIS OF LIVER DEPARTMENT OF MEDICAL SURGICAL NURSING

2. At the end of the class the students will be able to :- Describe the anatomy & physiology of the Liver . Define Cirrhosis of liver . Enlist the types of Cirrhosis of Liver . Describe the Pathophysiology . Enlist the Clinical Manifestations Enlist the Diagnostic Evaluation Enlist the Complications . Describe the management --- med,sur,nsg . Learning Objectives

3. ANATOMY OF LIVER

4. Definition Cirrhosis is a chronic condition characterized by replacement of normal liver tissue with diffuse fibrosis that disrupt the structure and function of the liver

5. DEFINITION Cirrhosis is a chronic, degenerative disease in which normal liver cells are damaged and are then replaced by fibrous tissue and blocking the flow of blood through the liver.

6. TYPES ALCOHOLIC CIRRHOSIS : the scar tissue characteristically surrounds the portal areas. This is most frequently caused by chronic alcoholism and is the most common type of cirrhosis POST NECROTIC CIRRHOSIS : there are broad bands of scar tissue. This is a late result of a previous bout of acute viral hepatitis BILIARY CIRRHOSIS : scaring occur in the liver around the bile ducts. This type of cirrhosis usually result from chronic biliary obstruction and infection

7. Causes Heavy alcohol consumption Chronic hepatitis C, B, D and viral Trauma of the liver Obesity Cystic fibrosis Autoimmune hepatitis Blocked bile duct Wilson’s disease Congestive heart failure Non-alcoholic fatty liver

8. Biliary atresia Gallbladder surgery Glycogen storage disease Galactosemia

9. PATHOPHYSIOLOGY Due to etiological causes Diffuse destruction and regeneration of liver cells Formation of fibrous tissue Destroyed liver cells are replaced gradually by scar tissue As necrotic tissue yields fibrosis, cirrhosis damage liver tissue

10. Obstruction in blood, lymph and bile flow Hepatic insufficiency

11. EARLY MANIFESTATIONS Loss of appetite Weight loss Enlarged liver Vascular spider Nausea, Vomiting Mild fever Abdominal pain Abnormal pigmentation

12. Ankle edema Nail changes Vitamin deficiency Intense itching Morning indigestion Lack of energy, tiredness Anemia

13. Late Clinical manifestation Liver enlargement. Jaundice Portal obstruction and ascites . Infection and peritonitis Gastrointestinal varices Personality changes Hepatic encephalopathy Mental deterioration

14. Hyponatremia . Water retention Bleeding oesophageal varices . Coagulopathies . Complications

15. DIAGNOSTIC All routine investigation---[CBC,LFT,KFT] Ultrasonography Percutaneous transheptic cholangiography Liver scan . Esophageal gastroduodenoscopy [EGD] Liver biopsy .   Diagnostic evaluation

16. The management is based on the presenting symptoms. Ammonia – Enemas, Neomycin, Lactulose. Gastric distress – Antacids.Antiemetics Nutritional deficiency – Vitamin and Mineral supplements . Ascites – Potassium sparing diuretics. Bleeding varices – Balloon Tamponade. Diuretic therapy Abdominal paracentesis . Bed rest. Vitamins and minerals supplements Medical Management

17. Nutrition Protein restriction and complete protein foods . Adequate carbohydrates . Fluids and sodium . Surgery---liver transplant (if necessary) Ct-- Medical Management

18. BREAKFAST Cornflakesor rice cripies Toast 2 with butter jam Light boiled eggs 2 Tea or coffee Toast 2,with butter Tea or coffee MID MORNING a glass of juice A glass of juice with peanuts LUNCH Roast pork with gravy Capatties Medium boiled potatoes 2 Vegetables Spinach/sweet corn Cauliflower Baked sponge and custard Rice and dal banana MID AFTERNOON Tea or coffee with fruit cake Tea or coffee with chocolate biscuits DINNER Poached cod Creamed potatoes Braised cabbage Carrots Rice pudding Bread and butter Khakhra with ghee Kichadi with kadi Icecream BED TIME A glass of milk

19. Patient education and health maintenance Stress the necessity of giving up alcohol completely Provide written dietary instructions Encouraging alternating periods of rest and ambulation Maintain some period of rest with elevation of leg to mobilize edema and ascites Encourage and assist with gradually increasing periods of exercise Encourage daily weighing for self monitoring of fluid retention depletion

20. Encourage patient to eat high calorie, moderate protein meal and to have supplementary feedings Discuss adverse effect of diuretic therapy Emphasize the importance of rest, a sensible lifestyle, and an adequate, well balanced diet Stress the continued follow up for lab test and evaluation by a health care provider

21. NURSING MANAGEMENT Nursing management will be based on the following nursing diagnosis. Acute Pain related to inflammation Imbalanced nutritional p attern less than body requirement related to nausea.

22. 3. Activity intolerance related to fatigue . 4. Imbalanced fluid electrolyte , more than body requirement related to ascites. 5. Risk for disturbed body image related to hormonal changes in the body. NURSING MANAGEMENT

23. Anatomy of the Liver . Definition of Cirrhosis of liver . Types of Cirrhosis of Liver . Pathophysiology of Cirrhosis of Liver. Clinical Manifestations Diagnostic Evaluation Complications. Management. Summary

24. BIBLIOGRAPHY Black, J.M. & Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical Management for Positive Outcomes (8th ed.). Philadelphia: Elsevier/Saunders. Ignatavicius , D.D. & Workman, M.L. (2010). Medical-Surgical Nursing: Patient- Centered Collaborative Care (6th ed.). Philadelphia: Elsevier/Saunders. Lewis, S.M., Dirkse , S.R., Heitkemper , M.M., & Bucher, L. (2010). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (7th ed.). St. Louis: Mosby. Smeltzer , S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

25. 28 Thank You