Introduction to Cirrhosis of the Liver

The liver has a wide range of functions, including filtering toxins from your blood, producing bile to help digest food, helping with blood clotting, and storing vitamins and minerals.

Cirrhosis of the liver is a chronic disease that is caused by long-term damage to the organ. Cirrhosis can cause major complications, including liver failure, bleeding in the esophagus or stomach, or death.

Clients with cirrhosis most likely experience liver damage from:

• Alcohol abuse (alcoholic hepatitis)
• Viral infections (hepatitis C)
• Autoimmune disorders (lupus or scleroderma)
• Genetic diseases (hemochromatosis or Wilson’s disease)
• Cystic fibrosis (severe mucus clogging the entire body & the liver)

Cirrhosis of the Liver Pathophysiology

The liver helps with digestion, detoxification, and blood filtering (about one liter of blood every minute). It also makes bile, which helps digest fat and stores red blood cells when they are not needed. Each time the liver is injured by excessive alcohol intake, medication overuse, or disease, it tries to repair itself.

In this process, scar tissue forms in place of healthy liver cells, which eventually hardens into nodes called fibrosis or cirrhosis. This scarring process can also cause nodules called hepatic adenomas. Severe cirrhosis complications could require a transplant, especially if the client experiences fluid build-up or bleeding in the stomach.

Memory Trick: Think liver cirrhosis – since normal healthy tissues get replaced with scar tissue, making the liver hard like a rock.

Cirrhosis of the Liver Signs & Symptoms

Clients with cirrhosis have an increased risk of developing liver cancer and intestinal bleeding, as well as experiencing other complications that can lead to death.

Symptoms of cirrhosis depend on how much scar tissue has formed in the liver. In the early stages, symptoms may be non-specific and hard to identify. Common symptoms include:

• Jaundice – Yellow skin and eyes from a build-up of bilirubin (dead RBCs).
• Portal hypertension – High pressure in the portal vein.
• Ascites – Huge fluid-filled abdomen as fluid backs up from the hard liver, and now spills into the third space.
• Esophageal Varices – The enlargement of veins in the esophagus. As blood backs up from the liver, it forces major pressure on the esophagus, causing the vessels to bulge.

Other symptoms include:

• Sudden weight loss
• Enlarged abdomen (from fluid buildup)
• Tenderness or pain in the area below your ribcage on the right side
• Itchiness or dry skin on your palms and soles
• Fatigue
• Nausea and vomiting

Nursing Assessment & Interventions for Cirrhosis

Nursing interventions for cirrhosis are most effective when they are tailored to the individual client. Therefore, nursing interventions should focus on each client as an individual, considering the stage of disease, underlying risk factors, and problems.

As part of a nursing care plan for cirrhosis, nursing assessments and interventions could include:

Assessments

• Current liver function (and compare with baseline levels).
• Blood pressure, pulse rate, and respiratory rate.
• Skin integrity for jaundice or other signs of liver failure (e.g., spider angiomas).
• Nutritional status (the client may require an intravenous line or tube feeding).
• Cognition and understanding of their condition so they can adhere to treatment recommendations (e.g., what medications are being prescribed).
• The abdomen for abdominal palpation (when the liver is enlarged and firm on palpation).

Interventions

• Educate clients about the causes of their illness and how to prevent complications.
• Encourage clients to eat a healthy diet and avoid alcohol and tobacco use.
• Provide emotional support and help them cope with changes in their lifestyle.

Lab Values for Cirrhosis of the Liver

The ABCs of the liver (Albumin, Bilirubin, Coagulation) will be low. This includes low calcium from the low albumin leading to the two classic signs: Trousseau’s and Chvostek’s.

• Albumin Low (under 3.5), Low platelets → Calcium Low
• Bbilirubin High
• Coagulation Panel (clotting time High), High PT, PTT, INR
• Ammonia High → Hepatic Encephalopathy
• Elevated ALT & AST

Cirrhosis Pharmacology

Neomycin – Neomycin’s impact on the intestinal bacterial flora effectively lowers blood ammonia in cirrhotic clients – whether or not they have neurologic abnormalities.
Lactulose – Lactulose is used to lower the ammonia levels in the blood. Ammonia is eliminated from the body by pulling it from circulation and into the colon.

Cirrhosis of the Liver Conclusion

The liver aids in blood filtration, cleansing, and digestion (about one liter of blood every minute). It performs a variety of tasks, such as removing toxins from the blood, creating bile to aid in food digestion, promoting blood clotting, and storing vitamins and minerals.

When cirrhosis of the liver occurs, scar tissue replaces healthy liver cells. This tissue eventually hardens into nodules, known as cirrhosis or fibrosis. Because of the decreased blood flow brought on by the liver’s scarring, the nodules enlarge and eventually develop into tumors known as hepatic adenomas.

Clients with cirrhosis are more likely to have liver cancer, gastrointestinal bleeding, and other life-threatening consequences.

Sources

https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/fibrosis-and-cirrhosis/cirrhosis
https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487