Liver Cirrhosis

1. Anatomy and physiology of the liver.

1. The liver is the largest organ of the body; it is located in the upper right part of the abdominal cavity.

2. The liver has multiple functions.

1. It produces bile, which aids digestion in the intestines.

2. It stores vitamins A, D, E, K, and B12.

3. It stores glycogen, releasing it as glucose when needed.

4. It metabolizes fats, carbohydrates, and protein.

5. It metabolizes estrogens.

6. It is very important in the coagulation (blood-clotting) process.

7. It destroys old red blood cells and removes bacteria and foreign bodies from the blood stream.

2. Definition of "cirrhosis."

1. It is a chronic liver disease of progressive degeneration of liver cells causing disruption of liver function.

2. The death of cells is replaced by scar tissue.

3. Factors that may increase the risk of cirrhosis.

1. Alcohol abuse (primary cause).

2. History of biliary obstruction and infection.

3. History of hepatitis.

4. History of severe congestive heart failure.

5. Malnutrition.

4. Signs and symptoms of cirrhosis.

1. Early symptoms:

1. Loss of appetite.

2. Nausea and vomiting.

3. Diarrhea or constipation.

4. Fever.

5. General weakness.

6. Edema.

2. Late symptoms:

1. Jaundice.

2. Swelling of abdomen

3. Weight loss.

4. Fatigue.

5. Confusion.

5. Measures that prevent or control cirrhosis.

1. Abstain from all alcohol (refer to alcohol treatment program or Alcoholics Anonymous).

2. Avoid over-the-counter drugs.

3. Plan regular rest period to decrease demands of the body and to increase supply to the liver.

4. Provide adequate skin care.

1. Prevent trauma to skin with frequent position changes, pressure relief devices, etc.

2. Follow good hygiene measures.

3. Keep fingernails short to prevent irritation from scratching.

5. Weigh daily for early detection of fluid retention.

6. Promote adequate nutrition.

1. Eat small, frequent meals high in calories and carbohydrates.

2. Take vitamin supplements.

3. Avoid foods high in ammonia and amines, such as cheese, salmon, and lima beans.

4. Avoid sodium. (Provide "Restrict Sodium" handout.)

7. Avoid contact with people who are ill, to avoid infections.

8. Report signs of bleeding and minimize possibility of trauma. (Avoid forceful nose blowing, avoid straining at stool, use soft toothbrush, etc.)

9. (For care giver only) Assess mental status and orient client as needed. (Provide "Reality Orientation" handout.)

10. Report to physician changes such as increased edema, fever, rapid weight loss, bleeding of any kind, or change in mental status.

11. Take medication as prescribed.

6. Possible complications of cirrhosis.

1. Esophageal varices (dilated veins in the foodtube).

2. Bleeding from varices.

3. Hemorrhage due to impaired coagulation.

4. Encephalopathy (dysfunction of the brain, which may progress from slight confusion to coma).

5. Renal failure.

6. Ascites (fluid accumulation in the abdomen).