Types of Cirrhosis

alcoholic: most common, chronic alcoholism

postnecrotic: previous viral, toxic, idiopathic hepatitis

biliary: chronic biliary obstruction & infection

cardiac: long-standing rt.-sided HF

Causes

malnutrition alcohol abuse chronic impair
bile excretion necrosis - hepatotoxins or hepatitis
CHF

Dx

ultrasound liver biopsy EGD
paracentesis peritoneal lavage labs

Related Labs

bili AST / ALT PT serum
globulin albumin ammonia serum alk.
phos.

Early S/S

anorexia indigestion nausea ache /
heaviness RUQ weakness, fatigue fever
enlarged liver & spleen

Late S/S

inc. in bili, AST, ALT, ammonia, serum alk. phos, serum
globulin, PT dec. in albumin jaundice, pruritus,
skin lesions fetor hepaticus asterixis
edema, ascites prom. abdominal wall veins
hematologic problems infection endocrine
problems neuro changes hepatorenal syndrome

Complications

ascites hepatic encephalopathy: high ammonia, hand
flapping, dec. LOC, twitch, tremor, fetor hepaticus
esophageal varices: bleed portal HTN

Nursing Interventions

bed rest, reduced activity no sedatives, alcohol,
opiates, acetaminophen diet: low protein, high carb &
cal multi vitamin therapy (Vit K & albumin) if
edema/ascites: restrict fluids & Na mouth care after
meals I&O, q d wts good hygiene Sx
infection TCDB position changes monitor
urine, stools, gums, skin (bleed, bruise) avoid injections:
apply pressure for 5min

NDx

Activity Intolerance Imbalanced Nutrition
Impaired Skin Integrity Increased Risk for Injury