Cirrhosis is a chronic liver disease characterized by scarring and damage to liver tissue. It is caused by repeated injury to the liver over many years from various factors like alcohol abuse, viral hepatitis, fatty liver disease. Signs and symptoms may include fatigue, bruising, jaundice, fluid accumulation and confusion. Complications arise due to impaired liver function and blood flow issues, leading to infections, malnutrition, and buildup of toxins. Nursing care involves assessing for complications, providing nutrition support, managing fluid overload, and patient education to prevent further liver damage.

2. OUTLINES:
1-Introduction
2-Definition
3-Causes
4-Signs and Symptoms
5-Complications
6-Nursing Care Plan
*Assessment
*Intervention
*Health Teaching
7-Summary
8-References

3. Introduction:
The liver weighs about 3 pounds and is the largest solid
organ in the body. It performs many important functions,
such as:
-Manufacturing blood proteins that aid in clotting, oxygen
transport, and immune system function
-Storing excess nutrients and returning some of the
nutrients to the bloodstream
-Manufacturing bile, a substance needed to help digest
food
-Helping the body store sugar (glucose) in the form of
glycogen
-Ridding the body of harmful substances in the
bloodstream, including drugs and alcohol
-Breaking down saturated fat and producing cholesterol

5. Definition:
Is a chronic disease characterized by
scaring and necrotic tissue replaced by
fibrotic tissue . Resulting in hepatic
insufficiency and portal hypertension

7. Causes:
Cirrhosis is caused by scar tissue that forms in your liver in response to damage
occurring over many years. Each time your liver is injured, it tries to repair itself.
In the process, scar tissue forms. As the scar tissue builds up, liver function
worsens. In advanced cirrhosis, the liver no longer works very well.
Some of the causes of cirrhosis are inherited or thought
to be inherited:
-Iron buildup in the body (hemochromatosis)
-Cystic fibrosis
-Copper accumulated in the liver (Wilson's disease)
-Poorly formed bile ducts (biliary atresia)
-Inherited disorders of sugar metabolism (galactosemia or glycogen
storage disease)
-Genetic digestive disorder (Alagille syndrome)
-Liver disease caused by your body's immune system (autoimmune
hepatitis)

8. Causes (Cont):
Others occur later in life:
-Chronic alcohol abuse
-Hepatitis C
-Hepatitis B
-Fat accumulating in the liver (nonalcoholic fatty liver
disease)
-Destruction of the bile ducts (primary biliary cirrhosis)
-Hardening and scarring of the bile ducts (primary
sclerosing cholangitis)
-Infection by a parasite common in developing countries
(schistosomiasis)
Some people may have more than one cause for
cirrhosis, such as alcohol abuse and viral hepatitis. If
doctors cannot find a cause for your condition, it's
called cryptogenic cirrhosis. Up to 20 percent of
people with cirrhosis have cryptogenic cirrhosis.

9. Signs & Symptoms :
Cirrhosis often has no signs or symptoms until
liver damage is extensive. When signs and
symptoms do occur, they may include:
-Fatigue
-Bleeding easily
-Bruising easily
-Itchy skin
-Yellow discoloration in the skin and eyes
(jaundice)
-Fluid accumulation in your abdomen (ascites)
-Loss of appetite
-Nausea
-Swelling in your legs
-Weight loss
-Confusion, drowsiness and slurred speech
(hepatic encephalopathy)
-Spider-like blood vessels on your skin

11. Complications:
Complications related to blood flow:
1-High blood pressure in the veins that supply the liver (portal
hypertension). Cirrhosis slows the normal flow of blood through the liver, thus
increasing pressure in the vein that brings blood from the intestines and spleen
to the liver.
2-Swelling in the legs and abdomen. Portal hypertension can cause fluid to
accumulate in the legs (edema) and in the abdomen (ascites). Edema and
ascites also may result from the inability of the liver to make enough of certain
blood proteins, such as albumin.
3-Enlargement of the spleen (splenomegaly). Portal hypertension can also
cause changes to the spleen. Decreased white blood cells and platelets in your
blood can be the first sign of cirrhosis.
4-Bleeding. Portal hypertension can cause blood to be redirected to smaller
veins. Strained by the extra load, these smaller veins can burst, causing serious
bleeding. High blood pressure also may cause enlarged veins (varices) and
lead to life-threatening bleeding in the esophagus (esophageal varices) or the
stomach (gastric varices). If the liver can't make enough clotting factors, this
also can contribute to continued bleeding.

12. Complications (Cont):
Other complications:
1-Infections. If you have cirrhosis, your body may have difficulty
fighting infections. Ascites can lead to bacterial peritonitis, a serious
infection.
2-Malnutrition. Cirrhosis may make it more difficult for your body to
process nutrients, leading to weakness and weight loss.
3-Buildup of toxins in the brain (hepatic encephalopathy). A liver
damaged by cirrhosis isn't able to clear toxins from the blood as well
as a healthy liver can. These toxins can then build up in the brain and
cause mental confusion and difficulty concentrating. With time, hepatic
encephalopathy can progress to unresponsiveness or coma.
4-Jaundice. Jaundice occurs when the diseased liver doesn't remove
enough bilirubin, a blood waste product, from your blood. Jaundice
causes yellowing of the skin and whites of the eyes and darkening of
urine.
5-Bone disease. Some people with cirrhosis lose bone strength and
are at greater risk of fractures.

16. Assessment:
Obtain history of chief complains and risk
factors
Perform abdominal examination and
assessing for ascities
Assess for bleeding
Assess weight and abdominal girth daily
Assess mental status
Assess fluid and nutritional status

17. Interventions:
Stop alcohol and toxic drugs
Correct nutritional status by vitamins, nutritional
supplements high calorie and low protein
Treat ascities and fluid over load by the following
1-dialy weight and assess abd girth
2- restrict sodium and water intake
3-bed rest to aid duresis
4-duretic therapy like spirolactone

18. Interventions (Cont):
Treatment of other problems associated with liver failure such as
anti emetic , lactulose, and streptomycin for hepatic encephalopathy
Sclero therapy and singes taken tube for esophageal varices
Liver transplantation (By Doctor)
If patient in a late stage , identify those patient at risk because they
are more liable for infections , bleeding than others

19. Health Teaching:
Drink alcohol in moderation, if at all.
Eat a healthy diet. Choose a plant-based diet that's full of fruits
and vegetables. Select whole grains and lean sources of protein.
Reduce the amount of fatty and fried foods you eat.
Maintain a healthy weight. An excess amount of body fat can
damage your liver. Talk to your doctor about a weight-loss plan if
you are obese or overweight.
Reduce your risk of hepatitis. Sharing needles and having
unprotected sex can increase your risk of hepatitis B and C. Ask
your doctor about hepatitis vaccinations.

20. Summary:
Cirrhosis occurs in response to damage to your liver. The liver damage
done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed
early and the cause is treated, further damage can be limited. As
cirrhosis progresses, more and more scar tissue forms, making it difficult
for the liver to function (decompensated cirrhosis). Advanced cirrhosis is
life-threatening.

21. References:
1-http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/
2-http://www.slideshare.org/clinical-cirrhosis/