Description of the Disease
Liver cirrhosis is a disease that causes hardening of a part of the liver thus hindering its functions. In the body, liver is located in the right upper side of the abdomen. The liver can regenerate itself in case of lost or damaged part. The regeneration process is usually very rapid. For liver cirrhosis to occur, the part of the damaged liver tissue is replaced by a hard fibrous tissue forming a scar and regenerative nodules (Damjanov, 2009). The scars replace the smooth liver tissue making the liver to harden. Cirrhosis is a long-term illness. A person can stay for many years without showing any signs and symptoms of liver cirrhosis. Signs and symptoms only become visible in case the liver damage is in a very severe state. A healthy liver involves carrying out many essential functions, which include removal of toxic substances from the body and making proteins and other essential compounds for the body (Egawa et al., 2014).
Risk Factors of Liver Cirrhosis
It is important to note that liver cirrhosis can affect anyone (men, women, young and elderly), but the categories of people with an utmost risk of cirrhosis include:
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Heavy alcohol drinkers.
People who have had a long-term liver infection, such as hepatitis B or hepatitis C.
People with an inherited liver disease, such as hemochromatosis. This is a disease, in case of which a lot of iron buildup in the body becomes toxic to the liver.
People whose immune system is acting against itself.
People who are clinically overweight or obese and have a fatty liver.
People exposed to drugs and other environmental toxins that can damage the liver (Egawa et al., 2014).
Disease Process
Cirrhosis of the liver describes replacement of the injured part of the liver with a hard scar made up of collagen. This occurs due to frequent normal wound healing response leading to an abnormal continuation of fibrogenesis, i.e., production of hard connective tissue and its deposition on the liver tissue (Huether & McCance, 2012). Cirrhosis in the progressive stage of liver fibrosis is accompanied by distortion of the liver blood vessels. It leads to diversion of blood pumped to the liver thus making the liver lack essential nutrients and also not to be in a position to remove waste products formed in the liver. The disruption of blood flow has adverse effects on liver cells leading to their destruction and since they are responsible for carrying out liver functions, a condition known as liver failure results. In case of liver failure, the functions of the liver are disrupted. The affected patients have blood with accumulated waste products that can be detected by performing liver function tests in the laboratory. Liver cirrhosis can progress to liver cancer (hepatocellular carcinoma) and can also affect other organs of the body (Damjonav, 2009). It can affect the kidney causing salt and water retention or the heart leading to heart attack.
Signs and Symptoms
It is necessary for people to seek medical attention if they manifest any of the following signs and symptoms associated with cirrhotic patients:
Yellowing of the skin, nails and sclera, white of the eye and jaundice. The yellow color results from the accumulation of bilirubin in the blood of diseased patients due to the incapacitation of the liver to excrete bilirubin.
Swelling of the abdomen (ascites) and that of the lower extremities, such as legs (edema). This results in fluid retention in tissues of diseased patients.
Loss of appetite, abdominal pain, nausea and vomiting of bloody material.
Excretion of dark urine and stool.
Men have enlarged breasts and small, shrunken testes.
Women have irregular or absent menstrual periods.
Neurologic problems such as memory loss, confusion, loss of consciousness, sleepy feeling, tremors and difficulty in performing simple tasks.
Observation of dry mouth and dry eyes (Huether & McCance, 2012).
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Nursing Management
Patients should be encouraged to maintain some resting periods with legs elevated to avoid accumulation of fluids in the legs (edema) or the abdomen (ascites).
Patients should be discouraged to consume a lot of fluids and taking sodium. Sodium promotes retention of water in the body.
Patients should be observed and the documentation of his/her condition should be made. Bleeding of gums and yellowing of the skin or the white of the eye should be recorded.
Stool of diseased patients should be inspected for amount, color and consistency. Dark stool should be taken to a hospital laboratory to test internal bleeding.
Patients should be observed for behavioral or personality changes, such as body weakness, hallucinations and anxiety, and reported to medical officers.
Family members should offer psychological support and encouragement to patients with liver cirrhosis.
Patients should be restricted from drinking alcohol or using drugs in case of perennial drug users (Ahrens, Prentice, & Kleinpell, 2010).
Patient Teaching
To avoid bleeding, patients should refrain from taking non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin. They should also avoid straining to defecate, blow their nose or sneeze too vigorously.
To advise the patient to have enough rest and a good nutrition with enough proteins. This helps to conserve energy and decrease the demands of the liver. Urge him/her to eat frequently small portions of meals. Advise him/ her to alternate periods of rest and activity to lower oxygen demand and prevent fatigue (Ahrens, Prentice, & Kleinpell, 2010).
Treatment and Prevention Plan of Liver Cirrhosis
Treatment of liver cirrhosis is dependent on the cause and stage of cirrhosis. The aim of treatment is to stop cirrhosis from getting worse, reverse the damage if possible and treat any disabling or life-threatening complications (Damjanov, 2009). Various treatment strategies are used viz.:
Use of anti-viral drugs to treat hepatitis B or C viruses if a patient is found to be infected by either of the viruses.
Use of steroid-based drugs in case the liver cirrhosis has occured as a result of immune disorders.
Patients with hemochromatosis should donate blood regularly to lower the amount of iron in their body.
Performing liver transplantation.
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Liver surgery can be done to cut the hardened part of the liver in order to allow the liver to grow again (regenerate) (Egawa et al., 2010).
Prevention of Liver Cirrhosis
Prevention involves educating the patient to change his/her lifestyle in case of chronic alcoholics and eliminating alcohol in the diet of such patients (Egawa et al., 2014). People with multiple sex partners should also be educated to practice safe, protected sex to avoid contracting hepatitis B virus, which can be sexually transmitted. Family members of infected patients should be advised to handle patients clothing and other materials that may contain his/her fluids, such as blood in case of hepatitis B or C virus that is suspected to avoid contracting the infection (Arhens et al, 2010).
Conclusion
Liver cirrhosis is a killer disease in patients with more than 50% of the liver being fibrotic. This is most common among people with a history of chronic alcoholism and people with chronic hepatitis viruses. Detection of the disease becomes even harder since liver cirrhosis manifests only after a large part of the liver is damaged and in most cases at a stage whereby reversing the process is difficult. The disease damages liver cells causing liver failure. Diagnosis mainly involves performing liver function tests or observing part of the liver (biopsy). Treatment of liver cirrhosis involves curing the underlying cause and limiting alcohol consumption as well as family and patient education together with intensive health promotion programs to educate the mass on risk factors and dangers of cirrhosis.