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

Causes  Chronic alcoholism  Bilharzias  Mal nutrition  Viral hepatitis  Toxic drugs  Chronic biliary obstruction

Pathophysiology  When normal liver cells replaced by fibrous cells,normal liver structure and function altered resulting in portal hyper tension, a cities,esophageal varices and hepatic encephalopathy  The progress of liver cirrhosis is slowly, for that reason P may come late with complication of liver cirrhosis

Clinical feature  Onset slowly may take years  Early complain include fatigue, anorexia, edema, epistaxis, gums bleeding, jaundice and weight loss  Later complains occurs due to chronic failure of the liver and obstruction of portal circulation which include constipation, esophageal varices, ascites, splenomegaly, pancytopenia, low albumin, DLOC and bleeding

Diagnostic test  LFT, liver scan  Liver biopsy to detect destruction and fibrosis of liver tissue  Abd U\S,  Esophagoscopy to assess varices  Paracentesis to examine ascitic fluid  CBC and electrolyte

Mangement  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

Con=- 4-abdominal paracentesis 5- administer albumin to maintain osmotic pressure  Treatment of other problems associated with liver failure such as anti emetic, lactulose, and streptomycin for hepatic encephalopathy  Sclerotherapy and singestaken tube for esophageal varices  Liver transplantation

Complication  Hyponatremia and water retention  Bleeding  Esophageal varices  Co- agulapatheis  Hepatic failure  Hepatic encephalopathy  Portal hypertension  Ascetics

Nursing care for P with L C  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  Assess P knowledge

Nursing diagnosis  Activity intolerance R\L to disease process and low energy  Goal =- promoting activity tolerance  N-implementation=-  Assess activity tolerance  Provide high caloric diet  Bed rest and assist patient in daily activity  Administer vitamin supplements  Reassess activity tolerance

 Altered nutrition less than body requirement R\L to anorexia and GIT disturbance  Goal =- improving nutritional status  Impaired skin integrity R\L to edema and jaundice  Goal =- maintaining skin integrity  Risk for bleeding R\L to altered clotting mechanism  Goal=- prevent bleeding

 Impaired level of consciousness R\L to deterioration of liver function and increase serum ammonia  Goal =- improve level of consciousness  Risk for infection R\L to low immune  Risk for collaborative problems or complication such as ……..  Knowledge deficit R\L to disease, drugs, complication and follow up