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

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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13.  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

14.  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