Cirrhosis Pathophysiology
Progressive hepatic fibrosis → nodular regeneration → distorted architecture → impaired function. Causes: alcohol (#1), chronic HCV, chronic HBV, NAFLD/NASH. Child-Pugh Score and MELD score assess severity and prognosis.
Portal Hypertension Complications
Elevated portal vein pressure → collateral circulation → varices (esophageal, gastric — risk of massive hemorrhage), splenomegaly, ascites. Esophageal varices: endoscopic banding + octreotide + prophylactic antibiotics. SBP: infection of ascitic fluid.
Hepatic Encephalopathy
Ammonia accumulates → neurotoxic effects. Signs: asterixis (flapping tremor), personality changes, confusion, coma. Treatment: Lactulose (target 2–4 loose stools/day); Rifaximin. Precipitants: GI bleed, infection, constipation.
Nursing Management
Daily weight, abdominal girth, I&O, mental status, asterixis. Paracentesis for large-volume ascites. Avoid: NSAIDs, nephrotoxic drugs, sedatives. Salt restriction 2g/day.
Important Notes
- Esophageal variceal bleeding: massive, rapidly fatal — IV access ×2, octreotide infusion, emergent endoscopy.
- Spironolactone: diuretic of choice for ascites.
Clinical Tips
- "Think ammonia" when a cirrhotic patient becomes confused — check NH3, give lactulose, find the precipitant.
Summary
Cirrhosis produces multisystem complications from portal hypertension and impaired liver function. Nursing care focuses on monitoring for life-threatening complications and symptom management.
