Liver consists of two main layers:
- Upper surface convex, situated below the diaphragm.
- Below the surface uneven and showing curve tranfersus fissure.
Liver function, consisting of;
- Changing the nutrients absorbed from the intestine and stored somewhere in the body, in accordance with the issuance of its use in tissue.
- Transform wastes and toxic materials to be excreted in the bile and urine.
- Produce, glucogenic enzyme glucose into glycogen.
- Secretion of bile, bile made in the liver salts formed in the reticulo endothelial system flowed into the bile.
- Formation of urea, the liver receives amino acid is converted into urea removed from the blood by the kidneys in urine.
- Prepare a final breakdown of fat for carbonic acid and water.
Disorder that can occur in the liver are:
Liver cirrhosis: a disease characterized by diffuse and chronic inflammation of the liver, followed by proliferation of connective tissue, degeneration and regeneration of liver cells causing chaos in the composition of the liver parenchyma.
There are two causes of cirrhosis, namely: cause unknown cause and with no known cause (idiopathic).
1. Known cause:
- Alcoholism
- Hepatitis B and C
- Chemical intoxication / extra hepatic
- Malnutrition
- Chronic cholestasis intra / extra hepatic
- Hepatic venous outflow obstruction
- Immunological disorders
- Metabolic abnormalities
- Hepatotoxic substances
- Haemochromatosis
- Weakness of the old heart
2. No known cause (idiopathic)
Excessive alcohol intake as well as other causes of liver cell damage and inflammation in the liver. What cause liver inflammation manifestations such as pain, fever, increased WBC, nausea, vomiting, anorexia, constipation, and fatigue. Inflammation also causes impaired liver blood flow and lymph flow, causing liver necrosis.
If this situation continues, can reach the stage of necrosis of the liver and cause many adverse effects systematically necrosis of the liver can lead to a decreased ability to metabolize carbohydrates, fats, and proteins. This situation led to levels of plasma proteins, decreased, decreased albumin arises in the body, giving rise to oncotic pressure causing edema and ascites. In addition to the decrease in the metabolism of carbohydrates, fats, and proteins can cause hypoglycemia, malnutrition, decreased, energy, causing weakness in the body.
Decrease in hormonal metabolism may also occur due to liver necrosis, causing manifestations palmar erythema, menstrual cycle disorders, testicular atrophy, gynecomastia, spider angioma, hair on the axillary and pubic hair loss.
Portal hypertension caused by liver necrosis caused splenomegaly, the impact anemia, leukopenia and thrombocytopenia. These circumstances increase the risk of bleeding in addition to the decrease in the absorption of vitamin K and risk of infection. Portal hypertension also cause venous pressure that tends to happen esophageal varices, varicose veins and superficial abdominal haemoroid.
Bilirubin metabolism also decreased due to liver necrosis, resulting in increased bilirubinemia and joundise arise. Additionally bilirubin is excreted in the urine so the color becomes dark urine. Stool color putty arising from impairment of bile in digestive system.
Most fatal consequence of liver necrosis that total liver failure in which all the functions are executed by the liver disorder causing fulminant hepatic failure condition called hepatic encephalopathy. Encephalopathy is characterized by increased serum ammonia, sleep disorders, halitosis, asterixis and respiratory acidosis may continue to lead to coma and eventually death.
Clinical Manifestations of Cirrhosis of the Liver
- Hepatomegaly, tend to occur early in the course of cirrhosis because the liver cells filled with fat. However, the further course of the disease, reduced heart size, after causing scarring of liver tissue shrinkage so palpable nodular on palpation.
- Portal obstruction and ascites.
- Gastrointestinal symptoms are not typical: anorexia, nausea and vomiting, diarrhea or constipation, bloating.
- Fever, fatigue, weight loss.
- Splenomegaly.
- Gastrointestinal varices: haemorhoid, esophageal varices, abdominal superficial varicose veins.
- Edema.
- Deficit of vitamins and anemia.
- Deterioration of mental status.
- Gender Endocrine: testicular atrophy, gynecomastia, axillary and pubic hair loss, menstrual disorders and spider angioma, and palmar erythema.
- Jaundice.
- Right upper quadrant abdominal pain.
Nursing Management for Cirrhosis of the Liver
1. Monitor complications
Acites, bleeding esophageal varices and hepatic encephalopathy is a very feared complication in patients with liver cirrhosis. In addition to kidney failure and infections are also very dangerous. For that family members should know where the manifestation should be reported immediately to healthcare personnel and when to seek help immediately.
2. Maximize the function of the liver
Diit setting is very important to minimize the risk of injury and maximize regeneration. Given diet should be low in protein in severe liver damage and if there is edema should be low in salt and water. When the process is not actively required a diet high in calories, high in protein. However, if there are signs hepatic coma, the amount of calories and protein should be discontinued. B vitamins and fat-soluble vitamins (A, D, E, K) is generally given to the client with alcoholic cirrhosis. Adequate rest is also very important to maximize the regeneration of the liver.
3. Treatment based on the cause
It's important to eliminate exposure hepatoxin, avoiding the use of alcohol. Given an antacid to reduce gastric distress and minimize the likelihood of gastrointestinal bleeding.
4. Prevention of infection
Includes adequate rest, proper diet and avoiding substance hepatoxcic. Provide a quiet environment to enhance the client breaks and also a means to reduce the risk of infection isolation from the surrounding environment.
5. Diuretics that retain potassium if acites artifacts and minimize symptoms of fluid and electrolyte changes caused by the use of diuretics.
Nursing - Care Plan of Cirrhosis of the Liver (sample)
