• Chronic liver disease by inflammation and fibrosis of liver tissue

3 classifications:

• Laennec's (Alcoholic) cirrhosis
• Biliary cirrhosis- obstruction of bile
• Posthepatic- postnecrotic; results from chronic liver disease such as hep. B & C

Manifestations:

• Protect form falls/injuries
• Electric razor- Risk for bleeding from abnm. clotting (Dec. PT production)
• Fluid Volume Excess
• Inc. Abdominal girth (from ascites)
• Muscle atrophy
• Asterixis- flapping tremor of hand (from inc. ammonia levels)
• Hepatic encephalopathy- lack of coordination, dec. memory, lack of orientation, coma (from inc. ammonia)
• Dec. Deep Tendon Reflexes
• Edema & ascites (altered protein metabolism --> Low albumin w/dec. osmotic pressure)
• Splenomegaly
• Portal hypertension
• Hemorrhoids
• Varicose veins
• Esophageal varices

Management:

• Abdominal paracentesis
• Diet restrictions: Low sodium
• Measure ab girth
• I&O, weight daily
• Maintain skin integrity, bleeding precautions, respiratory support
• Measure renal impairment- Creatinine & BUN levels
• Esophageal Varices- Sclerotherapy (drug therapy to sclerose bleeding vessel) & Esophageal tamponade (direct pressure by NG tube w/esophageal and gastric balloon)