Cirrhosis: Nursing process (ADPIE)

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Rita Davis is a 55-year-old African American woman with a history of cirrhosis from chronic hepatitis C infection.

Today, Rita is visiting the clinic for concerns about increased abdominal distention, loss of appetite, and fatigue.

Cirrhosis is a condition in which the liver, a large organ in the right upper quadrant of the abdomen, becomes irreversibly scarred from chronic inflammation.

Because the liver has many functions related to digestion, metabolism, detoxification, and production of important molecules the body needs, damage to the liver can have widespread impact on a person’s health.

Let’s look at some of the contributing factors for chronic liver inflammation.

One of the most common modifiable risk factors is long-term alcohol use.

On the other hand, non-modifiable risk factors for cirrhosis include viral hepatitis, autoimmune hepatitis, and other autoimmune disorders, including primary biliary cholangitis and primary sclerosing cholangitis, which can cause liver injury through progressive scarring of the bile ducts.

Liver injury can also occur from non-alcoholic fatty liver disease, in which fat cells build up in the liver.

Genetic disorders like hemochromatosis and Wilson’s disease can cause inflammation from accumulating elements like iron or copper in the liver, whereas alpha-1 antitrypsin deficiency creates malformed proteins that become stuck in the liver.

The liver is highly regenerative, meaning that after injury it replaces injured tissue with regenerative nodules.

These nodules are colonies of liver cells, or hepatocytes, surrounded by collagen-rich scar tissue.

This causes the smooth liver tissue to become bumpy and stiff.

Over time, inflammation causes bands of scar tissue to form between nodules.

As the scar tissue grows, it compresses the network of blood supply in the liver.

This leads to increased venous pressure and portal hypertension, which occurs as blood backs up into the portal vein.


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