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Liver cirrhosis

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VOL: 98, ISSUE: 50, PAGE NO: 32

AETIOLOGY AND RISK FACTORS
AETIOLOGY AND RISK FACTORS
- Cirrhosis describes excessive development of scar tissue within the liver, irrespective of the underlying cause. If chronic or repeated disease occurs the liver cannot regenerate itself and scarring, or fibrosis, develops.


- It can start slowly without symptoms, or with subtle symptoms such as slight weight loss and fatigue, until scar tissue builds up and interferes with liver function. By this stage, the liver cannot regenerate itself effectively.


- The most common causes are sustained alcohol misuse or the late effects of infection with one of the hepatitis viruses (hepatitis B and C).


- Other causes include non-alcoholic fatty liver disease, parasitic infection and prolonged exposure to some drugs and toxins.


- Deaths from cirrhosis among younger people are rising. In 2000, cirrhosis accounted for nearly 500 deaths in men aged 25-44 years and nearly 300 deaths in women of the same age. In both groups there is evidence of substantial numbers who drink heavily and in a pattern of binge drinking.


SIGNS AND SYMPTOMS
- Symptoms usually occur late in the scarring process.


- They include: loss of appetite; nausea and vomiting; dyspepsia; lethargy; weight loss; jaundice; itching; cellulitis; ascites; peripheral oedema; haematemesis; black, tarry stools; fever; confusion; increased sensitivity to drugs and alcohol; clotting disorders; and enlarged liver - palpable below the right rib.


- Complications: impotence in men; encephalopathy; gastric and oesophageal varices; liver cancer; and septicaemia.


DIAGNOSIS
- Physical examination.


- Liver function tests.


- X-ray, ultrasound, magnetic resonance imaging (MRI) or computerised tomography (CT) scan.


- Liver biopsy.


TREATMENT AND THERAPIES
- Medication can include: diuretics; antibiotics; vitamin supplements (B complex, C and K); propanolol, beta-adrenoreceptor blocker (to reduce risk of ruptured varices).


- Encephalopathy: a lowering of the nitrogen being absorbed from the gut with reduction in the intestinal flora by the use of laxatives and oral, non-absorbable antibiotics.


- Surgery: liver transplantation may be considered for patients with end-stage cirrhosis.


- Nutritional supplements.


SPECIFIC NURSING IMPLICATIONS
- Health education on alcohol and the dangers of excessive drinking. The recommended safe limits for weekly alcohol consumption are: 14 units for women and 21 units for men (1 unit = small glass of wine; half-pint of beer; single measure of spirits).


- Fluid balance.


- Tissue viability assessment.


- Nutritional status.


- Neurologic status.


RESEARCH AND DEVELOPMENT
The British Liver Trust website (see below) has details of ongoing and completed research into liver disease.


The NHS Plan states that a national strategy to tackle alcohol misuse will be implemented by 2004.


WEBSITES
British Liver Trust: (also contains details of Liver Nurses' Forum)



National Statistics (contains statistics on alcohol from 1978 onwards)


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