Liver Cirrhosis: Causes, Risk Factors, And Nursing Interventions

The Main Causes of Liver Cirrhosis

Question:

Discuss about the Acute Care Nursing for Eventual Development.

The main cause behind the development of liver cirrhosis by Mr Nathan James is his hepatitis C infection which he had encountered 10 years ago. This is because, according to the reports published by Chen and Morgan (2006), chronic hepatitis C is the leading cause of chronic liver disease and liver cirrhosis. Chen and Morgan (2006) have further opined that nearly one third of the chronically ill patient of hepatitis C develops progressive liver injury followed by fibrosis and eventual development of liver cirrhosis over a period of 20 to 30 years. Approximately 75 to 85% of hepatitis C virus infected individual will progress towards chronic hepatitis C infection and these individuals are more susceptible towards developing extrahepatic manifestations along with compensated and decompensated liver cirrhosis (Chen & Morgan, 2006).

The main risk factor which further made Mr Nathan James susceptible towards developing liver cirrhosis is consumption of alcohol. According to the case study, Mr James used to consume 2 cans of beer per day. Alcohol is the main contributing risk factor behind the development of liver cirrhosis or is also responsible for developing alcohol-induced liver cirrhosis (Askgaard et al.2015). However, from the case study, it is still not clear whether Mr Nathan James have developed alcoholic or non-alcoholic liver disease. Askgaard et al. (2015) have opined that regular drinking tendency or the pattern of drinking is associated with the development of liver cirrhosis.

The liver cirrhosis has hampered both the physical and mental state of Mr James. In the physiological parameter, it can be easily detected from the case study that he is spitting blood stained sputum along with weight loss and loss of appetite. Mr James has also developed certain unexplained scars over his arms along with distended abdomen, oedema in the ankles and mild jaundice. In the mental scale, Mr James irritated. Apart from Mr James, his family will also get affect. According to Golics et al. (2013), there is a significant impact on the quality of life of the members of family with patients of chronic disease. The family members of the patients experience worriedness, frustration and stress such that the members of the family are more emotionally affected by illness in comparison to the patient (Golics et al. 2013).

(Source: Tsochatzis, Bosch & Burroughs, 2014)

Corticosteroid is one of the most popular choices for treating the patient with alcohol induced liver cirrhosis. Corticosteroid acts via reducing the secretion of the inflammatory cytokines like intercellular adhesion molecule 1, tumour necrosis factor-α (TNF-α), IL-8 and interlukin (IL)-6. Corticosteroid like gluco-corticoid inhibits the initial events occurring in an inflammatory response. Gluco-corticoid inhibits vasodilatation via increasing the vascular permeability that occurs after the inflammatory insult and thus they decrease the migration of leukocyte towards the site of inflammation (Mathurin&Bataller, 2015). Thus cortico-steroid or gluco-corticosteroid is effective in treating liver cirrhosis because according to Dirchwolf and Ruf (2015), systemic inflammation and deregulation of the immune system are two most important pathological pathways of the disease development. Here systemic inflammation is mediated via activation of innate and adaptive immune cells which results in increase production of inflammatory and pro-inflammatory cytokines.Mathurin andBataller (2015)is of the opinion that upon administration of glucocorticoid, blood neutrophil leucocytosis reaches the pick along with the decrease in the blood serum concentration of monocytes, lymphocytes and esoniophills. Neutrophil leucocytosis inhibits the ability of neutrophil to accumulate at the site of inflammation and thereby reducing inflammatory response(Mathurin&Bataller, 2015).

Risk Factors for Developing Liver Cirrhosis

According to colchicine reduces acute injury of liver via inhibiting collagen secretion and increasing collagen degradation and thus decreasing the rate of liver fibrosis. According to Morgan et al. (2017), long term treatment of liver cirrhosis via colchicine does not decrease the overall mortality or mortality specific to liver among the patients who are in their advanced stage. The comprehensive impact of colchicine on morbidity of liver disease is marginal. However, treatment with colchicine, a mitotic spindle inhibitor is associated with decrease incidence of upper gastro-intestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis. The clinical significance behind the lower incidence of less gynecomastia, erythma and edema among the patients who are under colchicine treatment is unclear(Morgan et al., 2017). Colchicine however, helps to reduce the number of hospitalization, reduced rate of occurrence of hepatorenal syndrome. But the process by which colchicine reduces hepatorenal syndrome is also not known till now (Morgan et al., 2017).

According to Aron-Wisnewsky et al. (2012)oxygen saturation of patient must be in between 90 to 100% but in case of Mr Nathan James, the SpO2: 88% on RA and 95% on 6L through Hudson mask. The first nursing intervention will be to keep the oxygen saturation steady via continuation of titrated oxygen supply via Hudson mask or via the application of nasal canula. Proper oxygen saturation will also help to reduce the risk or chronicity of tachypnoia. Aron-Wisnewsky et al. (2012) have opined that patients of liver cirrhosis has a tendency to suffer from hypoxia and low amount of oxygen in blood of Mr James is the indication towards hypoxic conditions and hence external supply of oxygen will helpful to increase the oxygen saturation with the body.

Second nursing intervention, which must be done with 24 hours of emergency department admission include intravenous injection of Lasix to Mr James. Lasix is furosemide that is administered in order to reduce fluid within the body (oedema) caused via conditions like liver disease, heart failure and kidney disease (Qavi, Kamal &Schrier, 2015). Furosemide can also be define as water pill that helps in the formation of more urine and thereby reducing excess fluid content of the body(Qavi, Kamal &Schrier, 2015). Administration of Lasix will help in reducing the symptoms of Mr James like poor oxygen saturation, swelling of the lower extremity of foot (ankles) and distended abdomen. However, administration of Lasix should only be done after the approval from the medical practitioner (doctor). According to the reports published by Thapaliya et al. (2013), administration of Lasix have been found to provide positive results with patients of liver cirrhosis and who is suffering from ascites and portal hypertension.

Symptoms of Liver Cirrhosis

Immediate observance of fluid restricted diet (1500 ml) as per the orders coming from the medical officer is third most important nursing intervention that must be employed immediately after admission in emergency department. Along with fluid restricted diet, the output of urine should be measured after each shift. This is because, according to the recent report, renal dysfunction is the most common problem with the patients suffering from advanced liver disease like liver cirrhosis(Runyon, 2013). More specifically, alterations in the physiology of renal system in advanced to acute liver failure or liver cirrhosis with ascites can predispose patients to a specific form of renal problems(Runyon, 2013). Mr James has already displayed the signs and symptom of ascites for example distended stomach hence observance of fluid restricted diet will help lower retention of fluid inside the body and measurement of the urine output will help to ascertain the condition of the kidneys.

Another immediate nursing intervention include blood test for the detection of bilirubin content in blood as Mr James’s sclera show evidence of mild jaundice. According to Wang et al. (2012) since cirrhosis, is the disease of liver, occurrence of jaundice is a common phenomenon and hence detection of serum bilirubin will help to get a rough overview about the condition of the liver.

References

Aron-Wisnewsky, J., Minville, C., Tordjman, J., Lévy, P., Bouillot, J. L., Basdevant, A., ...&Pépin, J. L. (2012). Chronic intermittent hypoxia is a major trigger for non-alcoholic fatty liver disease in morbid obese. Journal of hepatology, 56(1), 225-233.

Askgaard, G., Grønbæk, M., Kjær, M. S., Tjønneland, A., &Tolstrup, J. S. (2015).Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. Journal of hepatology, 62(5), 1061-1067.

Chen, S.L. & Morgan, T.R. (2006).The natural history of hepatitis C virus (HCV) infection. International journal of medical sciences, 3(2), p.47.

Dirchwolf, M., &Ruf, A. E. (2015).Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis. World journal of hepatology, 7(16), 1974.

Golics, C. J., Basra, M. K. A., Salek, M. S., & Finlay, A. Y. (2013).The impact of patients’ chronic disease on family quality of life: an experience from 26 specialties. International journal of general medicine, 6, 787.

Mathurin, P., &Bataller, R. (2015).Trends in the management and burden of alcoholic liver disease. Journal of hepatology, 62(1), S38-S46.

Morgan, T. R., Weiss, D. G., Nemchausky, B., Schiff, E. R., Anand, B., Simon, F., ...&Lieber, C. (2017). Colchicine treatment of alcoholic cirrhosis: a randomized, placebo-controlled clinical trial of patient survival. Gastroenterology, 128(4), 882-890.

Qavi, A. H., Kamal, R., &Schrier, R. W. (2015).Clinical use of diuretics in heart failure, cirrhosis, and nephrotic syndrome. International journal of nephrology, 2015.

Runyon, B. A. (2013). Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 57(4), 1651-1653.

Thapaliya, K., Bhandary, A., Basnet, S., &Aryal, B. (2013).Clinical status of furosemide on liver cirrhosis with portal hypertension and ascites. Journal of Chitwan Medical College, 3(1), 65-66.

Tsochatzis, E. A., Bosch, J., & Burroughs, A. K. (2014).Liver cirrhosis. The Lancet, 383(9930), 1749-1761.

Wang, X., Zhang, A., Han, Y., Wang, P., Sun, H., Song, G., ...&Xie, N. (2012). Urine metabolomics analysis for biomarker discovery and detection of jaundice syndrome in patients with liver disease. Molecular & Cellular Proteomics, 11(8), 370-380.