NURSING CARE WITH
INTERFERENCE OF THE HEPATIS SIROSIS
DIGESTION SYSTEM
GROUP 9 :
1. CINDHY DWI SASTIKA (616080716005)
2. HERVINA LUZWINTA ZAGOTO (616080716015)
3. LIDYA NANDA SARI (616080716022)
4. MARDALISA HUTAGALUNG (616080716024)
5. NURFAIZA (616080715026)
6. NURHANANI AFIFAH (616080716035)
7. SAFITRI GUNAWAN (616080716050)
CHAPTER I
PRELIMINARY
A. Background
Based on data from World Health Organization (WHO) 2010, hepatitis cirrhosis is
the fifth highest chronic disease in the world. More than 600,000,000 new cases
are diagnosed globally every year. According to the results of the Basic Health
Research (RISKESDAS) in 2013 that the number of people diagnosed as Hepatic
at health-care facilities based on symptoms, shows a twofold increase when
compared to 2007 and 2013 data.
In Indonesian, the prevalence of cirrhosis of the liver is not present, only
reports from several centers of education only. In RS Dr. Sardjito Yogyakarta the
number of liver cirrhosis patients ranged from 4.1% of patients treated in the
Internal Medicine Department within 1 year 2004 (not published).
A. Problem Formula
1. What is hepatic cirrhosis?
2. What is the cause of cirrhosis of the hepatis?
3. What are the symptoms of hepatic cirrhosis?
4. What is the pathophysiology of cirrhosis of the hepatic?
5. What are diagnostic tests of hepatic cirrhosis?
6. What are the complications of hepatic cirrhosis?
7. How is management of cirrhosis of the hepatic disease?
B. Purpose of writing
8. To know the definition of hepatic cirrhosis
9. To determine the cause of cirrhosis of the hepatis
10. To know the symptoms of cirrhosis hepatis
11. To determine the pathophysiology of hepatic cirrhosis
12. To know the diagnostic examination of cirrhosis of hepatis disease
13. To know the complications of hepatic cirrhosis
14. To know the management of hepatic cirrhosis
CHAPTER II
THEORETICAL REVIEW
[Link]
Cirrhosis is a pathological condition that illustrates the end-stage of
progressive hepatic fibrosis characterized by distortion of the hepatic
architecture and the formation of regenerative nodules. (Sudoyo Aru, et
al. 2009).
This chronic liver disease is characterized by normal liver
architecture destruction by connective tissue sheets and liver cell
regeneration nodules, unrelated to normal vasculature (Sylvia [Link]).
2. Etiology
There are 3 types of hepatic cirrhosis :
a. Laennec cirrhosis in which scar tissue typically surrounds the
portal area. Often caused by chronic alcoholic.
[Link] cirrhosis, where there is a wide band of scar tissue
as a result of continued acute viral hepatitis that occurred
sebeblum him.
c. Biliary cirrhosis, in which the formation of scar tissue occurs in
the liver around the bile ducts. occurs due to chronic biliary
obstruction and infection (cholangitis).
2. Physiological Anatomy
a. Hepatic Structure
Hepar is the largest gland in the human body weighing 1500 or 1.5 kg. The
superior part of the convex hepar and etraced under the right dome of the
diagfragma. The inferior portion of the hollow and under his liver is the
right kidney, gastric, pancreas, and intestine.
b. Liver Funtion
• Hepar performs vital functions, so that humans can not live without the
liver. Hepar plays an important role in the metabolism of carbohydrates,
proteins, fats, which are brought to the liver via portal veins after
absorption by the small intestinal villi.
c. Detoxification
•Hepar has an important role in the detoxification of endogenous and
exogenous substances. One of the highly toxic substances that the liver
treats is ammonia. This ammonia is produced in the large intestine,
bacteria work on proteins to produce ammonia. Through the
enterohepatic circulation, the liver releases ammonia from the blood and
converts it into urea so it is not toxic.
5. Clinical Manifestations
a. Patient Complaints
[Link]
[Link] urine
[Link] size of waist circumference increases
[Link] decline in appetite and weight loss
[Link] (yellowing on skin and eyes) appears l ater
b. Classic sign
1. Red palms
2. Dilation of blood vessels
3. Gynecomastia is not a specific sign
4. Increased protombin time is a more distinctive sign
5. Encephalopathy hepatitis with acute fulminant hepatitis may occur in a
short period of time and the patient will feel drowsy, delirium,
convulsions, and coma within 24 hours
6. The onset of hepatitis encephalopathy with chronic liver failure is slower
and weaker
6. Diagnostic check
a. Examination of abnormal liver function:
1. Increased serum alkaline phosphate, ALT, and AS T (due to hepatic tissue
destruction
2. Increased levels of blood ammonia (resulting from damage to protein
metabolism)
3. PT elongated (due to damage of protomin synthesis and clotting factor)
b. Hepatic biopsy can confirm the diagnosis when serum and radiological
examination can not be concluded
c. CT scans, or MRT are performed to assess hepatic size, the degree of
obstruction of hepatic blood flow
d. Serum electrolytes show hypokalemia, alkalosis, and hyponatremia (caused
by increased aldosterone accretion in response to a low volume of
extracellular fluid secondary to ascites)
e. Urinalysis shows bilirubinuria
f. TDL showed a decrease in HR, hemoglobin, hematocrit, platelets, and SDP
(the result of secondary marrow depression to renal failure and nutrient
metabolism damage)
g. SGOT, SGPT, LDH (up)
h. Retrograde endoscopy kolangiopankreatografi (ERCP) koledukus duct
obstruction
i. Eesophagoscopy (varicose veins) with barium esophagography
j. Biopsy hepar & ultrasonografi (Nurarif & Kusuma, 2015).
7. Complications
a. Portal Hypertension
[Link]
c. Varicose Gastroesophageal
[Link] Bacterial Peritonisis
e. Hepatic encephalopathy
f. Hepatorenal Syndrome
• 8. Management
a. Rest in bed until there is improvement of jaundice,
ascites, and fever.
[Link] protein diet
c. Overcoming infection with antibiotics
[Link] the nutritional status
e. Roboransia. Vitamin B compleks. Do not eat and
drink ingredients that contain alcohol.
CHAPTER III
CASE REVIEW
A. Nursing Diagnosis
1. Acute pain b.d inflammatory acute
[Link] risk of nutritional imbalance is less than
body requirements b.d inadequate nutrition input
[Link] intolerance b.d physical weakness
CHAPTER IV
FINALE
[Link]
• Cirrhosis is a pathological condition that
illustrates the end-stage of progressive hepatic
fibrosis characterized by distortion of the hepatic
architecture and the formation of regenerative
nodules. (Sudoyo Aru, et al. 2009, p...). Various
causes of hepatic cirrhosis include: Malnutrition,
chronic cholestasis, toxic / infection, metabolism:
DM, alcohol, viral hepatitis B & C.
[Link]
It is expected that nurses can improve health
services, by providing health education to patients
and families of patients about cirrhosis hepatis
disease, ways of prevention of transmission by the
family, and how to care for patients at home, so that
the family expected to get a better insight about
cirrhosis disease hepatis.
