A.

Hypothesis Cirrhosis is a term that refers to a group of chronic diseases of the liver in which normal liver cells are damaged and replaced by scar tissue, decreasing the amount of normal liver tissue. The distortion of the normal liver structure by the scar tissue interferes with the flow of blood through the liver. It also handicaps the function of the liver which, through the loss of normal liver tissue, leads to failure of the liver to perform some of its critically important functions. The diseases that lead to cirrhosis do so because they injure and kill liver cells and the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmune liver disease in which the body's immune system attacks the liver. In the case of our patient, the factors that have a significant effect on the clients predisposition to liver cirrhosis are age, his gender as a male, alcohol consumption, his autoimmune hepatitis, and his occupation as a lottery operator and tour guide.

A. Predisposing Factors 1. Host Gender- Males are most likely engage in heavy alcoholic drinking. Age 2. Agent Autoimmune Hepatitis Alcoholic drinker 3. Environment B. Ecologic Model C. Analysis The Web model shows the relationship among the more than two predisposing factors mainly agent, host and environment which also determine their imbalance that may lead to an occurrence of a disease. This primarily talks of the multiple causation of the disease. Patients with cirrhosis may have few or no symptoms and signs of liver disease. Some of the symptoms may be nonspecific, that is, they don't suggest that the liver is their cause.

Some of the more common symptoms and signs of cirrhosis include: Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood, Fatigue, Weakness, Loss of appetite, Itching, Easy bruising from decreased production of blood clotting factors by the diseased liver. The pathological hallmark of cirrhosis is the development of scar tissue that replaces normal parenchyma, blocking the portal flow of blood through the organ and disturbing normal function. Recent research shows the pivotal role of the stellate cell, a cell type that normally stores vitamin A, in the development of cirrhosis. Damage to the hepatic parenchyma leads to activation of the stellate cell, which becomes contractile (called myofibroblast) and obstructs blood flow in the circulation. In addition, it secretes TGF-1, which leads to a fibrotic response and proliferation of connective tissue. Furthermore, it disturbs the balance betweenmatrix metalloproteinases and the naturally occurring inhibitors (TIMP 1 and 2), leading to matrix breakdown and replacement by connective tissue-secreted matrix. D. Conclusion It can be inferred in the statements above that the client is suffering from Liver Cirrhosis, and can plausibly be caused by the identified pre-disposing risk factors such as his gender, age, being a heavy alcoholic drinker and has hepatitis B. E. Management Treatment for cirrhosis depends on the cause of the disease and whether complications are present. The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. Hospitalization may be necessary for cirrhosis with complications. Eating a nutritious diet- Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If ascites develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. To improve nutrition, the doctor may add a liquid supplement taken by mouth or through a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach. Avoiding alcohol and other substances- People with cirrhosis are encouraged not to consume any alcohol or illicit substances, as both will cause more liver damage. Because many vitamins and medicationsprescription and over-the-countercan affect liver function, a doctor should be consulted before taking them. Treatment for cirrhosis also addresses specific complications. For edema and ascites, the doctor will recommend diureticsmedications that remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. Oral antibiotics may be prescribed to prevent infection. Severe infection with ascites will require intravenous (IV) antibiotics. Hepatic encephalopathy is treated by cleansing the bowel with lactulosea laxative given orally or in enemas. Antibiotics are added to the treatment if necessary. Patients may be asked to reduce dietary protein intake. Hepatic encephalopathy may improve as other complications of cirrhosis are controlled. Some people with cirrhosis who develop hepatorenal failure must undergo regular hemodialysis treatment, which uses a machine to clean wastes from the blood. Medications are also given to improve blood flow through the kidneys.

Other treatments address the specific causes of cirrhosis. Treatment for cirrhosis caused by hepatitis depends on the specific type of hepatitis. For example, interferon and other antiviral drugs are prescribed for viral hepatitis, and autoimmune hepatitis requires corticosteroids and other drugs that suppress the immune system. Medications are given to treat various symptoms of cirrhosis, such as itching and abdominal pain. NURSING MANAGEMENT Nursing interventions written in the care plan.