J Drug Dev Del 2019 Inno Volume 2: 1 Journal of Drug Development and Delivery Liver Cirrhosis- Mini Review with a Case Report Saleha Sadeeqa* Institute of Pharmacy, Lahore College for Women University, Lahore, Iram Amanullah Pakistan Abstract Article Information Liver cirrhosis is a diffuse process characterized by liver necrosis, Article Type: Case Report Article Number: JDDD109 abnormal nodules that lack normal lobular organization. It is a late Received Date: 12 March, 2019 stagefibrosis of andscarring conversion of the liverof normal caused liver by manyarchitecture forms ofinto liver structurally diseases Accepted Date: 28 March, 2019 and conditions, such as hepatitis and chronic alcoholism. Lifestyle Published Date: 04 April, 2019 etiological treatment, prophylactic treatment, pre-transplantation care *Corresponding author: Saleha Sadeeqa, Assistant andmodifications liver transplantation. reduce risk of cirrhosis. Clinical management includes Professor, Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan. Tel: +923054122345; Keywords: Email: salehasadeeqa(at)gmail.com Introduction Liver Cirrhosis; Symptoms and Management. Citation: Sadeeqa S, Amanullah I (2019) Liver Cirrhosis- Mini Review with a Case Report. J Drug Dev Del Vol: 2, one cause is present in the same person. Globally, 57% of cirrhosis is Issu: 1 (13-15). Liver cirrhosis has many possible causes; sometimes more than cases.attributable [1] It occurs to either in response hepatitis to B damage (30%) orto yourhepatitis liver. C Each (27%) time Alcohol when Copyright: © 2019 Sadeeqa S. This is an open-access consumption is another major cause, accounting for about 20% of the article distributed under the terms of the Creative Commons liver is injured, it tries to repair itself. In the process, scar tissue forms. As Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the for the liver to function. The liver damage done by cirrhosis generally original author and source are credited. can’tcirrhosis be undone. progresses, But ifmore liver and cirrhosis more scar is diagnosed tissue forms, early making and the it causedifficult is treated, further damage can be limited and, rarely, reversed. [2] of the disease, it becomes smaller. Its surface becomes irregular, Macroscopically, the liver is initially enlarged, but with the progression with steatosis. Depending on the size of the nodules, there are three macroscopicthe consistency types: is firm,micronodular, and the colormacronodular, is often yellow,and mixed if associated cirrhosis. In the micro nodular form or portal cirrhosis, regenerating nodules are less than 3 mm. In macro nodular cirrhosis or post-necrotic cirrhosis, onthe microscopy: nodules are thelarger presence than 3 ofmm. regenerating Mixed cirrhosis nodules consists of hepatocytes of nodules and of different sizes. However, cirrhosis is defined by its pathological features these nodules. Fibrosis can also proliferate even if the underlying process the presence of fibrosis, or the deposition of connective tissue between destruction of other normal tissues in the liver. [3] that caused it has resolved or ceased. The fibrosis in cirrhosis can lead to Hepatic encephalopathy, Hepatorenal syndrome, Spontaneous bacterial peritonitis,Complications Portal hypertensiveinclude Ascites, gastropathy, Esophageal Infection, variceal Hepatocellular bleeding, carcinoma.[4-6] The gold standard for diagnosis of cirrhosis is a liver needle approach. A biopsy is not necessary if the clinical, laboratory, and radiologicbiopsy, through data suggests a percutaneous, cirrhosis. [7] transjugular, laparoscopic, or fine- Lifestyle interventions reduce risk of cirrhosis by taking care of liver. These include: www.innovationinfo.org Avoiding alcohol, eating a healthy diet as fruits and Interventions vegetables, whole grains and lean sources of protein, less Management of drug related problems maintaining a Two diuretics should be reduced to one. amount of fatty and fried foods and Caffeinated coffee may healthy weight, reducing risk of hepatitis, as sharing needles Paracetamol should be replaced by other antipyretic. andprotect having against unprotected fibrosis and sex livercan increasecancer [8] risk of hepatitis Lisinopril is contraindicated in angiodema it should be replaced by Beta blockers. B and C, eating low-sodium diet as excess salt can cause Antibiotics must be prescribed. body to retain fluids, worsening swelling in abdomen and carefully,legs. Avoiding avoid infections, drugs such cirrhosis as aspirin makes and itibuprofen more difficult and use to Promote nutrition afight lower off dose infections of acetaminophen. and using over-the-counter [9] medications SupportEnteral or with parenteral specific feedingsvitamins mayand minerals.be ordered. prophylactic treatment, pre-transplantation care and liver Assist with paracentesis, if needed transplantation.Clinical management Treatment includes guidelines etiological include: antibioticstreatment, to treat infections, laxatives, such as lactulose, to decrease the risk of constipation, alcoholic cirrhosis caused by alcohol up (ascites) to be drained. Assist in set-up, positioning, and Patients may require the abdominal fluid that has built abuse is treated by abstaining from alcohol, treatment for post-procedure site assessments and monitoring as needed. hepatitis-related cirrhosis involves medications used to Daily weights treat the different types of viral hepatitis, such as interferon or oral antiviral such as entecavir and tenofovir in patients of is losing weight cirrhosis due to Hepatitis B prevents progression of cirrhosis, This indicates if fluid has been accumulating, or if patient treatment of autoimmune hepatitis related cirrhosis involves Dietary adjustments: decrease protein, decrease corticosteroids, cirrhosis caused by Wilson’s disease is sodium, restrict fluids treated with chelation therapy to remove the copper for accumulate This will decrease the amount of fluid that may example,If complications penicillamine. cannot [2] be controlled or when the liver Initiate bleeding precautions ceases functioning, liver transplantation is necessary. Survival from liver transplantation has been improving is compromised it can affect these factors, and therefore put the Coagulationpatient at a higherfactors risk are createdfor bleeding in the liver, and if the liver severityover the of1990s, disease and and the other five-year medical survival risk factors rate isin now the Conserve energy recipient.around 80%. Transplantation The survival necessitates rate depends the uselargely of immuneon the suppressants. [10] conserve energy so they can prioritize energy use to Objectives mealtimesPatients and with self cirrhosiscare. tire easily; cluster care and To elaborate liver cirrhosis background including Reassessment causes, features, pathology, complications, prevention and treatment. Review the data base and medical care plan, monitor To make a pharmaceutical care plan of a liver cirrhosis weight and blood pressure, note and address electrolyte patient on daily bases for excess fluid volume, assess daily patient. respiratory assessment (vitals, labs, auscultation). Case presentation imbalances and finally complete a careful and comprehensive Discussion and Conclusion Patient was suffering from liver cirrhosis secondary to presented with chief complaint of padal edema, abdominal hepatitis which is irreversible state. Her chief complaints 27 years old married female with body weight 45kg distention and abdominal pain since one month. She was were abdominal pain, abdominal distension and pedal hypertensive during her pregnancy and c-section was edema. USG report showed end stage liver cirrhosis, coarse and necrotic liver. The risk behind this severe suffering was serum electrolytes and total proteins was performed which the hepatitis in the past left untreated which appeared as showedperformed increase two months level ofago. ALT Laboratory and AST test and CBC, decrease LFT, RFT, Hb. a complication, patient was on palliative care to provide Ultrasound report showed coarse liver and speenomegaly. patient with relief from the symptoms, pain, and stress of Recommended drugs for present illness a serious illness, such as cirrhosis. The goal of palliative care is to improve quality of life for both the patient and the patient’s family and it is appropriate at any stage and for any type of cirrhosis.[11] Desired outcomes of such patient Tab aldoctone 10mg O.D, Inj risek 10mg iv B.D, Inj flagyl should be to minimize continued liver damage, optimize 500mg iv T.D.S, Syp Duphalac 2tbsp B.D, Inj Lasix 20mg iv B.D, Tab Zestril 5mg HS, Tab Panadol 2tabs SOS J Drug Dev Del 2019 14 www.innovationinfo.org nutrition, maximize hepatic circulation, minimize and cirrhosis. prevent respiratory complications.[9]Lifestyle interventions 5. Hepatic encephalopathy: pathophysiology . alcohol, limit salt in diet, get vaccinated for hepatitis A & B, Sundaram V, Shaikh OS (2009) 6. and emerging therapies. Med. Clin. NorthPortal Am Hypertensive 93: 819-836 Gastropathy: andare beneficial pneumococcal including pneumonia. smoking Liver cessation damage and from stop cirrhosisdrinking cannot be reversed, but the treatment could stop or delay SciKim 55: MY, 3561-3567 Choi H, . Baik SK (2010) Correlation with Portal Hypertension and Prognosis in Cirrhosis. Dig Dis 7. Grant A, Neuberger J (1999) Guidelines on the use of liver biopsy in clinical practice. References further