a. Cirrhosis is a chronic disease of the liver characterized by destruction of the parenchyma (functional) cells, with fibrotic tissue replacement.

This degeneration causes impaired blood and lymph flow, which results in hepatic insufficiency. The major causes of cirrhosis are alcohol abuse and chronic hepatitis.

b. Cirrhosis has a long, latent period with vague gastrointestinal symptoms including anorexia, indigestion, nausea, vomiting, constipation, and diarrhea.

c. The latent period ends with the abrupt appearance of abdominal swelling and pain, hematemesis, and dependent edema. Skin turgor is poor, with accompanying dryness and pruritis.

d. The condition advances to include symptoms that are a result of hepatic insufficiency, portal HTN, and hepatic encephalopathy. Such symptoms include:

(1) Ascites.

(2) Jaundice.

(3) Bleeding tendencies (nosebleeds, bleeding gums, easy bruising).

(4) Bleeding esophageal varices (2º portal HTN).

(5) Limited thoracic expansion that interferes with gas exchanges (2 ascites).

(6) Central nervous system disorders (2º hepatic encephalopathy) to include lethargy, slurred speech, mental changes, and peripheral neuritis.