Cirrhosis of liver

cirrhosis of liver

1. CIRRHOSIS OF LIVER SHEMIL CLINICAL INSTRUCTOR DMWIMS

2. LIVER Liver  is the largest gland in human body. It is also the largest (internal)  organ  in our body and can weigh up to 1.5 kg for a human adult . It is in the upper-right abdomen, just under the rib cage and below the diaphragm. The liver is part of the digestive system The liver has 2 main lobes: the larger right lobe and the smaller left lobe. Each lobe is divided into segments

3. BLOOD VESSELS The liver has 2 major sources of blood: portal vein – carries blood from the digestive system to the liver (75 % of the liver’s blood supply comes from the portal vein). hepatic artery – supplies the liver with oxygen-rich blood from the heart

4. FUNCTIONS 1.produces bile Bile helps the small intestine digest fat and absorb fats, cholesterol and some vitamins. 2.absorbs and uses (metabolizes) bilirubin Bilirubin is a yellow-red substance formed from hemoglobin when red blood cells (RBCs) break down. The iron from the hemoglobin is stored in the liver or used by the bone marrow to produce new RBCs. 3.helps the body make blood-clotting (coagulation) factors The body needs bile, which is produced by the liver, to absorb vitamin K. The body uses vitamin K to produce blood-clotting factors.

5. 4.helps the body metabolize fat Bile breaks down fat from food to make it easier to digest. 5.metabolizes protein Liver enzymes break down proteins from food so they can be digested and used by the body. 6.metabolizes carbohydrates The body breaks down carbohydrates from food into glycogen, which is stored in the liver. The liver breaks down glycogen into glucose and releases it into the blood to maintain normal blood sugar levels.

6. 7.stores vitamins and minerals Vitamins A, D, E, K and B12 are stored in the liver. The liver stores and releases copper as needed. 8.filters the blood The liver filters certain substances from the blood so that they don’t build up and cause damage. These substances can come from within or outside the body

7. DEFINITION Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins.

8. CAUSES 1.  Alcohol( typically, more than two or three drinks per day over a number of years ) 2. Hepatitis B 3. Hepatitis C 4. Non-alcoholic fatty liver disease. a . Overweight   b. Diabetes c . High blood fats 5. A number of less common causes include,   a . Autoimmune hepatitis  b. Primary biliary cirrhosis( Primary biliary   cholangitis is an autoimmune disease of the liver. It results from a slow, progressive destruction of the small bile ducts of the liver, causing bile and other toxins to build up in the liver, a condition called cholestasis .) c . Hemochromatosis( accumulation of iron in the body) d . Certain medications . e. Gallstones. 

9. SYMPTOMS  Early on, there are often no symptoms. As the disease worsens a person may become, Tired, weak,itchy  swelling in the lower legs Yellow skin,Anorexia,indigestion,changes in bowel habits. Fluid build up in the abdomen Spider-like blood vessels on the skin. Bleeding from dilated veins in the esophagus or dilated stomach veins.  Liver cancer. Hepatic encephalopathy. Apraxia.

10. DIAGNOSIS Liver Biopsy Lab findings Thrombocytopenia Alkaline phosphatase - slightly elevated but less than 2-3 times the upper limit of normal . Bilirubin  - may elevate as cirrhosis progresses.

11. CT MRI USG

12. MANAGEMENT Generally, liver damage from cirrhosis cannot be reversed, but treatment could stop or delay further progression and reduce complications . A healthy diet-increase CHO& Calories. Protein and fats as tolerated. Antibiotics are prescribed for infections, and various medications can help with itching. Laxatives , such as lactulose, decrease risk of constipation.

13. Alcoholic cirrhosis is caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. Cirrhosis caused by Wilson's disease, in which copper builds up in organs, is treated with chelation therapy (for example, penicillamine) to remove the copper

14. PREVENTING FURTHER LIVER DAMAGE Regardless of underlying cause of cirrhosis, alcohol and paracetamol, as well as other potentially damaging substances, are discouraged . Vaccination of susceptible patients should be considered for  Hepatitis A and Hepatitis B. TRANSPLANTATION If complications cannot be controlled or when the liver ceases functioning, liver transplantation is necessary . The survival rate depends largely on the severity of disease and other medical problems in the recipient.

15. PALLIATIVE CARE Palliative care is specialized medical care that focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness, such as cirrhosis. Especially in the later stages, people with cirrhosis experience significant symptoms such as abdominal swelling, itching, leg edema, and chronic abdominal pain which would be amenable for treatment through palliative care.

16. COMPLICATIONS Ascites  Diuretics may be necessary to suppress ascites. Diuretic options for inpatient treatment include aldosterone antagonists (spironolactone) and loop diuretics. If a rapid reduction of volume is required,  paracentesis  is the preferred option. Esophageal variceal bleeding For portal hypertension, propranolol is a commonly used agent to lower blood pressure over the portal system .

17. Hepatic encephalopathy . High-protein food increases the Ammonia balance and would theoretically increase encephalopathy. Spontaneous bacterial peritonitis . People with ascites due to cirrhosis are at risk of spontaneous bacterial peritonitis.

18. Portal hypertensive gastropathy Which refers to changes in the mucosa of the stomach in people with portal hypertension, and is associated with cirrhosis severity. Infection Cirrhosis can cause immune system dysfunction, leading to infection. Signs and symptoms of infection may be a specific and are more difficult to recognize (for example, worsening encephalopathy but no fever). Hepatocellular carcinoma

19. PREVENTION R educe alcohol intake programs to reduce the transmission of viral hepatitis, and screening of relatives of people with hereditary liver diseases . Little is known on modulators of cirrhosis risk and progression. Coffee consumption appears to help protect against cirrhosis .