Liver Cirrhosis

The disease Liver Cirrhosis, its definition, epidemiology, pathophysiology and anatomy, its medical and nursing management.

1. Liver Liver
CirrhosisCirrhosis
Presented by: Dave Jay S. Manriquez Presented by: Dave Jay S. Manriquez
RN.RN.

3. Largest gland in the body
4 lobes
Produced bile
Contains bile salts, pigments, phospholipids,
cholesterol and a variety of electrolytes

4. Bilirubin
Metabolism
•Blood
•Conjugated &
Conjugated
•Urine – Urobilinogen
•Stool – Stercobilin

5. Definition:
uDiffuse disorder of liver characterised
by;
uComplete loss of normal architecture,
uReplaced by extensive fibrosis with,
uRegenerating parenchymal nodules.

6. A chronic progressive disease of the liver
characterized by diffused damage to cells
with fibrosis and nodular regeneration

Repeated destruction of hepatic cells
causes the formation of scar tissues

7. Introduction
Cirrhosis is common end result of many
chronic liver disorders.
Diffuse scarring of liver – follows
hepatocellular necrosis of hepatitis.
Inflammation
Loss of normal architecture & function.

8. Major types of Cirrhosis
Laennec Cirrhosis
Post necrotic
Biliary
Cardiac

9. Micronodular cirrhosis:

10. Alcoholic Hepatitis

11. Macronodular Cirrhosis

12. Nutmeg Liver-Cardiac Sclerosis

13. Prevalence of Liver Cirrhosis
around the world

14. Normal Liver

15. Cirrhosis

16. Etiology of Cirrhosis
Alcoholic liver disease 60-70%
Viral hepatitis 10%
Biliary disease 5-10%
Primary hemochromatosis 5%
Cryptogenic cirrhosis 10-15%

17. Pathogenesis:
Hepatocyte injury leading to necrosis.
Alcohol, virus, drugs, toxins, genetic etc..
Chronic inflammation - (hepatitis).
Bridging fibrosis.
Regeneration of remaining hepatocytes
Proliferate as round nodules.
Loss of vascular arrangement results in
regenerating hepatocytes ineffective.

18. Assessment
Anorexia and wt. loss
Early morning nausea and vomiting (with
blood)
Flatulence and changes in bowel habits
Emaciation
fatigue

19. Jaundice
Abdominal pain and tenderness
Ascites
Peripheral edema

20. Dry skin and rashes
Petechiae
ecchymosis

21. Spider angiomas (nose, cheeks, upper
thorax and shoulders)
Hepatomegaly
Protruding umbilicus
Dilated abdominal veins

22. Fector hepaticus
Asterixis
delirium

23. Males (increase estrogen)
Gynecomastia
Impotence
Fall of body hair
Atrophy of testicles

24. Females (increase androgren)
Hirsutism
Acne
Deepening of voice

Increase virilism

25. Cirrhosis
Clinical
Features

26. Pathophysiology
Liver insult
Alcoholic Ingestion, Viral hepatitis
Exposure to toxins
Hepatocyte
damage
Alterations in
blood and
lymph flow
liver
Inflammation
pain
fever
anorexiaNausea
vomiting
fatigue
Increase
wbc

27. Liver
necrosis
liver liver
failurefailure
Liver fibrosisLiver fibrosis
And scarringAnd scarring

28. Dec.androgen/
Estrogen p.
Decrease ADH
Dec.met.of CHON
And Carb./
Dec.Fat
bile
Vit.k absop.
hyperbilirubinemia
Plasma
CHON
Bilirubin metabolism
Bilirubin excretion
In urine

Clay-colored
stool
Dark urine
jaundice
Bleeding
tendencies
Spider
angiomas
Testicular
atrophy
Gyneco
mastia
Palmar
Erythema
Loss of
Body hair
Menstrual
changes
edema
Hypoglycemia Acites
Edema

29. Liver fibrosisLiver fibrosis Portal HPN
ascites
Anemia
Thrombocytopenia
leukopenia
splenomegaly
bleeding
hemorrhoids
Superficial
Abdominal
varices
Esophageal
varices
edema
infection
Delayed
Wound
healing
bleeding

30. Liver failureLiver failure
Inability to
Metabolize
ammonia
Hepatic
encephalopathy
Confusion to
Hepatic
coma
DEATHDEATH
Increase
serum
ammonia
Asterexis
Respiratory
acidosis
Alterations
In
sleep
Foul breath

31. Liver Biopsy – Cirrhosis

32. Liver Biopsy – Cirrhosis:

33. MRI Cirrhosis

34. Complications:
Congestive splenomegaly.
Bleeding varices.
Hepatocellular failure.
Hepatic encephalitis / hepatic coma.
Hepatocellular carcinoma.

35. Hepatocellular Carcinoma

36. Conclusions:
Common end result of diffuse liver damage.
(Viral hepatitis, Alcohol, congenital, drugs, toxins & Idiopathic)
Characterised by diffuse loss of architecture.
Fibrous bands & regenerating nodules distort
and abstruct blood flow. (inefficient function)
Hepatocellular insufficiency & portal
hypertension.
Shrunken, scarred liver, ascitis,
spleenomegaly, liver failure, CNS toxicity.

37. Thank you and Thank you and
May God be May God be
GlorifiedGlorified

38. Resources
Medical Surgical Nursing (Joyce M.Black,
et.al)
Pathology of Hepatitis & CirrhosisPathology of Hepatitis & Cirrhosis
Venkatesh Murthy Shashidhar Venkatesh Murthy Shashidhar Associate
Professor of Pathology Fiji School of Medicine