Liver Cirrhosis

Presented by: Dave Jay S. Manriquez RN.

 Largest gland in the body

4 lobes
Produced bile

Contains bile salts, pigments, phospholipids, cholesterol and a variety of electrolytes

Bilirubin Metabolism
Blood Conjugated & Conjugated Urine Urobilinogen Stool Stercobilin

Definition:
1. Diffuse disorder of liver characterised by;
2. Complete loss of normal architecture, 3. Replaced by extensive fibrosis with, 4. Regenerating parenchymal nodules.

 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

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.

Major types of Cirrhosis

Laennec Cirrhosis

Post necrotic
Biliary

Cardiac

Micronodular cirrhosis:

Alcoholic Hepatitis

Macronodular Cirrhosis

Nutmeg Liver-Cardiac Sclerosis

Prevalence of Liver Cirrhosis around the world

Normal Liver

Cirrhosis

Etiology of Cirrhosis
Alcoholic liver disease 60-70%

Viral hepatitis
Biliary disease

10%
5-10%

Primary hemochromatosis
Cryptogenic cirrhosis

5%
10-15%

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.

Assessment
Anorexia and wt. loss

Early morning nausea and vomiting (with blood)

Flatulence and changes in bowel habits Emaciation fatigue

 Jaundice Abdominal pain and tenderness Ascites Peripheral edema

 Dry skin and rashes Petechiae ecchymosis

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

 Fector hepaticus Asterixis delirium

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

Females (increase androgren) Hirsutism Acne Deepening of voice Increase virilism

Cirrhosis Clinical Features

Pathophysiology
Liver insult Alcoholic Ingestion, Viral hepatitis Exposure to toxins

Increase wbc

Hepatocyte damage liver Inflammation

Alterations in blood and lymph flow

pain
fever
anorexia

fatigue
Nausea vomiting

Liver necrosis

liver failure

Liver fibrosis And scarring

Decrease ADH
edema Dec.androgen/ Estrogen p.
Dec.met.of CHON And Carb./ Dec.Fat
Plasma CHON

Palmar Loss of Spider Erythema angiomas Body hair

Testicular Gyneco Menstrual atrophy mastia changes

Hypoglycemia

Edema Bleeding tendencies

Acites

Vit.k absop.
bile Bilirubin excretion In urine

Clay-colored stool

Dark urine jaundice

Bilirubin metabolism

hyperbilirubinemia

ascites edema
Esophageal varices

hemorrhoids

bleeding

Liver fibrosis

Portal HPN

Superficial Abdominal varices

splenomegaly bleeding
Anemia Thrombocytopenia leukopenia

infection

Delayed Wound healing

Increase serum ammonia

Alterations In sleep

Foul breath

Liver failure

Inability to Metabolize ammonia

Hepatic encephalopathy Confusion to Hepatic coma

Asterexis

Respiratory acidosis

DEATH

Liver Biopsy Cirrhosis

Liver Biopsy Cirrhosis:

MRI Cirrhosis

Complications:
Congestive splenomegaly.
Bleeding varices. Hepatocellular failure.

Hepatic encephalitis / hepatic coma.

Hepatocellular carcinoma.

Hepatocellular Carcinoma

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.

Thank you and May God be Glorified

Resources
Medical Surgical Nursing (Joyce M.Black, et.al)

Pathology of Hepatitis & Cirrhosis

Venkatesh Murthy Shashidhar Associate

Professor of Pathology Fiji School of Medicine