Cirrhosis of liver

Objectives
By the end of this presentation the learners will
be able to :
 Define cirrhosis of liver
 Describe the structure and functions of normal
liver
 Enlist the causes and types of cirrhosis
 Understand the pathogenesis
 Enlist the clinical features
 Objectives Cont..

 Discuss the diagnostic tests

 Explain the management strategies
 Conduct a comprehensive nursing care
 Assess and manage the nutritional status
 Enlist the complications of cirrhotic liver
 Cirrhosis of liver

A chronic ,progressive and

diffused liver disease
characterised by complete loss
of normal architecture replaced
by extensive degeneration and
destruction to the liver .
 Normal Liver
•The largest gland of the

body
•A chemical factory
•The liver is located
behind the ribs in the
upper
right portion of the body
•It weighs about 1500gms
•It has four lobes
 Liver Functions:
 Metabolism – Carbohydrate, Fat & Protein
 Secretory – bile, Bile acids, salts & pigments
 Excretory – Bilirubin, drugs, toxins
 Synthesis – Albumin, coagulation factors
 Storage – Vitamins, carbohydrates etc.
 Detoxification – toxins, ammonia, etc.
 Causes of cirrhosis
Chronic hepatitis due to hepatitis B,C
& D viruses
Alcohol
Metabolic disease e.g Wilson’disease
Autoimmune hepatitis
Extra hepatic bile obstruction
 Types of cirrhotic liver
Alcoholic cirrhosis
Postnecrotic cirrhosis
Biliary cirrhosis
Cardiac cirrhosis
 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.
s
s
 Clinical
Features

•Portal
hypertention
•Hepatic
dysfunction
 Investigations
Physical examination
Serum albumen
WBC,RBC abnormal values
Liver enzymes elevation
Ascetic tap for C/S
Bilirubin metabolism abnormalities

USG and CT scan

Liver biopsy
 Alcoholic Liver Injury:
 Ethyl alcohol : Common cause of
acute/Chronic liver disease
 Alcoholic Liver disease - Patterns
 Fatty change,
 Acute hepatitis (Mallory Hyalin)
 Chronic hepatitis with Portal fibrosis
 Cirrhosis, Chronic Liver failure

 All reversible except cirrhosis stage.

 Postnecrotic cirrhosis
Broad bands of scar tissue
A late result of previous bout of acute
viral hepatitis
Islands of residual normal tissue and
regenerating liver tissue may project
 Biliary Cirrhosis
•Scaring occurs in the liver
around the bileducts
• It is the result of chronic
biliary obstruction
• Due to infection
( cholangitis)
• Less common type of
hepatic cirrhosis
 Management
Symptomatic treatment
Antacids
Vitamins and nutritional

supplements
Potassium sparing diuretics
Avoidance of alcohol
Peritoneovenous shunt
 Nursing care
Mobilization
Comfortable position of patient on bed
Daily weight
 Maintain Intake and output
In time medication
Oxygen therapy if needed
Provide skin care(pressure areas care)
Avoid falling and other injuries
Improving nutritional status
 Nutritional status
•Nutritious high protien diet
•Supplimented by vitamins,folic acid and iron
•Encourage to eat
•Small frequent meals
• protien restricted if encephalopathy
develops
•Sodium restricted
•A high caloric intake should be maintained
 Complications
Bleeding and haemorrhage
Hepatic Encephalopathy
Fluid volume excess
Ascites
Progressive wasting of muscles
Deranged metabolism
 Cont...
Complications
Oesophageal varices
Anorexia
Purpura
Wt loss
Splenomegaly
 Conclusions
 Common end result of diffuse liver
damage.
 Characterised by diffuse loss of
architecture.
 Fibrous bands & regenerating nodules
 Shrunken, scarred liver, ascitis,
spleenomegaly, liver failure, CNS toxicity.
 References
 Essentials of Pathophysiology by

Thomus J.Nowak & A.Gordon Handford

 Medical-Surgical Nursing by
Suzanne C.Smeltzer Brenda bare
 www.google.com