Presented by: Dave Jay S. Manriquez RN.
Liver Cirrhosis
• Largest gland in the body
• 4 lobes
• Produced bile
• Contains bile salts, pigments, phospholipids, cholesterol and a variety of
electrolytes
• Definition:
• Diffuse disorder of liver characterised by;
• Complete loss of normal architecture,
• Replaced by extensive fibrosis with,
• 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
 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
 Etiology of Cirrhosis
 Alcoholic liver disease 60-70%
 Viral hepatitis 10%
 Biliary disease 5-10%
 Primary hemochromatosis 5%
 Cryptogenic cirrhosis 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

Pathophysiology
Liver insult
Alcoholic Ingestion, Viral hepatitis
Exposure to toxins
Increase Hepatocyte
pain
wbc
damage
liver
fatigue fever
Inflammation
anorexia
Nausea Alterations in
vomiting blood and
lymph flow
Liver
necrosis
liver Liver fibrosis
failure And scarring

edema
ascites
Esophageal
varices
hemorrhoid
bleedin
s
g
Liver fibrosis Portal HPN
Superficial
Abdominal
varices
splenomegaly
bleeding
Delayed
Wound
Anemia healing
Thrombocytopenia
infection
leukopenia

Decrease ADH Palmar Loss of
edema Erythema Body hair
Dec.androgen/
Estrogen p.
Testicular
Gyneco Menstrual
Dec.met.of CHON atrophy
Plasma
changes
mastia
And Carb./ CHON
Dec.Fat
Edema
Acites
Hypoglycemia
Vit.k absop. Bleeding
tendencies
bile
Clay-
Bilirubin excretion
Dark urine
In urine
jaundice
hyperbilirubinemia
Bilirubin metabolism

Spider
angiomas
Increase
Alterations
serum
In
ammonia Foul breath
sleep
Hepatic
Inability to
Liver failure encephalopathy
Metabolize
ammonia
Asterexis Confusion to
Hepatic
Respiratory coma
acidosis
DEATH
Complications:
• Congestive splenomegaly.
• Bleeding varices.
• Hepatocellular failure.
• Hepatic encephalitis / hepatic coma.
• Hepatocellular carcinoma.
 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.
Bibliography
 Medical Surgical Nursing (Joyce M.Black, et.al)
 Pathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Associate
Professor of Pathology Fiji School of Medicine

Country/Region Extrapolated Prevalence Population Estimated Used

Cirrhosis of the liver in North America (Extrapolated Statistics)
293,655,4051
USA 431,846
32,507,8742
Canada 47,805
Cirrhosis of the liver in Europe (Extrapolated Statistics)
8,174,7622
Austria 12,021
10,348,2762
Belgium 15,218
60,270,708 for UK2
Britain (United Kingdom) 88,633
1,0246,1782
Czech Republic 1,832
5,413,3922
Denmark 7,960
5,214,5122
Finland 7,668
60,424,2132
France 88,859
10,647,5292
Greece 15,658
82,424,6092
Germany 121,212
293,9662
Iceland 432
10,032,3752
Hungary 14,753
33,4362
Liechtenstein 49
3,969,5582
Ireland 5,837
58,057,4772
Italy 85,378
462,6902
Luxembourg 680
32,2702
Monaco 47
16,318,1992
Netherlands (Holland) 23,997
38,626,3492
Poland 56,803
10,524,1452
Portugal 15,476
40,280,7802
Spain 59,236
8,986,4002
Sweden 13,215
7,450,8672
Switzerland 10,957
60,270,7082
United Kingdom 88,633
2,918,0002
Wales 4,291
Cirrhosis of the liver in the Balkans (Extrapolated Statistics)
3,544,8082
Albania 5,212
407,6082
Bosnia and Herzegovina 599
4,496,8692
Croatia 6,613
2,040,0852
Macedonia 3,000
10,825,9002
Serbia and Montenegro 15,920
Cirrhosis of the liver in Asia (Extrapolated Statistics)
141,340,4762
Bangladesh 207,853

2,185,5692
Bhutan 3,214
1,298,847,6242
China 1,910,070
1,019,2522
East Timor 1,498
6,855,1252
Hong Kong s.a.r. 10,081
1,065,070,6072
India 1,566,280
238,452,9522
Indonesia 350,666
127,333,0022
Japan 187,254
6,068,1172
Laos 8,923
445,2862
Macau s.a.r. 654
23,522,4822
Malaysia 34,591
2,751,3142
Mongolia 4,046
86,241,6972
Philippines 126,826
5,420,2802
Papua New Guinea 7,971
82,662,8002
Vietnam 121,562
4,353,8932
Singapore 6,402
159,196,3362
Pakistan 234,112
22,697,5532
North Korea 33,378
48,233,7602
South Korea 70,932
19,905,1652
Sri Lanka 29,272
22,749,8382
Taiwan 33,455
64,865,5232
Thailand 95,390
Cirrhosis of the liver in Eastern Europe (Extrapolated Statistics)
7,868,3852
Azerbaijan 11,571
10,310,5202
Belarus 15,162
7,517,9732
Bulgaria 11,055
1,341,6642
Estonia 1,973
4,693,8922
Georgia 6,902
15,143,7042
Kazakhstan 22,270
2,306,3062
Latvia 3,391
3,607,8992
Lithuania 5,305
22,355,5512
Romania 32,875
143,974,0592
Russia 211,726
5,423,5672
Slovakia 7,975
2,011,473 2
Slovenia 2,958
7,011,556 2
Tajikistan 10,311
47,732,0792
Ukraine 70,194

26,410,4162
Uzbekistan 38,838
Cirrhosis of the liver in Australasia and Southern Pacific (Extrapolated
Statistics)
19,913,1442
Australia 29,284
3,993,8172
New Zealand 5,873
Cirrhosis of the liver in the Middle East (Extrapolated Statistics)
28,513,6772
Afghanistan 41,931
76,117,4212
Egypt 111,937
1,324,9912
Gaza strip 1,948
67,503,2052
Iran 99,269
25,374,6912
Iraq 37,315
6,199,0082
Israel 9,116
5,611,2022
Jordan 8,251
2,257,5492
Kuwait 3,319
3,777,2182
Lebanon 5,554
5,631,5852
Libya 8,281
25,795,9382
Saudi Arabia 37,935
18,016,8742
Syria 26,495
68,893,9182
Turkey 101,314
2,523,9152
United Arab Emirates 3,711
2,311,2042
West Bank 3,398
20,024,8672
Yemen 29,448
Cirrhosis of the liver in South America (Extrapolated Statistics)
272,9452
Belize 401
184,101,1092
Brazil 270,736
15,823,9572
Chile 23,270
42,310,7752
Colombia 62,221
14,280,5962
Guatemala 21,000
104,959,5942
Mexico 154,352
5,359,7592
Nicaragua 7,881
6,191,3682
Paraguay 9,104
27,544,3052
Peru 40,506
3,897,9602
Puerto Rico 5,732
25,017,3872
Venezuela 36,790
Cirrhosis of the liver in Africa (Extrapolated Statistics)
10,978,5522
Angola 16,144

1,639,2312
Botswana 2,410
3,742,4822
Central African Republic 5,503
9,538,5442
Chad 14,027
2,998,0402
Congo Brazzaville 4,408
58,317,0302
Congo kinshasa 85,760
71,336,5712
Ethiopia 104,906
20,757,0322
Ghana 30,525
32,982,1092
Kenya 48,503
3,390,6352
Liberia 4,986
11,360,5382
Niger 16,706
12,5750,3562
Nigeria 26,103
8,238,6732
Rwanda 12,115
10,852,1472
Senegal 15,959
5,883,8892
Sierra leone 8,652
8,304,6012
Somalia 12,212
39,148,1622
Sudan 57,570
44,448,4702
South Africa 65,365
1,169,2412
Swaziland 1,719
36,070,7992
Tanzania 53,045
26,390,2582
Uganda 38,809
11,025,6902
Zambia 16,214
1,2671,8602
Zimbabwe 5,399