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Liver Cirrhosis
 

Liver Cirrhosis

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

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

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    Liver Cirrhosis Liver Cirrhosis Presentation Transcript

    • 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:
      • 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
    • 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 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
    • Cirrhosis Clinical Features
    • Pathophysiology
      • Alterations in blood and lymph flow
      Liver insult Alcoholic Ingestion, Viral hepatitis Exposure to toxins Hepatocyte damage liver Inflammation pain fever anorexia Nausea vomiting fatigue Increase wbc
    • Liver necrosis liver failure Liver fibrosis And scarring
    • 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
    • Liver fibrosis Portal HPN ascites Anemia Thrombocytopenia leukopenia splenomegaly bleeding hemorrhoids Superficial Abdominal varices Esophageal varices edema infection Delayed Wound healing bleeding
    • Liver failure Inability to Metabolize ammonia Hepatic encephalopathy Confusion to Hepatic coma DEATH Increase serum ammonia Asterexis Respiratory acidosis Alterations In sleep Foul breath
    • 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