Liver Cirrhosis

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: