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1. LIVER
ANATOMY PHYSIOLOGY
AND HIS DISEASE
PREPARED BY : MUHAMMAD MAAZ

2. OBJECTIVE
• By the end of this lecture student will ba able to know
• Liver Anatomy and physiology
• Structure and function of liver
• What is cancer of liver
• Cause, sign ,symptoms and treatment of liver cancer
• What is cirrhosis of the liver
• Cause , medical and nursing management of the cirrhosis of the liver

3. LIVER
• Largest gland and internal organ in the body
• Weight at 1to 2.3 kg
• Location. In the upper part of the abdominal cavity just below the diaphragm
• Occupies whole of the right hypochondrium ,greater part of the epigastrium with
extension into left hypochondrium

4. • Lobes of Liver
• There are four lobes of Liver
• 1 . Right lobes ( largest lobes)
• 2. Left lobes ( smaller ,wedge shape)
• 3. Caudate
• 4. Quadrate

5. • The other two , the caudate and quadrates lobes are on posterior surface
• The portal fissure or porta hepatis region on posterior surface where various
structure
Enter and leave the gland ..

7. STRUCTURE OF LIVER
• Iobes are made up a tiny functional unit , called lobules
• Lobules are formed by coubidal cell, the hepatocytes , arranged in pair of column rediating from
central vein.
• Between two pairs of columns are sinusoids , containing mixed blood from portal vein and
hepatic artery
• In the cell lining of sinusoids kupffer cell ( hepatic macrophages digest and destroy any foreign
partical flowing to the liver) are present
• Sinusoids drain blood into central vein and then merge with hepatic vein ,which empty into the
inferior vena cava
• In the columns of liver cell bile canaliculi are present which join up to form right and left hepatic
which drain bile from liver

8. FUNCTION OF LIVER
• Bile production and excretion
• Metabolism of carbohydrates, fats and proteins
• Breakingdown of erythrocytes and defense against microbes
• Excretion of bilirubin
• Detoxification of drug and toxic substances
• Storage of iron , glycogen,fat soluble vitamins and vit B12
• Production of heat

9. LIVER DISEASE
• Cancer of the Liver
• Hepatocellular carcinoma (HCC) or hepatoma, is the most common type of primary liver cancer and it starts in the main cell type in the liver, the
hepatocytes. Cholangiocarcinoma, or bile duct cancer, starts in the cells lining the bile ducts (which connect the liver to the bowel and gall bladder)
• Angiosarcoma, which starts in the blood vessels. This is a rare type of liver cancer that is more likely to occur in people over 70.
• Secondary cancer in the liver is cancer that started in another part of the body but has spread to the liver. If you have secondary cancer in the liver, it
may be useful to read information about the primary cancer in conjunction with this information or about cancer of unknown primary.
•
• A secondary cancer is named after the primary site where it began, for example bowel cancer with liver secondaries. In this information, we use the
term “secondary cancer in the liver” to refer to any cancer type that has spread to the liver.
•
• It is estimated that more than 2,900 people were diagnosed with liver cancer in 2022. The average age at diagnosis is 68 years old.

10. • Pathophysiology
Hepatocellular carcinoma (HCC) primarily arises in a cirrhotic liver, where repeated
inflammation and fibrinogenesis predispose the liver to dysplasia and malignant
transformation.
Manifestation
When signs and symptoms do appear, they may include unintentional weight loss,
loss of appetite, upper abdominal pain, nausea and vomiting, general weakness and
fatigue, abdominal swelling, jaundice where your eyes and skin turn yellow, and
white, chalky stools.

11. • Diagnostic procedures
• Clinical examination and physical assessment
• Some test and diagnostic procedures used for liver cancer such as CT scan or MRI
• Positron emission tomography ( PET) also used
• Medical Management
• It may include surgery, chemotherapy, using heat to destroy the cancer (thermal
ablation), using targeted medicines, and radiotherapy. The specialist care team
looking after you will: explain the treatments, benefits and side effects. Work with you
to create a treatment plan that is best for you.

12. • Nursing management
• Nursing management for the patient with cirrhosis of the liver should focus on
promoting rest, improving nutritional status, providing skin care, reducing risk of
injury, and monitoring and managing complications
• Nurses have a huge set of responsibilities for handling a patient with cancer.
Nursing care plans for cancer involve assessment, support for therapies (e.g.,
chemotherapy, radiation, etc.), pain control, promoting nutrition, and providing
emotional support.

13. CIRRHOSIS OF THE LIVER
• Cirrhosis is a type of liver damage where healthy cells are replaced by scar tissue.
Common causes include excessive drinking of alcohol, hepatitis B and C virus
infections, and fatty liver that’s caused by obesity and diabetes.

14. • Causes
• Cirrhosis is usually a result of liver damage from conditions such as hepatitis B or C, or
chronic alcohol use. The damage done by cirrhosis typically cannot be undone. But if
caught early enough and depending on the cause, there is a chance of slowing it with
treatment.
• Pathophysiology
• Cirrhosis is characterized by fibrosis and nodule formation of the liver secondary to
chronic injury, leading to alteration of the normal lobular organization of the liver.
Various insults can injure the liver, including viral infections, toxins, hereditary
conditions, or autoimmune processes.

15. • Manifestation
• Feel sick (nausea) lose your appetite. Lose weight and muscle mass. Get red
patches on your palms and small, spider-like blood vessels on your skin (spider
angiomas) above waist levean

16. • Medical management
• A build-up of fluid in your tummy area (ascites) or legs and ankles (peripheral oedema) is a
common complication when cirrhosis progresses. The main treatments are cutting out salt from
your diet and taking a type of medicine called a diuretic, such as spironolactone or furosemide
• Surgical Management
• Liver transplant surgery
• In advanced cases of cirrhosis, when the liver stops working properly, a liver transplant may be
the only treatment option. A liver transplant is a procedure to replace your liver with a healthy
liver from a deceased donor or with part of a liver from a living donor

17. • Diagnostic evaluation
• Tests to confirm a diagnosis of cirrhosis include a complete blood count (CBC), liver
enzyme, liver function and electrolyte testing as well as screening for other health
conditions such as hepatitis B and C viruses, liver cancer or gallstones. In most cases, a
liver biopsy is used to confirm the diagnosis.
• Nursing Management
• Nursing management for the patient with cirrhosis of the liver should focus on
promoting rest, improving nutritional status, providing skin care, reducing risk of
injury, and monitoring and managing complications

18. • Nursing care for patients with liver failure focuses on supporting body systems,
managing signs and symp- toms of decreased liver function, and avoiding worsening
cerebral edema. Monitor level of consciousness, blood pressure, volume status, blood
and coagulation tests, and signs and symptoms.
• Diuretics, which are used in combination with a low-salt diet to reduce the amount of
fluid in your body, which helps with swelling (oedema)
• medicine to help with high blood pressure in the main vein that takes blood to the
liver (portal hypertension)
• prescription creams to ease skin itching

19. MCQ
1.The most common type of primary liver cancer is:
a.Hepatocellular carcinoma75%
b .Intrahepatic cholangiocarcinoma (bile duct cancer)9%
c .Hepatoblastoma6%
d. None of the above7%
2. Aflatoxin B1 is a known risk factor for primary liver cancer.
A .True
B .False
3.Early-stage primary liver cancer is often hard to detect during a physical examination.
A.True
B.False

20. • 4.Which of the following are common symptoms of primary liver cancer?
• A.Weakness or fatigue
• B.Unexplained weight loss
• C.Pain in the right upper quadrant of the abdomen
• D.All of the above
• 5. A blood test can be used to help diagnose primary liver cancer.
• A .True
• B. False

21. • 6.Liver metastases are common in many types of cancer, especially those of the GI
tract, breast, lung, and pancreas. Symptoms of early liver metastases may be
asymptomatic, and nonspecific symptoms often develop first. Which of the
following symptoms of metastases is usually absent or mild until the terminal
stage of the disease?
• A.Hepatic bruits
• B. Hepatomegaly
• C.Jaundice
• D. Splenomegaly

22. 7. If liver metastases are suspected in a patient, which of the following studies has good sensitivity
and specificity for the diagnosis?
A. CT scan without contrast
B. Liver function tests
C. MRI with contrast
D .Ultrasonography
• 8The nurse is caring for a male client with cirrhosis. Which of the following assessment findings
indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
• A. Ascites and orthopnea B. Purpura and petechiae C . Dyspnea and fatigue D .Gynecomastia
and testicular atrophy

23. 9. Which term is used to describe a chronic liver disease in which scar tissue surrounds the portal
areas?
A. Postnecrotic cirrhosis
B .Alcoholic cirrhosis
C. Biliary cirrhosis
D. Compensated cirrhosis
10.A male client with a history of cirrhosis and alcoholism is admitted to the hospital with severe
dyspnea resulting in ascites. The nurse must be aware that the ascites are most likely the result of
increased.
A. Pressure in the portal vein B. Production of serum albumin C . Secretion of bile salts D
.Interstitial osmotic pressure

24. 11.A client with cirrhosis is at risk for developing complications. Which
condition is the most serious and potentially life-threatening?
A. Ascites
B .Esophageal varices
C. Peripheral edema
D .Asterixis (liver flap)
12.A nurse is completing an assessment of a client with cirrhosis. Which of the
following nursing assessment is important to notify the physician?
A. Slurred speech B. Expanding ecchymosis C . Ascites and serum albumin
of 3.2 g/dl D . Hematocrit of 37% and hemoglobin of 12g/dl

25. 13.Which of the following statements is true about the weight of the human liver?
(a) 1.30 kg to 1.56 kg
(b) 1.44 kg to 1.66 kg
(c) 1.36 kg to 1.71 kg
(d) 1.68 kg to 1.86 kg
14.Which of the following is the function of the human liver?
(a) Production of bile
(b) Metabolization of fats
(c) Metabolization of carbohydrates
(d) All of the above

26. 15.Cirrhosis of liver is caused by the chronic intake of
A.Opium B. Alcohol C. Tobacco D. Cocaine
16. The most specific indicator of liver cirrhosis is an increase in the level of
................... Enzyme
A. CoA B. SGPT C.LDH D. CPK
17.Damage to gastric mucosa is increased by alcohol plus
A. Valium B . Marijuana C. Aspirin D. Bariburates

27. 18.A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be
avoided with this patient?*
A. Beef tips and broccoli rabe
B. Pasta noodles and bread
C. Cucumber sandwich with a side of grapes
D. Fresh salad with chopped water chestnuts
19.________ reside in the liver and help remove bacteria, debris, and old red blood cells.*
A. Hepatocytes
B. Langerhan cells
C. Enterocytes
D. Kupffer cells

28. 20.While providing mouth care to a patient with late-stage cirrhosis, you note a
pungent, sweet, musty smell to the breath. This is known as:*
A. Metallic Hepatico
B. Fetor Hepaticus
C. Hepaticoacidosis
D. Asterixis