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Liver Cirrhosis


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

Published in: Education, Health & Medicine
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Liver Cirrhosis

  1. 1. Liver Cirrhosis Presented by: Dave Jay S. Manriquez RN.
  2. 3. <ul><li>Largest gland in the body </li></ul><ul><li>4 lobes </li></ul><ul><li>Produced bile </li></ul><ul><li>Contains bile salts, pigments, phospholipids, cholesterol and a variety of electrolytes </li></ul>
  3. 4. Bilirubin Metabolism <ul><li>Blood </li></ul><ul><ul><li>Conjugated & Conjugated </li></ul></ul><ul><li>Urine – Urobilinogen </li></ul><ul><li>Stool – Stercobilin </li></ul>
  4. 5. Definition: <ul><li>Diffuse disorder of liver characterised by; </li></ul><ul><li>Complete loss of normal architecture , </li></ul><ul><li>Replaced by extensive fibrosis with, </li></ul><ul><li>Regenerating parenchymal nodules . </li></ul>
  5. 6. <ul><li>A chronic progressive disease of the liver characterized by diffused damage to cells with fibrosis and nodular regeneration </li></ul><ul><li>Repeated destruction of hepatic cells causes the formation of scar tissues </li></ul>
  6. 7. Introduction <ul><li>Cirrhosis is common end result of many chronic liver disorders. </li></ul><ul><li>Diffuse scarring of liver – follows hepatocellular necrosis of hepatitis. </li></ul><ul><li>Inflammation </li></ul><ul><li>Loss of normal architecture & function. </li></ul>
  7. 8. Major types of Cirrhosis <ul><li>Laennec Cirrhosis </li></ul><ul><li>Post necrotic </li></ul><ul><li>Biliary </li></ul><ul><li>Cardiac </li></ul>
  8. 9. Micronodular cirrhosis:
  9. 10. Alcoholic Hepatitis
  10. 11. Macronodular Cirrhosis
  11. 12. Nutmeg Liver-Cardiac Sclerosis
  12. 13. Prevalence of Liver Cirrhosis around the world
  13. 14. Normal Liver
  14. 15. Cirrhosis
  15. 16. Etiology of Cirrhosis <ul><li>Alcoholic liver disease 60-70% </li></ul><ul><li>Viral hepatitis 10% </li></ul><ul><li>Biliary disease 5-10% </li></ul><ul><li>Primary hemochromatosis 5% </li></ul><ul><li>Cryptogenic cirrhosis 10-15% </li></ul>
  16. 17. Pathogenesis: <ul><li>Hepatocyte injury leading to necrosis. </li></ul><ul><ul><li>Alcohol, virus, drugs, toxins, genetic etc.. </li></ul></ul><ul><li>Chronic inflammation - (hepatitis). </li></ul><ul><li>Bridging fibrosis. </li></ul><ul><li>Regeneration of remaining hepatocytes Proliferate as round nodules. </li></ul><ul><li>Loss of vascular arrangement results in regenerating hepatocytes ineffective. </li></ul>
  17. 18. Assessment <ul><li>Anorexia and wt. loss </li></ul><ul><li>Early morning nausea and vomiting (with blood) </li></ul><ul><li>Flatulence and changes in bowel habits </li></ul><ul><li>Emaciation </li></ul><ul><li>fatigue </li></ul>
  18. 19. <ul><li>Jaundice </li></ul><ul><li>Abdominal pain and tenderness </li></ul><ul><li>Ascites </li></ul><ul><li>Peripheral edema </li></ul>
  19. 20. <ul><li>Dry skin and rashes </li></ul><ul><li>Petechiae </li></ul><ul><li>ecchymosis </li></ul>
  20. 21. <ul><li>Spider angiomas (nose, cheeks, upper thorax and shoulders) </li></ul><ul><li>Hepatomegaly </li></ul><ul><li>Protruding umbilicus </li></ul><ul><li>Dilated abdominal veins </li></ul>
  21. 22. <ul><li>Fector hepaticus </li></ul><ul><li>Asterixis </li></ul><ul><li>delirium </li></ul>
  22. 23. <ul><li>Males (increase estrogen) </li></ul><ul><li>Gynecomastia </li></ul><ul><li>Impotence </li></ul><ul><li>Fall of body hair </li></ul><ul><li>Atrophy of testicles </li></ul>
  23. 24. <ul><li>Females (increase androgren) </li></ul><ul><li>Hirsutism </li></ul><ul><li>Acne </li></ul><ul><li>Deepening of voice </li></ul><ul><li>Increase virilism </li></ul>
  24. 25. Cirrhosis Clinical Features
  25. 26. Pathophysiology <ul><li>Alterations in blood and lymph flow </li></ul>Liver insult Alcoholic Ingestion, Viral hepatitis Exposure to toxins Hepatocyte damage liver Inflammation pain fever anorexia Nausea vomiting fatigue Increase wbc
  26. 27. Liver necrosis liver failure Liver fibrosis And scarring
  27. 28. 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
  28. 29. Liver fibrosis Portal HPN ascites Anemia Thrombocytopenia leukopenia splenomegaly bleeding hemorrhoids Superficial Abdominal varices Esophageal varices edema infection Delayed Wound healing bleeding
  29. 30. Liver failure Inability to Metabolize ammonia Hepatic encephalopathy Confusion to Hepatic coma DEATH Increase serum ammonia Asterexis Respiratory acidosis Alterations In sleep Foul breath
  30. 31. Liver Biopsy – Cirrhosis
  31. 32. Liver Biopsy – Cirrhosis:
  32. 33. MRI Cirrhosis
  33. 34. Complications: <ul><li>Congestive splenomegaly. </li></ul><ul><li>Bleeding varices. </li></ul><ul><li>Hepatocellular failure. </li></ul><ul><ul><li>Hepatic encephalitis / hepatic coma. </li></ul></ul><ul><li>Hepatocellular carcinoma. </li></ul>
  34. 35. Hepatocellular Carcinoma
  35. 36. Conclusions: <ul><li>Common end result of diffuse liver damage. (Viral hepatitis, Alcohol, congenital, drugs, toxins & Idiopathic) </li></ul><ul><li>Characterised by diffuse loss of architecture. </li></ul><ul><li>Fibrous bands & regenerating nodules distort and abstruct blood flow. (inefficient function) </li></ul><ul><li>Hepatocellular insufficiency & portal hypertension. </li></ul><ul><li>Shrunken, scarred liver, ascitis, spleenomegaly, liver failure, CNS toxicity. </li></ul>
  36. 37. Thank you and May God be Glorified
  37. 38. Resources <ul><li>Medical Surgical Nursing (Joyce M.Black, </li></ul><ul><li>Pathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine </li></ul>