2. Functions of the liver
• The liver regulates most chemical levels in the blood and
excretes a product called bile.
• This helps carry away waste products from the liver. All the
blood leaving the stomach and intestines passes through the
liver.
• The liver processes this blood and breaks down, balances, and
creates the nutrients and also metabolises drugs into forms that
are easier to use for the rest of the body or that are nontoxic.
• More than 500 vital functions have been identified with the
liver.
3. Some of the more well-known functions include the following:
• Production of bile, which helps carry away waste and break down fats
in the small intestine during digestion
• Production of certain proteins for blood plasma
• Production of cholesterol and special proteins to help carry fats
through the body
• Conversion of excess glucose into glycogen for storage (glycogen can
later be converted back to glucose for energy) and to balance and
make glucose as needed.
• Regulation of blood levels of amino acids, which form the building
blocks of proteins
• Processing of haemoglobin for use of its iron content (the liver stores
iron)
4. • Conversion of poisonous ammonia to urea (urea is an end product
of protein metabolism and is excreted in the urine)
• Clearing the blood of drugs and other poisonous substances
• Regulating blood clotting
• Resisting infections by making immune factors and removing
bacteria from the bloodstream
• Clearance of bilirubin, also from red blood cells. If there is an
accumulation of bilirubin, the skin and eyes turn yellow.
When the liver has broken down harmful substances, its by-products
are excreted into the bile or blood. Bile by-products enter the intestine
and leave the body in the form of feces. Blood by-products are filtered
out by the kidneys, and leave the body in the form of urine.
5. Introduction
• Cirrhosis occurs in response to damage to
liver. Each time liver is injured, it tries to
repair itself. In the process, scar tissue forms.
As cirrhosis progresses, more and more scar
tissue forms, making it difficult for the liver
to function.
6. Definition
• Cirrhosis is a chronic disease characterized by
replacement of normal liver tissue with diffuse
fibrosis that disrupts the structure and function of
the liver. (Brunner)
• Cirrhosis is defined as the presence of large
amounts of scar tissue in the liver due to many
years of liver inflammation and injury.
(Mayo Clinic)
7. Types
There are three types of cirrhosis or scarring of the liver:
• Alcoholic cirrhosis, in which the scar tissue characteristically surrounds the portal
areas. This is most frequently due to chronic alcoholism and is the most common type
of cirrhosis.
• Post-necrotic cirrhosis, in which there are broad bands of scar tissue as a late result
of a previous bout of acute viral hepatitis.
• Biliary cirrhosis, in which scarring occurs in the liver around the bile ducts. This
type usually is the result of chronic biliary obstruction and infection (cholangitis); it is
much less common than the other two types.
8. Causes
• Chronic alcohol abuse
• Chronic viral hepatitis (hepatitis B and C)
• Fat accumulating in the liver (nonalcoholic fatty liver disease)
Other possible causes include:
• Iron buildup in the body (hemochrombtosis)
• Cystic fibrosis
• Copper accumulated in the liver (Wilson's disease)
• Poorly formed bile ducts (biliary atresia)
• Genetic digestive disorder (Alagille syndrome)
• Liver disease caused by body's immune system (autoimmune hepatitis)
• Destruction of the bile ducts (primary biliary cirrhosis)
• Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
• Infection such schistosomiasis
• Medications
9.
10. Symptoms
Cirrhosis often has no signs or symptoms until liver damage is
extensive. When signs and symptoms do occur, they may include:
• Fatigue
• Bleeding easily
• Bruising easily
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Fluid accumulation in abdomen (ascites)
• Loss of appetite
• Nausea
11. • Swelling in legs
• Weight loss
• Confusion, drowsiness and
s l u r r e d s p e e c h ( h e p a t i c
encephalopathy)
• Spider-like blood vessels on skin
• Redness in the palms of the
hands
• Testicular atrophy in men
• Breast enlargement in men
12. Complications
Complications of cirrhosis can include:
Complications related to blood flow:
• High blood pressure in the veins that supply the liver
(portal hypertension). Cirrhosis slows the normal flow of
blood through the liver, thus increasing pressure in the vein
that brings blood from the intestines and spleen to the liver.
• Swelling in the legs and abdomen. Portal hypertension can
cause fluid to accumulate in the abdomen (ascites). Edema and
ascites also may result from the inability of the liver to make
enough of certain blood proteins, such as albumin.
13. • E n l a r g e m e n t o f t h e s p l e e n
(splenomegaly). Portal hypertension
can also cause changes to the spleen.
• Bleeding. Portal hypertension can cause
blood to be redirected to smaller veins,
causing them to increase in size and
become varices. Strained by the extra
load, these smaller veins can burst,
causing serious bleeding. If the liver
can't make enough clotting factors, this
also can contribute to continued
bleeding.
14. Other complications:
•Infections. If there cirrhosis, body may have difficulty fighting
infections. Ascites can lead to spontaneous bacterial peritonitis,
a serious infection.
•Malnutrition. Cirrhosis may make it more difficult for body to
process nutrients, leading to weakness and weight loss.
•Buildup of toxins in the brain (hepatic encephalopathy). A
liver damaged by cirrhosis isn't able to clear toxins from the
blood as well as a healthy liver can. These toxins can then
build up in the brain and cause mental confusion and difficulty
concentrating.
15. •Jaundice. Jaundice occurs when the diseased liver
doesn't remove enough bilirubin, a blood waste
product, from blood. Jaundice causes yellowing of the
skin and whites of the eyes and darkening of urine.
•Increased risk of liver cancer. A large proportion of
people who develop liver cancer that forms within the
liver itself have cirrhosis.
•Acute-or-chronic liver failure. Some people end up
experiencing multi organ failure.
16. Diagnosis
Liver function.
• Blood is checked for excess bilirubin, which is a product of red blood cells
breaking down.
• Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate
dehydrogenase (LDH). An increased level of these enzymes may mean injury
to the liver and the death of liver cells.
• Alkaline phosphatase (ALP). An increased ALP level may mean blockage of
bile ducts.
Kidney function. Blood is checked for creatinine as kidney function may
decline in later stages of cirrhosis (decompensated cirrhosis).
Tests for hepatitis B and C. Blood is checked for the hepatitis viruses.
Clotting. International normalized ratio (INR) is checked for blood's ability to
clot.
17. Doctor may order imaging and other tests to further diagnose
cirrhosis:
• Magnetic resonance elastography or transient
elastography. It is a technology that combines MRI imaging
with low-frequency vibrations to create a visual map
(elastogram) that shows stiffness of body tissues.
• Other imaging tests. MRI, CT and ultrasound create images
of the liver.
• Biopsy. A tissue sample (biopsy) is not necessarily needed to
diagnose cirrhosis. However, doctor may use it to identify the
severity, extent and cause of liver damage.
18. Treatment for the underlying cause of cirrhosis
In early cirrhosis, it may be possible to minimize damage to the
liver by treating the underlying cause. The options include:
• Treatment for alcohol dependency. People with cirrhosis
caused by alcohol abuse should stop drinking.
• Weight loss. People with cirrhosis caused by nonalcoholic
fatty liver disease may become healthier if they lose weight.
• Medications to control hepatitis. Medications may limit
further damage to liver cells caused by hepatitis B or C
through specific treatment of these viruses.
19. Treatment for complications of cirrhosis
• Excess fluid in body. A low-sodium diet and medication to prevent fluid
buildup in the body may help control ascites and swelling. At times, a small
tube — a transjugular intrahepatic portosystemic shunt (TIPS) — is placed in
the vein within the liver to reduce blood pressure in liver and slow the rate of
fluid accumulation.
• Portal hypertension. Certain blood pressure medications may control
increased pressure in the veins that supply the liver (portal hypertension) and
prevent severe bleeding. In severe cases, a TIPS can be placed in the vein
within the liver to reduce blood pressure in liver and to prevent further
bleeding.
• Infections. Patient may receive antibiotics or other treatments for infections.
• Increased liver cancer risk. Doctor will recommend blood tests and
ultrasound exams every six months to look for signs of liver cancer.
20.
21. Liver transplantation
In advanced cases of cirrhosis, when the liver ceases to
function, a liver transplant may be the only treatment
option. People usually need to consider this option when
they develop symptoms from cirrhosis, such as jaundice,
significant fluid retention (ascites), bleeding varices,
hepatic encephalopathy, kidney dysfunction, or liver
cancer. A liver transplant replaces liver with a healthy liver
from a deceased donor or with part of a liver from a living
donor.
22. Nursing diagnosis
1Imbalanced Nutrition: Less Than Body
Requirements
2 Excess Fluid Volume
3 Risk for Impaired Skin Integrity
4 Risk for Injury
5 Risk for Acute Confusion
6 Disturbed Body Image
7Deficient Knowledge
25. • Few cancers originate in the liver.
• Primary tumors ordinarily occur in patients with chronic
liver disease (cirrhosis)
• Hepatocellular carcinoma (HCC), the most common
type of primary liver tumor, usually cannot be resected
because of rapid and metastasis elsewhere.
• Other types include cholangiocellular carcinoma (CCC)
and combined HCC and CCC.
• If found early resection may be possible: however, early
detection is rare.
26. Etiology
• Cirrhosis, hepatitis B and C, and exposure to
certain chemical toxins have been implicated in
the etiology of HCC.
• Cigarette smoking, especially when combined
with alcohol use, has also been identified as a risk
factor.
• Half of all advanced liver cancer cases represent
metastases from other primary sites.
28. Clinical manifestations
• Early manifestations include pain ( dull ache in
upper right quadrant, epigastrium, or back), recent
weight loss, loss of strength, anorexia and anemia.
• Liver enlargement and irregular surface may be
noted on palpation
• Jaundice is present only if larger bile duct are
occluded.
• Ascites occurs if portal veins are obstructed.
29. Diagnosis
• History collection and physical
examination.
• Tumor marker identification: it includes
alfa fetoprotein (AFP), carcinoembryonic
antigen ( CEA)
31. Treatment
Surgical management
• Hepatic lobectomy: can be performed when the primary
hepatic tumor is localized or when the primary site can
be completely excised and the metastasis is limited.
• Capitalising on the regenerative capacity of the liver
cells, 90% of the liver has been removed.
• The presence of cirrhosis limits the ability of the liver to
regenerate.
32. • Liver transplantation: removal of the liver
and replacement with a healthy donor has
been successful, but recurrence rate of
primary liver malignancy after
transplantation is 75-85%.
33. Percutaneous biliary drainage
• Percutaneous biliary drainage is used to bypass
biliary ducts obstructed by the liver, pancreatic,
or bile ducts tumours in patients with inoperable
tumors or those who are surgical risk.
• Complications include sepsis, leakage of bile,
haemorrhage, and reobstruction of the biliary
system.
34.
35.
36. • Radiation therapy
Radiation therapy uses high-powered beams of
energy, such as X-rays and protons, to kill cancer
cells.
• Chemotherapy
Chemotherapy uses drugs to destroy cancer cells,
doctor may recommend chemotherapy to decrease
the chance that the cancer will recur.
