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 va...
Bilirubin
Metabolism
•Blood
•Conjugated &
Conjugated
•Urine – Urobilinogen
•Stool – Stercobilin
Definition:
1. Diffuse disorder of liver characterised
by;
2. Complete loss of normal architecture,
3. Replaced by extensi...
 A chronic progressive disease of the liver
characterized by diffused damage to cells
with fibrosis and nodular regenerat...
Introduction
 Cirrhosis is common end result of many
chronic liver disorders.
 Diffuse scarring of liver – follows
hepat...
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 hemoc...
Pathogenesis:
 Hepatocyte injury leading to necrosis.
 Alcohol, virus, drugs, toxins, genetic etc..

 Chronic inflammat...
Assessment
 Anorexia and wt. loss
 Early morning nausea and vomiting (with
blood)
 Flatulence and changes in bowel habi...
 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 vei...
 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
Liver insult
Alcoholic Ingestion, Viral hepatitis
Exposure to toxins

Increase
wbc

fatigue
Nausea
vomitin...
Liver
necrosis

liver
failure

Liver fibrosis
And scarring
Decrease ADH
edema
Dec.androgen/
Estrogen p.
Dec.met.of CHON
And Carb./
Dec.Fat

Plasma
CHON

Hypoglycemia

Palmar
Loss of...
ascites
edema
Esophageal
varices

hemorrhoids

Liver fibrosis

Portal HPN

bleeding

Superficial
Abdominal
varices

spleno...
Increase
serum
ammonia

Liver failure

Inability to
Metabolize
ammonia

Asterexis

Alterations
In
sleep

Foul breath

Hepa...
Liver Biopsy – Cirrhosis
Liver Biopsy – Cirrhosis:
MRI Cirrhosis
Complications:
 Congestive splenomegaly.
 Bleeding varices.
 Hepatocellular failure.

 Hepatic encephalitis / hepatic ...
Hepatocellular Carcinoma
Conclusions:
 Common end result of diffuse liver damage.
(Viral hepatitis, Alcohol, congenital, drugs, toxins & Idiopathi...
Thank you and
May God be
Glorified
Resources
 Medical Surgical Nursing (Joyce M.Black,
et.al)

Pathology of Hepatitis & Cirrhosis

Venkatesh Murthy Shashid...
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Livercirrhosisl 090306011045-phpapp01

  1. 1. Liver Cirrhosis Presented by: Dave Jay S. Manriquez RN.
  2. 2.  Largest gland in the body  4 lobes  Produced bile  Contains bile salts, pigments, phospholipids, cholesterol and a variety of electrolytes
  3. 3. Bilirubin Metabolism •Blood •Conjugated & Conjugated •Urine – Urobilinogen •Stool – Stercobilin
  4. 4. Definition: 1. Diffuse disorder of liver characterised by; 2. Complete loss of normal architecture, 3. Replaced by extensive fibrosis with, 4. Regenerating parenchymal nodules.
  5. 5.  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
  6. 6. 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.
  7. 7. Major types of Cirrhosis  Laennec Cirrhosis  Post necrotic  Biliary  Cardiac
  8. 8. Micronodular cirrhosis:
  9. 9. Alcoholic Hepatitis
  10. 10. Macronodular Cirrhosis
  11. 11. Nutmeg Liver-Cardiac Sclerosis
  12. 12. Prevalence of Liver Cirrhosis around the world
  13. 13. Normal Liver
  14. 14. Cirrhosis
  15. 15. Etiology of Cirrhosis  Alcoholic liver disease 60-70%  Viral hepatitis 10%  Biliary disease 5-10%  Primary hemochromatosis 5%  Cryptogenic cirrhosis 10-15%
  16. 16. 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.
  17. 17. Assessment  Anorexia and wt. loss  Early morning nausea and vomiting (with blood)  Flatulence and changes in bowel habits  Emaciation  fatigue
  18. 18.  Jaundice  Abdominal pain and tenderness  Ascites  Peripheral edema
  19. 19.  Dry skin and rashes  Petechiae  ecchymosis
  20. 20.  Spider angiomas (nose, cheeks, upper thorax and shoulders)  Hepatomegaly  Protruding umbilicus  Dilated abdominal veins
  21. 21.  Fector hepaticus  Asterixis  delirium
  22. 22. Males (increase estrogen)  Gynecomastia  Impotence  Fall of body hair  Atrophy of testicles
  23. 23. Females (increase androgren)  Hirsutism  Acne  Deepening of voice  Increase virilism
  24. 24. Cirrhosis Clinical Features
  25. 25. Pathophysiology Liver insult Alcoholic Ingestion, Viral hepatitis Exposure to toxins Increase wbc fatigue Nausea vomiting Hepatocyte damage liver Inflammation Alterations in blood and lymph flow pain fever anorexia
  26. 26. Liver necrosis liver failure Liver fibrosis And scarring
  27. 27. Decrease ADH edema Dec.androgen/ Estrogen p. Dec.met.of CHON And Carb./ Dec.Fat Plasma CHON Hypoglycemia Palmar Loss of Spider Erythema angiomas Body hair Testicular Gyneco Menstrual atrophy mastia changes Edema Vit.k absop. bile Bilirubin excretion In urine Bilirubin metabolism Acites Bleeding tendencies Clay-colored stool Dark urine hyperbilirubinemia jaundice
  28. 28. ascites edema Esophageal varices hemorrhoids Liver fibrosis Portal HPN bleeding Superficial Abdominal varices splenomegaly bleeding Anemia Thrombocytopenia leukopenia infection Delayed Wound healing
  29. 29. Increase serum ammonia Liver failure Inability to Metabolize ammonia Asterexis Alterations In sleep Foul breath Hepatic encephalopathy Respiratory acidosis Confusion to Hepatic coma DEATH
  30. 30. Liver Biopsy – Cirrhosis
  31. 31. Liver Biopsy – Cirrhosis:
  32. 32. MRI Cirrhosis
  33. 33. Complications:  Congestive splenomegaly.  Bleeding varices.  Hepatocellular failure.  Hepatic encephalitis / hepatic coma.  Hepatocellular carcinoma.
  34. 34. Hepatocellular Carcinoma
  35. 35. 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.
  36. 36. Thank you and May God be Glorified
  37. 37. Resources  Medical Surgical Nursing (Joyce M.Black, et.al) Pathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine

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