cirrhosis of liver

1. CIRRHOSIS OF LIVER
SHEMIL
CLINICAL INSTRUCTOR
DMWIMS

3. LIVER
 Liver is the largest gland in human body. It is also the largest
(internal) organ in our body and can weigh up to 1.5 kg for a human
adult. It is in the upper-right abdomen, just under the rib cage
and below the diaphragm. The liver is part of the digestive system
 The liver has 2 main lobes: the larger right lobe and the smaller
left lobe. Each lobe is divided into segments

5. BLOOD VESSELS
The liver has 2 major sources of blood:
 portal vein – carries blood from the digestive system to the liver
(75% of the liver’s blood supply comes from the portal vein).
 hepatic artery – supplies the liver with oxygen-rich blood from the
heart

6. FUNCTIONS
1.produces bile
 Bile helps the small intestine digest fat and absorb fats, cholesterol and some
vitamins.
2.absorbs and uses (metabolizes) bilirubin
 Bilirubin is a yellow-red substance formed from hemoglobin when red blood
cells (RBCs) break down.
 The iron from the hemoglobin is stored in the liver or used by the bone marrow
to produce new RBCs.
3.helps the body make blood-clotting (coagulation) factors
 The body needs bile, which is produced by the liver, to absorb vitamin K. The
body uses vitamin K to produce blood-clotting factors.

7. 4.helps the body metabolize fat
Bile breaks down fat from food to make it easier to digest.
5.metabolizes protein
Liver enzymes break down proteins from food so they can be
digested and used by the body.
6.metabolizes carbohydrates
The body breaks down carbohydrates from food into glycogen,
which is stored in the liver. The liver breaks down glycogen into
glucose and releases it into the blood to maintain normal blood
sugar levels.

8. 7.stores vitamins and minerals
 Vitamins A, D, E, K and B12 are stored in the liver.
 The liver stores and releases copper as needed.
8.filters the blood
 The liver filters certain substances from the blood so that they don’t
build up and cause damage. These substances can come from within or
outside the body

9. DEFINITION
Cirrhosis is a slowly progressing disease in which
healthy liver tissue is replaced with scar tissue, eventually
preventing the liver from functioning properly. The scar tissue
blocks the flow of blood through the liver and slows the processing
of nutrients, hormones, drugs, and naturally produced toxins.

11. CAUSES
1. Alcohol( typically, more than two or three drinks per day over a number of years )
2. Hepatitis B
3. Hepatitis C
4. Non-alcoholic fatty liver disease.
a. Overweight
b. Diabetes
c. High blood fats
5. A number of less common causes include,
a. Autoimmune hepatitis
b. Primary biliary cirrhosis(Primary biliary cholangitis is an autoimmune disease of the liver. It results from a
slow, progressive destruction of the small bile ducts of the liver, causing bile and other toxins to build up in the liver, a condition
called cholestasis.)
c. Hemochromatosis(accumulation of iron in the body)
d. Certain medications.
e. Gallstones.

12. SYMPTOMS
 Early on, there are often no symptoms.
As the disease worsens a person may become,
 Tired, weak,itchy
 swelling in the lower legs
 Yellow skin,Anorexia,indigestion,changes in bowel habits.
 Fluid build up in the abdomen
 Spider-like blood vessels on the skin.
 Bleeding from dilated veins in the esophagus or dilated stomach veins.
 Liver cancer.
 Hepatic encephalopathy.
 Apraxia.

13. DIAGNOSIS
1. Liver Biopsy
2. Lab findings
 Thrombocytopenia
 Alkaline phosphatase - slightly elevated but less than
2-3 times the upper limit of normal.
 Bilirubin - may elevate as cirrhosis progresses.

14.  CT
 MRI
 USG

15. MANAGEMENT
 Generally, liver damage from cirrhosis cannot be reversed, but
treatment could stop or delay further progression and reduce
complications.
 A healthy diet-increase CHO& Calories. Protein and fats as
tolerated.
 Antibiotics are prescribed for infections, and various medications
can help with itching.
 Laxatives, such as lactulose, decrease risk of constipation.

16.  Alcoholic cirrhosis is caused by alcohol abuse is treated by
abstaining from alcohol.
 Treatment for hepatitis-related cirrhosis involves medications used
to treat the different types of hepatitis, such as interferon for
viral hepatitis and corticosteroids for autoimmune hepatitis.
 Cirrhosis caused by Wilson's disease, in which copper builds up in
organs, is treated with chelation therapy (for example, penicillamine)
to remove the copper

17. PREVENTING FURTHER LIVER DAMAGE
 Regardless of underlying cause of cirrhosis, alcohol
and paracetamol, as well as other potentially damaging
substances, are discouraged.
 Vaccination of susceptible patients should be considered
for Hepatitis A and Hepatitis B.
TRANSPLANTATION
 If complications cannot be controlled or when the liver ceases
functioning, liver transplantation is necessary. The survival rate
depends largely on the severity of disease and other medical
problems in the recipient.

18. PALLIATIVE CARE
Palliative care is specialized medical care that focuses on providing
patients with relief from the symptoms, pain, and stress of a
serious illness, such as cirrhosis.
Especially in the later stages, people with cirrhosis experience
significant symptoms such as abdominal swelling, itching, leg edema,
and chronic abdominal pain which would be amenable for treatment
through palliative care.

19. COMPLICATIONS
Ascites
 Diuretics may be necessary to suppress ascites. Diuretic options for
inpatient treatment include aldosterone antagonists (spironolactone)
and loop diuretics.
 If a rapid reduction of volume is required, paracentesis is the preferred
option.
Esophageal variceal bleeding
 For portal hypertension, propranolol is a commonly used agent to lower
blood pressure over the portal system.

21. Hepatic encephalopathy.
 High-protein food increases the Ammonia balance and would
theoretically increase encephalopathy.
Spontaneous bacterial peritonitis.
 People with ascites due to cirrhosis are at risk of spontaneous
bacterial peritonitis.

22. Portal hypertensive gastropathy
 Which refers to changes in the mucosa of the stomach in
people with portal hypertension, and is associated with
cirrhosis severity.
Infection
 Cirrhosis can cause immune system dysfunction, leading
to infection. Signs and symptoms of infection may be a specific
and are more difficult to recognize (for example, worsening
encephalopathy but no fever).
Hepatocellular carcinoma

23. PREVENTION
 Reduce alcohol intake
 programs to reduce the transmission of viral hepatitis, and
screening of relatives of people with hereditary liver diseases.
 Little is known on modulators of cirrhosis risk and
progression. Coffee consumption appears to help protect against
cirrhosis.