CASE PRESENTATION OF LIVER CIRRHOSIS PPT

1. NON ALCOHOLIC LIVER
CIRRHOSIS
GUIDED BY
HEMAKSHI CHAUDHARI
DEPT OF CLINICAL
PHARMACY
RCPIPER,SHIRPUR
PRESENTED BY
MADHUKAR THAGNAR
M.PHARM 1ST YEAR
SEAT NO : 22MPP1010
DEPT OF CLINICAL
PHARMACY
RCPIPER,SHIRPUR

2. DEFINITION
Cirrhosis of liver is a chronic,
progressive disease
characterized by widespread
fibrosis(scarring) and nodule
formation.
The development of cirrhosis
is an insidious, prolonged
course, usually after decades
of chronic liver disease.

3. Cirrhosis is a consequence of chronic liver disease,
Characterized by replacement of liver tissue by
fibrosis, scar tissue and regenerative nodules
It leading to loss of liver function.

4. It is a chronic
disease in
which there
has been
diffuse
destruction
and fibrotic
regeneration
of hepatic
cells.

5. SYMPTOMS
1. yellowing of the
skin and whites of the
eyes (jaundice)
2. vomiting blood.
3. itchy skin.
4. Red palms
5. Lack of body hair
6. Mentally distrub
condition.

6. STAGES OF LIVER DAMAGE

7. CLASSIFICATION
Nonalcoholic Fatty
Liver (NAFL)
Nonalcoholic
Steatohepatitis (NASH)

8. NON ALCOHOLIC FATTY LIVER
(NAFL)
NAFL is A form of NAFLD
Have fat in your liver but little or no inflammation or
liver damage.
NAFL typically does not progress to cause liver
damage or complications. However, NAFL can cause
pain from enlargement of the liver.

9. NON ALCOHOLIC STEATOHEPATITIS
(NASH).
NASH is the form of NAFLD in which you
have inflammation of the liver and liver
damage,
1. in addition to fat in your liver
2.The inflammation and liver damage of
NASH can cause fibrosis, or scarring, of the
liver.
3. NASH may lead to cirrhosis, in which the
liver is scarred and permanently damaged.
Cirrhosis can lead to liver cancer

10. ETIOLOGY & RISK FACTORS
chronic (long-term) viral infections
of the liver (hepatitis types B and C),
fatty liver associated with obesity
and diabetes,
alcohol abuse.

11. PATHOPHYSIOLOGY

12. H
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P
A
T
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C
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C
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P
H
A
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P
A
T
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Y

14. STAGES OF LIVER DAMAGE

15. PROFORMA
Name : Mr . XYZ
Address : Shirpur
Age : 72 yrs.
Sex : Male
Weight : 65 kgs.
Hospital name : I.G.M Hospital Shirpur
D.O.A : 12/01/2023
D.O.D : 16/01/2023
Consultant name : Dr. Parag Patil

16. HISTORY OF PRESENT ILLNESS
A 72 yrs Year old male patient Admitted in Hospital
under Dr. Patil.
Patient have no drug Allergy.Problem with signs of
abdomen pain &fatigue
Chief Complaints
Abdomen pain
Fatigue
Anorexi
Weakness
Fever

17. HEMATOLOGY REPORT
Test name Result Normal Range
Hemoglobin 8.0 g/dl 12-14.5 g/dl
Total Leukocyte count 10110/cu.mm 4000-11000 /cu.mm
Differential:
NEUT % 68% 50-70%
LYMP% 18% 20-40%
EOS % 10% 1-6%
MONO% 04% 2-10%
BASO% 00% 0-1%
Platelets: 1,36,000 /cu.mm 1,50,000-4,50,500

18. BIOCHEMICAL TESTS
TEST RESULT NORMAL RANGE
Serum albumine 2.6 mg/dl 3.2 – 5.0 mg/dl
TEST RESULT Bio. Referal interval
Glucose 176.94 mg/dl 40-70 mg/dl
Serum Potassium( K+) 3.49 mg/dl // Normal =3.5 -5.5
mmol/L
Serum Sodium(Na+) 134 meq/L // Normal = 135-155
Ammonia (NH3+) 181.48 µmol/L // Normal = 16-
60

19. MEDICAL REPORT Sonography

20. Sr.no Medication Dose Frequemcy Route
1 INJ.TAXIM 1mg Twice a day IV
2 INJ. PAN40 40mg Once a day IV
3 INJ. ONDEM 4mg Thrice a day IV
4 TAB. RCIFAX 450 mg Twice a day ORAL
5 TAB. ULYSES 150 mg Twice a day ORAL
6 SYP. LIVOMYNE 400 ml Twice a day ORAL
7 INJ. LORNIT 5mg Twice a day IV
8 INJ. ALBUMIN 20% Once a day IV
9 TAB. ATARAX 25mg Twice a day ORAL

21. PHARMACETICAL TREATMENT -
1. INJ.TAXIM (CEFDOTOXIME) :-To Treat Bacterial Infection In Our Body As
Lungs , Urinary Tract , Blood Etc.
2. INJ. PAN40(PENTOPRAZOLE):- Used To Reduce Amount Of Acid Produced In
Stomach
3. INJ. ONDEM (ONDENSETRON):- to control nausea and vomitting action ;
blocking the action of serotonin , a chemical that stimulates the vomitting center
(chemoreceptor trigger zone-CTZ)located in brain
4. TAB.RCIFAX (RIFAXIMIN):- To Treat Infection And Relives Symptoms Of
Hepatic Encephalopathy
5. TAB.ULYSES (URSODEOXYCHOLIC ACID) ;- To Reduces Blood Cholesterol
Level In Blood

22. 6. SYP.LIVOMYNE (KALMEGH,PUNARNARA, BHUMYAMALAKI,
KATUKI ):- Helps To Regulate Liver Function And Protect From Liver Against
Harmful Drugs ,Alcohol,and Other Infection
7. INJ. LORNIT (ORNITHINE + ASPARTIC ACID):- Decrease NH3 Level Used
In Hepatic Encephalopathy
Protect Liver From Damage And Improving Health Of Liver
8. INJ. ALBUMIN20% :- To Treat Blood Volume Loss
Used In Hypovolemia
9. TAB. ATARAX (HYDROXYZINE HYDROCHLORIDE) :-
To Treat Anxiety Or To Help You Feel Sleepy

23. PATIENT COUNSELING
1.Eating A Healthy Diet
2.Limiting Your Portion Sizes
3.Maintaining A Healthy Weight.
4..Limiting Your Intake Of Fats
5.In Your Diet Omega-3 Fatty Acids, Which
Reduce Your Chance Of Heart Disease
6..Eating More Fruits, Vegetables, And Whole
Grains.

24. DRUG-DRUG INTERACTIONS @ LEXICOMP
1.RISK RATING :- no action needed
2.SUMMARY :- QT prolonging agents may inhance the
QTc- prolonging effect of ondensetron
3.SEVERITY :- minor
4.RELIABILITY :- fair
5.MANAGEMENT :- no action is required for the
majority of patients .
Inceased ECG monitoring may be considered in patient
at high risk for QT interval prolongation (eg. Older age,
female se, hypokalemia, hypomagnesemia , liver
diseases, heart diseses )
ONDENSETRON
HYDROXYZINE HYDROCHLORIDE
(QT Prolonging agents)

25. REFERENCE:
1.Roger and Walker. Clinical Pharmacy and Therapeutics- Churchill
Livingstone publication.
2.https://www.niddk.nih.gov/health-information/liver-disease/nafld-
nash/definition-facts
3. slideshare.com
4.Google search engine
5.1mg app website.
6. IGM Hospital shirpur

26. THANK YOU !