Cirrhosis is a late-stage liver disease caused by extensive liver cell destruction and regeneration resulting in scar tissue replacing healthy liver tissue. It has many potential causes including chronic alcohol abuse, viral hepatitis, fatty liver disease, and genetic disorders. Cirrhosis is progressive and can lead to liver failure. Complications include portal hypertension, which can cause dangerous bleeding from esophageal or gastric varices, as well as ascites, infections, malnutrition, and liver cancer. Treatment focuses on managing complications, following medication regimens, and procedures to prevent variceal bleeding such as band ligation.

1. Liver cirrhosis
Shagufta Imran
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2. What is Cirrhosis?
• Cirrhosis is a late-stage liver disease in which
healthy liver tissue is replaced with scar tissue
and the liver is permanently damaged.
• Extensive destruction of liver cells
Cells attempt to regenerate
• Regenerative process is disorganized
• Functional liver tissue is destroyed and scarring of
liver occurs
• Overgrowth of fibrous connective tissue,
distorting liver structure; obstructing blood flow
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3. Cirrhosis Facts
• Progressive, leads to liver failure
• The end stage of any chronic liver disease
• Insidious, prolonged course is leading cause of
death
• Twice as common in men
• Highest incidence between ages40 and 60
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4. Four Types of Cirrhosis
• Alcoholic
• Post-necrotic
• Biliary/obstructive
• Cardiac
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5. Types
Alcoholic cirrhosis: Usually associated with alcohol
abuse
Most common cause of cirrhosis
• Causes metabolic changes in liver fat accumulates in
liver (fatty liver)Fatty liver potentially reversible.
• If alcohol abuse continues, widespread liver scar
formation occurs
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6. Cont…..types
• Post Necrotic cirrhosis
• Complication of viral infection
toxicity autoimmune hepatitis
• 20% of patient’s with chronivc
hep c will develop cirrhosis
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7. Cont…..types
Biliary Cirrhosis:
• Associated with chronic biliary obstruction/
infection
• Primary sclerosing cholangitis
• Defused fibrosis of liver
• Jaundice is main feature
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8. Cont…..types
Cardiac cirrhosis:
• Develops from long –standing right heart
failure
• Results in patients with cor-pulmonale,
constrictive pericarditis and tricuspid
insufficiency
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9. Causes
• Chronic alcohol abuse
• Chronic viral hepatitis (hepatitis B, C and D)
• Fat accumulating in the liver (nonalcoholic
fatty liver disease)
• Iron buildup in the body (hemochromatosis)
• Cystic fibrosis
• Copper accumulated in the liver (Wilson's
disease)
• Poorly formed bile ducts (biliary atresia)
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10. Causes……….
• Alpha-1 antitrypsin deficiency
• Inherited disorders of sugar metabolism (galactosemia or
glycogen storage disease)
• Genetic digestive disorder (Alagille syndrome)
• Liver disease caused by your 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 as syphilis or brucellosis
• Medications, including methotrexate or isoniazid
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11. Risk factors
• Drinking too much alcohol. Excessive alcohol
consumption is a risk factor for cirrhosis.
• Being overweight. Being obese increases your risk of
conditions that may lead to cirrhosis, such as
nonalcoholic fatty liver disease and nonalcoholic
steato-hepatitis.
• Having viral hepatitis. Not everyone with chronic
hepatitis will develop cirrhosis, but it's one of the
world's leading causes of liver disease.
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12. Diagnostic Studies
• Enzyme levels (AST, ALT)
initially elevated due to release from damaged
liver cells In end-stage liver disease AST &
ALT may be normal
• Decrease in total protein albumin
• Increase in serum bilirubin globulin levels
• Prothrombin time prolonged
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13. Early Signs of cirrhosis
• Nausea and vomiting
• Anorexia
• Diarrhea or constipation
• Pain
• Fever
• Weight loss
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14. Later Manifestations
• Jaundice
• Skin Lesions/Spider angiomas
• Palmer erythema
• Thrombocytopenia
• Leukopenia
• Anemia
• Coagulation disorders
• Endocrine disturbance
• Peripheral neuropathy & peripheral edema
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15. • Dilated blood vessels (spider angiomas)
Palmar erythema
• Hematologic Problems Thrombocytopenia Leukopenia Anemia
Vitamin K deficiency
• Endocrine Problems: Inactivation of adrenocortical hormones
Men Women
Hyperaldosteronism
• Peripheral Neuropathy
&Peripheral Edema, Neuropathies results in mixed nervous
symptoms Sensory symptoms are most common
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16. Complications
Portal Hypertension
• Bleeding. Portal hypertension can cause blood to be
redirected to smaller veins. Strained by the extra
pressure, these smaller veins can burst, causing
serious bleeding. Portal hypertension may cause
enlarged veins (varices) in the esophagus (esophageal
varices) or the stomach (gastric varices) and lead to
life-threatening bleeding. If the liver can't make
enough clotting factors, this also can contribute to
continued bleeding.
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17. Complications
Esophageal & Gastric Varices
• Complex of twisting veins at lower end of esophagus enlarged
& swollen Gastric-upper portion of stomach may occur alone
or in combination with esophageal
• Poorly Tolerate high pressure, bleeding easily with distention
• Rupture in response to irritation
• Most life threatening complication!!
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18. Complications
• Swelling in the legs and abdomen.
• The increased pressure in the portal vein can cause fluid to
accumulate in the legs (edema) and 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.
• Enlargement of the spleen (splenomegaly). Portal
hypertension can also cause changes to and swelling of the
spleen, and trapping of white blood cells and platelets.
Decreased white blood cells and platelets in your blood can be
the first sign of cirrhosis.
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19. Complications
• Infections.
• If you have cirrhosis, your body may have difficulty
fighting infections. Ascites can lead to bacterial
peritonitis, a serious infection.
• Malnutrition.
• Cirrhosis may make it more difficult for your body to
process nutrients, leading to weakness and weight loss.
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20. Complications
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. With time, hepatic encephalopathy can progress
to unresponsiveness or coma.
Jaundice
• Jaundice occurs when the diseased liver doesn't remove
enough bilirubin, a blood waste product, from your blood.
Jaundice causes yellowing of the skin and whites of the eyes
and darkening of urine.
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21. Complications
Bone disease.
• Some people with cirrhosis lose bone strength and are at
greater risk of fractures.
Increased risk of liver cancer.
• A large proportion of people who develop liver cancer
have pre-existing cirrhosis.
• Some people end up experiencing multi-organ failure.
Researchers now believe this is a distinct complication in
some people who have cirrhosis, but they don't fully
understand its causes.
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22. Nursing diagnosis
Based on the assessment data, the major nursing
diagnosis for the patient are:
• Activity intolerance related to fatigue, lethargy,
and malaise.
• Imbalanced nutrition: less than body
requirements related to abdominal distention and
discomfort and anorexia
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23. Nursing Management
• Promoting rest
• Improving nutritional status
• Providing skin care
• Reducing risk of injury
• Monitoring and managing
complications.
• Following drug regimen
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24. Treatment for Varices
• Stop bleeding
• Manage airway
• Prevent aspiration of blood
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25. Treatment cont…
Propranolol
Sandostatin
Vasopressin
Band ligation of varices
Endoscopic sclerotherapy of esophageal varices
has been anecdotally associated with the
development of portal vein thrombosis
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26. Balloon tamponed-mechanical compression of varices
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27. Avoid:
alcohol & irritating foods
What common drugs should
be avoided?
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28. Acute Bleed Supportive
Measures
• FFP, PRBC’s, Vitamin K Antibiotics
• Protonix
• Zantac
• Propanolol
• Prevent factors that may increase intra-
abdominal pressure
• Higher incidence of recurrent bleeds, so
continued therapy is necessary!!
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29. Shunting Procedures
Used more after 2nd major
bleeding episode TIPS
shunt is placed between
systemic and portal venous
systems redirect’s portal
blood flow reduces portal
venous pressure
decompresses varices
contraindicated in patient’s
with hepatic encephalopathy
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