Liver cirrhosis is a chronic, progressive disease characterized by diffuse damage to liver cells and the replacement of liver tissue with fibrosis and regenerating nodules. It has many potential causes, with alcohol use being the most common in 60-70% of cases. Common symptoms include fatigue, jaundice, abdominal pain, ascites, and complications can include bleeding varices, hepatic encephalopathy, and liver failure.

1. Presented by: Dave Jay S. Manriquez RN.
Liver Cirrhosis
• Largest gland in the body
• 4 lobes
• Produced bile
• Contains bile salts, pigments, phospholipids, cholesterol and a variety of
electrolytes
• Definition:
• Diffuse disorder of liver characterised by;
• Complete loss of normal architecture,
• Replaced by extensive fibrosis with,
• Regenerating parenchymal nodules
 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
 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.
 Major types of Cirrhosis
 Laennec Cirrhosis
 Post necrotic
 Biliary
 Cardiac
 Etiology of Cirrhosis
 Alcoholic liver disease 60-70%
 Viral hepatitis 10%
 Biliary disease 5-10%
 Primary hemochromatosis 5%
 Cryptogenic cirrhosis 10-15%
• 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.
• Assessment
• Anorexia and wt. loss
• Early morning nausea and vomiting (with blood)

2. • Flatulence and changes in bowel habits
• Emaciation
• fatigue
 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 veins
 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

3. Pathophysiology
Liver insult
Alcoholic Ingestion, Viral hepatitis
Exposure to toxins
Hepatocyte
damage
Alterations in
blood and
lymph flow
liver
Inflammation
pain
fever
anorexiaNausea
vomiting
fatigue
Increase
wbc
liverliver
failurefailure
Liver fibrosisLiver fibrosis
And scarringAnd scarring
Liver
necrosis

4. Liver fibrosisLiver fibrosis Portal HPN
ascites
Anemia
Thrombocytopenia
leukopenia
splenomegaly
hemorrhoid
s
Superficial
Abdominal
varices
Esophageal
varices
infection
bleeding
bleedin
g
edema
Delayed
Wound
healing

5. Dec.androgen/
Estrogen p.
Decrease ADH
Dec.met.of CHON
And Carb./
Dec.Fat
bile
Vit.k absop.
hyperbilirubinemia
Plasma
CHON
Bilirubin metabolism
Bilirubin excretion
In urine
Clay-
colored
stool
Dark urine
jaundice
Bleeding
tendencies
Testicular
atrophy Gyneco
mastia
Palmar
Erythema
Loss of
Body hair
Menstrual
changes
edem
a
Hypoglycemia
Acites
Edema

6. Complications:
• Congestive splenomegaly.
• Bleeding varices.
• Hepatocellular failure.
• Hepatic encephalitis / hepatic coma.
• Hepatocellular carcinoma.
 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.
Bibliography
 Medical Surgical Nursing (Joyce M.Black, et.al)
 Pathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Associate
Professor of Pathology Fiji School of Medicine
Foul breath
Hepatic
encephalopathy
Inability to
Metabolize
ammonia
Asterexis
Respiratory
acidosis
Confusion to
Hepatic
coma
Liver failureLiver failure
DEATHDEATH
Increase
serum
ammonia
Alterations
In
sleep
Spider
angiomas

7. Country/Region Extrapolated Prevalence Population Estimated Used
Cirrhosis of the liver in North America (Extrapolated Statistics)
USA 431,846 293,655,4051
Canada 47,805 32,507,8742
Cirrhosis of the liver in Europe (Extrapolated Statistics)
Austria 12,021 8,174,7622
Belgium 15,218 10,348,2762
Britain (United Kingdom) 88,633 60,270,708 for UK2
Czech Republic 1,832 1,0246,1782
Denmark 7,960 5,413,3922
Finland 7,668 5,214,5122
France 88,859 60,424,2132
Greece 15,658 10,647,5292
Germany 121,212 82,424,6092
Iceland 432 293,9662
Hungary 14,753 10,032,3752
Liechtenstein 49 33,4362
Ireland 5,837 3,969,5582
Italy 85,378 58,057,4772
Luxembourg 680 462,6902
Monaco 47 32,2702
Netherlands (Holland) 23,997 16,318,1992
Poland 56,803 38,626,3492
Portugal 15,476 10,524,1452
Spain 59,236 40,280,7802
Sweden 13,215 8,986,4002
Switzerland 10,957 7,450,8672
United Kingdom 88,633 60,270,7082
Wales 4,291 2,918,0002
Cirrhosis of the liver in the Balkans (Extrapolated Statistics)
Albania 5,212 3,544,8082
Bosnia and Herzegovina 599 407,6082
Croatia 6,613 4,496,8692
Macedonia 3,000 2,040,0852

8. Serbia and Montenegro 15,920 10,825,9002
Cirrhosis of the liver in Asia (Extrapolated Statistics)
Bangladesh 207,853 141,340,4762
Bhutan 3,214 2,185,5692
China 1,910,070 1,298,847,6242
East Timor 1,498 1,019,2522
Hong Kong s.a.r. 10,081 6,855,1252
India 1,566,280 1,065,070,6072
Indonesia 350,666 238,452,9522
Japan 187,254 127,333,0022
Laos 8,923 6,068,1172
Macau s.a.r. 654 445,2862
Malaysia 34,591 23,522,4822
Mongolia 4,046 2,751,3142
Philippines 126,826 86,241,6972
Papua New Guinea 7,971 5,420,2802
Vietnam 121,562 82,662,8002
Singapore 6,402 4,353,8932
Pakistan 234,112 159,196,3362
North Korea 33,378 22,697,5532
South Korea 70,932 48,233,7602
Sri Lanka 29,272 19,905,1652
Taiwan 33,455 22,749,8382
Thailand 95,390 64,865,5232
Cirrhosis of the liver in Eastern Europe (Extrapolated Statistics)
Azerbaijan 11,571 7,868,3852
Belarus 15,162 10,310,5202
Bulgaria 11,055 7,517,9732
Estonia 1,973 1,341,6642
Georgia 6,902 4,693,8922
Kazakhstan 22,270 15,143,7042
Latvia 3,391 2,306,3062
Lithuania 5,305 3,607,8992
Romania 32,875 22,355,5512

9. Russia 211,726 143,974,0592
Slovakia 7,975 5,423,5672
Slovenia 2,958 2,011,473 2
Tajikistan 10,311 7,011,556 2
Ukraine 70,194 47,732,0792
Uzbekistan 38,838 26,410,4162
Cirrhosis of the liver in Australasia and Southern Pacific (Extrapolated
Statistics)
Australia 29,284 19,913,1442
New Zealand 5,873 3,993,8172
Cirrhosis of the liver in the Middle East (Extrapolated Statistics)
Afghanistan 41,931 28,513,6772
Egypt 111,937 76,117,4212
Gaza strip 1,948 1,324,9912
Iran 99,269 67,503,2052
Iraq 37,315 25,374,6912
Israel 9,116 6,199,0082
Jordan 8,251 5,611,2022
Kuwait 3,319 2,257,5492
Lebanon 5,554 3,777,2182
Libya 8,281 5,631,5852
Saudi Arabia 37,935 25,795,9382
Syria 26,495 18,016,8742
Turkey 101,314 68,893,9182
United Arab Emirates 3,711 2,523,9152
West Bank 3,398 2,311,2042
Yemen 29,448 20,024,8672
Cirrhosis of the liver in South America (Extrapolated Statistics)
Belize 401 272,9452
Brazil 270,736 184,101,1092
Chile 23,270 15,823,9572
Colombia 62,221 42,310,7752
Guatemala 21,000 14,280,5962
Mexico 154,352 104,959,5942
Nicaragua 7,881 5,359,7592

10. Paraguay 9,104 6,191,3682
Peru 40,506 27,544,3052
Puerto Rico 5,732 3,897,9602
Venezuela 36,790 25,017,3872
Cirrhosis of the liver in Africa (Extrapolated Statistics)
Angola 16,144 10,978,5522
Botswana 2,410 1,639,2312
Central African Republic 5,503 3,742,4822
Chad 14,027 9,538,5442
Congo Brazzaville 4,408 2,998,0402
Congo kinshasa 85,760 58,317,0302
Ethiopia 104,906 71,336,5712
Ghana 30,525 20,757,0322
Kenya 48,503 32,982,1092
Liberia 4,986 3,390,6352
Niger 16,706 11,360,5382
Nigeria 26,103 12,5750,3562
Rwanda 12,115 8,238,6732
Senegal 15,959 10,852,1472
Sierra leone 8,652 5,883,8892
Somalia 12,212 8,304,6012
Sudan 57,570 39,148,1622
South Africa 65,365 44,448,4702
Swaziland 1,719 1,169,2412
Tanzania 53,045 36,070,7992
Uganda 38,809 26,390,2582
Zambia 16,214 11,025,6902
Zimbabwe 5,399 1,2671,8602