The document discusses cirrhosis of the liver. It begins by describing the normal anatomy and function of the liver. Cirrhosis is defined as a diffuse disorder characterized by complete loss of normal liver architecture and replacement by extensive fibrosis and regenerating nodules. Cirrhosis results from repeated damage to liver cells from various chronic conditions and risk factors. This causes scarring that disrupts blood flow and liver function. Common complications include liver failure, portal hypertension, ascites, and increased risk of liver cancer.

1. Liver
Cirrhosis
Presented by: Dave Jay S. Manriquez
RN.

3.  Largest gland in the body
 4 lobes
 Produced bile
 Contains bile salts, pigments, phospholipids,
cholesterol and a variety of electrolytes

4. Bilirubin
Metabolism
•Blood
•Conjugated &
Conjugated
•Urine – Urobilinogen
•Stool – Stercobilin

5. Definition:
1. Diffuse disorder of liver characterised
by;
2. Complete loss of normal architecture,
3. Replaced by extensive fibrosis with,
4. Regenerating parenchymal nodules.

6.  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

7. 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.

8. Major types of Cirrhosis
 Laennec Cirrhosis
 Post necrotic
 Biliary
 Cardiac

9. Micronodular cirrhosis:

10. Alcoholic Hepatitis

11. Macronodular Cirrhosis

12. Nutmeg Liver-Cardiac Sclerosis

13. Prevalence of Liver Cirrhosis
around the world

14. Normal Liver

15. Cirrhosis

16. Etiology of Cirrhosis
 Alcoholic liver disease
60-70%
 Viral hepatitis
10%
 Biliary disease
5-10%
 Primary hemochromatosis
5%
 Cryptogenic cirrhosis
10-15%

17. 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.

18. Assessment
 Anorexia and wt. loss
 Early morning nausea and vomiting (with
blood)
 Flatulence and changes in bowel habits
 Emaciation
 fatigue

19.  Jaundice
 Abdominal pain and tenderness
 Ascites
 Peripheral edema

20.  Dry skin and rashes
 Petechiae
 ecchymosis

21.  Spider angiomas (nose, cheeks, upper
thorax and shoulders)
 Hepatomegaly
 Protruding umbilicus
 Dilated abdominal veins

22.  Fector hepaticus
 Asterixis
 delirium

23. Males (increase estrogen)
 Gynecomastia
 Impotence
 Fall of body hair
 Atrophy of testicles

24. Females (increase androgren)
 Hirsutism
 Acne
 Deepening of voice
 Increase virilism

25. Cirrhosis
Clinical
Features

26. 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

27. Liver
necrosis
liver
failure
Liver fibrosis
And scarring

28. 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

29. ascites
edema
Esophageal
varices
hemorrhoids
Liver fibrosis
Portal HPN
bleeding
Superficial
Abdominal
varices
splenomegaly
bleeding
Anemia
Thrombocytopenia
leukopenia
infection
Delayed
Wound
healing

30. Increase
serum
ammonia
Liver failure
Inability to
Metabolize
ammonia
Asterexis
Alterations
In
sleep
Foul breath
Hepatic
encephalopathy
Respiratory
acidosis
Confusion to
Hepatic
coma
DEATH

31. Liver Biopsy – Cirrhosis

32. Liver Biopsy – Cirrhosis:

33. MRI Cirrhosis

34. Complications:
 Congestive splenomegaly.
 Bleeding varices.
 Hepatocellular failure.
 Hepatic encephalitis / hepatic coma.
 Hepatocellular carcinoma.

35. Hepatocellular Carcinoma

36. 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.

37. Thank you and
May God be
Glorified

38. Resources
 Medical Surgical Nursing (Joyce M.Black,
et.al)
Pathology of Hepatitis & Cirrhosis
Venkatesh Murthy Shashidhar Associate
Professor of Pathology Fiji School of Medicine