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Cirrhosis of the Liver: Causes, Symptoms, and Treatment
- 1. Cirrhosis of the Liver
- 2. Description • A chronic, progressive disease of the liver –Extensive parenchymal cell degeneration –Destruction of parenchymal cells
- 3. Description • Regenerative process is disorganized, resulting in abnormal blood vessel and bile duct relationships from fibrosis
- 4. Description • Normal lobular structure distorted by fibrotic connective tissue • Lobules are irregular in size and shape with impaired vascular flow • Insidious, prolonged course
- 5. Statistics • > 50% of liver disease in the US is directly related to alcohol consumption • Of the estimated 15 million alcoholics in the USA 10-20% have or will develop cirrhosis
- 6. Statistics • Growing number of cases related to chronic hepatitis C • 4th leading cause of death in people between 35 and 54 years of age
- 7. Statistics • Direct correlation between alcohol consumption in any geographic area and the death rate from cirrhosis in that area
- 8. Etiology and Pathophysiology • Cell necrosis occurs • Destroyed liver cells are replaced by scar tissue • Normal architecture becomes nodular
- 9. Etiology and Pathophysiology • Four types of cirrhosis: – Alcoholic (Laennec’s) cirrhosis – Postnecrotic cirrhosis – Biliary cirrhosis – Cardiac cirrhosis
- 10. Etiology and Pathophysiology • Alcoholic (Laennec’s) Cirrhosis – Associated with alcohol abuse – Preceded by a theoretically reversible fatty infiltration of the liver cells – Widespread scar formation
- 11. Etiology and Pathophysiology • Postnecrotic Cirrhosis – Complication of toxic or viral hepatitis – Accounts for 20% of the cases of cirrhosis – Broad bands of scar tissue form within the liver
- 12. Etiology and Pathophysiology • Biliary Cirrhosis – Associated with chronic biliary obstruction and infection – Accounts for 15% of all cases of cirrhosis
- 13. Etiology and Pathophysiology • Cardiac Cirrhosis – Results from longstanding severe right- sided heart failure
- 14. Manifestations of Liver Cirrhosis Fig. 42-5
- 15. Clinical Manifestations Early Manifestations • Onset usually insidious • GI disturbances: – Anorexia – Dyspepsia – Flatulence – N-V, change in bowel habits
- 16. Clinical Manifestations Early Manifestations • Abdominal pain • Fever • Lassitude • Weight loss • Enlarged liver or spleen
- 17. Clinical Manifestations Late Manifestations • Two causative mechanisms – Hepatocellular failure – Portal hypertension
- 18. Clinical Manifestations Jaundice • Occurs because of insufficient conjugation of bilirubin by the liver cells, and local obstruction of biliary ducts by scarring and regenerating tissue
- 19. Clinical Manifestations Jaundice • Intermittent jaundice is characteristic of biliary cirrhosis • Late stages of cirrhosis the patient will usually be jaundiced
- 20. Clinical Manifestations Skin • Spider angiomas (telangiectasia, spider nevi) • Palmar erythema
- 21. Clinical Manifestations Endocrine Disturbances • Steroid hormones of the adrenal cortex (aldosterone), testes, and ovaries are metabolized and inactivated by the normal liver
- 22. Clinical Manifestations Endocrine Disturbances • Alteration in hair distribution – Decreased amount of pubic hair – Axillary and pectoral alopecia
- 23. Clinical Manifestations Hematologic Disorders • Bleeding tendencies as a result of decreased production of hepatic clotting factors (II, VII, IX, and X)
- 24. Clinical Manifestations Hematologic Disorders • Anemia, leukopenia, and thrombocytopenia are believed to be result of hypersplenism
- 25. Clinical Manifestations Peripheral Neuropathy • Dietary deficiencies of thiamine, folic acid, and vitamin B12
- 26. Complications • Portal hypertension and esophageal varices • Peripheral edema and ascites • Hepatic encephalopathy • Fetor hepaticus
- 27. Complications Portal Hypertension • Characterized by: – Increased venous pressure in portal circulation – Splenomegaly – Esophageal varices – Systemic hypertension
- 28. Complications Portal Hypertension • Primary mechanism is the increased resistance to blood flow through the liver
- 29. Complications Portal Hypertension Splenomegaly • Back pressure caused by portal hypertension chronic passive congestion as a result of increased pressure in the splenic vein
- 30. Complications Portal Hypertension Esophageal Varices • Increased blood flow through the portal system results in dilation and enlargement of the plexus veins of the esophagus and produces varices
- 31. Complications Portal Hypertension Esophageal Varices • Varices have fragile vessel walls which bleed easily
- 32. Complications Portal Hypertension Internal Hemorrhoids • Occurs because of the dilation of the mesenteric veins and rectal veins
- 33. Complications Portal Hypertension Caput Medusae • Collateral circulation involves the superficial veins of the abdominal wall leading to the development of dilated veins around the umbilicus
- 34. Complications Peripheral Edema and Ascites • Ascites: - Intraperitoneal accumulation of watery fluid containing small amounts of protein
- 35. Complications Peripheral Edema and Ascites • Factors involved in the pathogenesis of ascites: - Hypoalbuminemia - Levels of aldosterone - Portal hypertension
- 36. Complications Hepatic Encephalopathy • Liver damage causes blood to enter systemic circulation without liver detoxification
- 37. Complications Hepatic Encephalopathy • Main pathogenic toxin is NH3 although other etiological factors have been identified • Frequently a terminal complication
- 38. Complications Fetor Hepaticus • Musty, sweetish odor detected on the patient’s breath • From accumulation of digested by- products
- 39. Development of Ascites Fig. 42-6
- 40. Diagnostic Studies • Liver function tests • Liver biopsy • Liver scan • Liver ultrasound
- 41. Diagnostic Studies • Esophagogastroduodenoscopy • Prothrombin time • Testing of stool for occult blood
- 42. Collaborative Care • Rest • Avoidance of alcohol and anticoagulants • Management of ascites
- 43. Collaborative Care • Prevention and management of esophageal variceal bleeding • Management of encephalopathy
- 44. Nutritional Therapy • Diet for patient without complications: – High in calories – CHO – Moderate to low fat – Amount of protein varies with degree of liver damage
- 45. Nursing Management Nursing Assessment • Past health history • Medications • Chronic alcoholism • Weight loss