Liver Liver CirrhosisCirrhosis

Presented by: Dave Jay S. Manriquez Presented by: Dave Jay S. Manriquez RN.RN.

Largest gland in the body

4 lobes

Produced bile

Contains bile salts, pigments, phospholipids, cholesterol and a variety of electrolytes

Bilirubin Metabolism

•Blood

•Conjugated & Conjugated

•Urine – Urobilinogen

•Stool – Stercobilin

Definition:

1. Diffuse disorder of liver characterised by;

2. Complete loss of normal architecture,

3. Replaced by extensive fibrosis with,

4. 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

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.

Major types of Cirrhosis

Laennec Cirrhosis

Post necrotic

Biliary

Cardiac

Micronodular cirrhosis:

Alcoholic Hepatitis

Macronodular Cirrhosis

Nutmeg Liver-Cardiac Sclerosis

Prevalence of Liver Cirrhosis around the world

Normal Liver

Cirrhosis

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)

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

CirrhosisClinical

Features

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

Livernecrosis

liver liver

failurefailure

Liver fibrosisLiver fibrosis

And scarringAnd scarring

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

stoolDark urine

jaundice

Bleeding

tendencies

Spider

angiomas

Testicular

atrophyGyneco

mastia

Palmar

Erythema

Loss of

Body hair

Menstrual

changes

edema

Hypoglycemia AcitesEdema

Liver fibrosisLiver fibrosis Portal HPN

ascites

Anemia

Thrombocytopenia

leukopenia

splenomegaly

bleedinghemorrhoids

Superficial

Abdominal

varices

Esophageal

varices

edema

infection

Delayed

Wound

healing

bleeding

Liver failureLiver failure

Inability to

Metabolize

ammonia

Hepatic

encephalopathy

Confusion to

Hepatic

coma

DEATHDEATH

Increase

serum

ammonia

Asterexis

Respiratory

acidosis

Alterations

In

sleep

Foul breath

Liver Biopsy – Cirrhosis

Liver Biopsy – Cirrhosis:

MRI Cirrhosis

Complications:

Congestive splenomegaly.

Bleeding varices.

Hepatocellular failure.

Hepatic encephalitis / hepatic coma.

Hepatocellular carcinoma.

Hepatocellular Carcinoma

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.

Thank you and Thank you and May God be May God be GlorifiedGlorified

Resources

Medical Surgical Nursing (Joyce M.Black, et.al)

Pathology of Hepatitis & CirrhosisPathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine