Download - Liver Cirrhosis
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