liver cirrhosis

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The disease Liver Cirrhosis, its definition, epidemiology, pathophysiology and anatomy, its medical and nursing management.

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

2. 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:

  • Diffusedisorder of liver characterised by;
  • Complete loss of normal architecture ,
  • Replaced by extensivefibrosis with,
  • 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

  • Alterations in blood and lymph flow

Liver insult Alcoholic Ingestion, Viral hepatitis Exposure to toxins Hepatocyte damage liverInflammation pain fever anorexia Nausea vomiting fatigue Increase wbc 27. Liver necrosis liverfailure Liver fibrosis And scarring 28. 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-coloredstool Dark urine jaundice Bleeding tendencies Spider angiomas Testicular atrophy Gyneco mastia Palmar Erythema Loss of Body hair Menstrualchanges edema Hypoglycemia Acites Edema 29. Liver fibrosis Portal HPN ascites Anemia Thrombocytopenia leukopenia splenomegaly bleeding hemorrhoids Superficial Abdominal varices Esophageal varices edema infection Delayed Wound healing bleeding 30. Liver failure Inability to Metabolize ammonia Hepaticencephalopathy Confusion to Hepatic coma DEATH Increase serumammonia Asterexis Respiratoryacidosis Alterations Insleep Foul breath 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 & CirrhosisVenkatesh Murthy ShashidharAssociate Professor of Pathology Fiji School of Medicine