Pathophysiology On Liver Cirrhosis

Liver Cirrhosis
Presented by: Dave Jay S. Manriquez 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
Biliary disease
10%
5-10%
Primary hemochromatosis
Cryptogenic cirrhosis
5%
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
Cirrhosis Clinical Features
Pathophysiology
Liver insult Alcoholic Ingestion, Viral hepatitis Exposure to toxins
Increase wbc
Hepatocyte damage liver Inflammation

Alterations in blood and lymph flow
pain
fever
anorexia
fatigue
Nausea vomiting
Liver necrosis
liver failure
Liver fibrosis And scarring
Decrease ADH
edema Dec.androgen/ Estrogen p.
Dec.met.of CHON And Carb./ Dec.Fat
Plasma CHON
Palmar Loss of Spider Erythema angiomas Body hair
Testicular Gyneco Menstrual atrophy mastia changes
Hypoglycemia
Edema Bleeding tendencies
Acites
Vit.k absop.
bile Bilirubin excretion In urine
Clay-colored stool
Dark urine jaundice
Bilirubin metabolism
hyperbilirubinemia
ascites edema
Esophageal varices
hemorrhoids
bleeding
Liver fibrosis
Portal HPN
Superficial Abdominal varices
splenomegaly bleeding
Anemia Thrombocytopenia leukopenia
infection
Delayed Wound healing
Increase serum ammonia
Alterations In sleep
Foul breath
Liver failure
Inability to Metabolize ammonia
Hepatic encephalopathy Confusion to Hepatic coma
Asterexis
Respiratory acidosis
DEATH
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 May God be Glorified
Resources
Medical Surgical Nursing (Joyce M.Black, et.al)
Pathology of Hepatitis & Cirrhosis
Venkatesh Murthy Shashidhar Associate

Professor of Pathology Fiji School of Medicine

Pathophysiology On Liver Cirrhosis

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Liver Cirrhosis

Presented by: Dave Jay S. Manriquez RN.

Largest gland in the body

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

Repeated destruction of hepatic cells causes the formation of scar tissues

Major types of Cirrhosis

Nutmeg Liver-Cardiac Sclerosis

Prevalence of Liver Cirrhosis around the world

Early morning nausea and vomiting (with blood)

Jaundice Abdominal pain and tenderness Ascites Peripheral edema

Dry skin and rashes Petechiae ecchymosis

Fector hepaticus Asterixis delirium

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

Cirrhosis Clinical Features

Hepatocyte damage liver Inflammation

Liver fibrosis And scarring

Palmar Loss of Spider Erythema angiomas Body hair

Testicular Gyneco Menstrual atrophy mastia changes

Edema Bleeding tendencies

Dark urine jaundice

Superficial Abdominal varices

Delayed Wound healing

Increase serum ammonia

Inability to Metabolize ammonia

Hepatic encephalopathy Confusion to Hepatic coma

Liver Biopsy Cirrhosis

Liver Biopsy Cirrhosis:

Hepatic encephalitis / hepatic coma.

Characterised by diffuse loss of architecture.

Shrunken, scarred liver, ascitis, spleenomegaly, liver failure, CNS toxicity.

Thank you and May God be Glorified

Pathology of Hepatitis & Cirrhosis

Venkatesh Murthy Shashidhar Associate

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