cirrhosis - copy

8/21/2019 Cirrhosis - Copy

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CIRRHOSIS OFCIRRHOSIS OF

LIVERLIVER

Presented by Sehrish ShaqoorBScN 2nd yr


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CIRRHOSIS-DEFINITION

Cirrhosis is a chronic, progressive and

diffuse liver disease, characterisized byreplacement of normal tissues with diffusefibrosis that disrupt the structure and function ofliver

!istologically, cirrhosis is an irreversiblealteration of the liver architecture, consisting ofhepatic fibrosis and areas of nodular regeneration

"nown as #iver $eath


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ETIOLOGY

COMMON % Chronic hepatitis due to hepatitis B,C & D viruses

% Alcohol

LESS COMMON % Metabolic disease

& Hemochromatosis e!cessive deposition o" iron in the liver#& $ilson%s disease e!cessive deposition o" copper in liver#

& alpha' antitr(psin de"icienc(

& C(stic "ibrosis

& )l(co*en stora*e disease


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ETIOLOGY

B+L+A- OBS./C.+ON % 0rimar( biliar( cirrhosis

% Secondar( biliar( cirrhosis resultin* "rom stricture,stone or neoplasm

% 0rimar( sclerosin* cholan*itis

D/)S % Meth(ldopa % +sonia1id

% Methotre!ate


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ETIOLOGY

HE0A.+C CON)ES.+ON

% Cardiac "ailure

% Buddchiari s(ndrome

O.HES

% Cr(pto*enic cirrhosis o" un2no3n etiolo*(

% Autoimmune hepatitis


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'ypes'ypes

There are three types of liver cirrhosis.

1. Alcoholic cirrhosis

Scar tissue surroundsportal area.

Cause;

Chronic alcoholism2. Postnecrotic cirrhosis

Broad band of scar tissue


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ContCont

Cause;

Acute viral hapetitis

3. Billiary cirrhosis

scarrin in liver around bile duct

Cause;Billiary obstraction

!nfection


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Pathogenesis(Pathogenesis(

Brid*in* "ibrosis 4 loss o" architecture5

Obstruction to blood "lo3 & shunts5

0ortal h(pertension spleen, varices

Liver "ailure 4 , 6aundice, Ascites, edema, bleedin*,

7aundice5

Hormone imbalance 4 , testes atroph( etc55


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Pathogenesis(Pathogenesis(

"iver#s response to in$ury hepatocyte

reeneration and collaen formation

%eeneration occurs &ith distortedarchitecture in the form of nodules

'hen the collaen synthesis rate e(ceeds

the deradation rate cirrhosis results

)irtually all cases of chronic liver disease

lead to cirrhosis


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CLINICAL FEATURES

NONS0EC+8+C

% $ea2ness % 8ati*abilit(

% $ei*ht loss

% Muscle cramps

% Anore!ia % Nausea

% Occasional vomitin*

% Abdominal pain

S0EC+8+C

% 0ortal h(pertension % Hepatic insu""icienc(s


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Clinical )anifestations ofClinical )anifestations of

CirrhosisCirrhosisCompensated

*ever

An+le edemaSpleenomealy

Abdominal pain

Palmer erythema,pista(is

-epatomealy

ecompensated

Ascites

/aundice'ea+ness

Purpura

-ypotention

'hite nails

'eiht loss


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LAB INVESTIGATIONS

L8.S

% Elevated AL. &AS.

% educed albumin

% 0rolon*ed prothombin time


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LAB INVESTIGATIONS

SE/M ELEC.OL-.ES

% educed serum sodium

% esultin* in dilutional h(ponatremia

BLOOD C0

% Anemia due to h(persplenism or blood loss

% Decreased .LC or ma( be increased in in"ection or

normal

% educed platelet count


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LAB INVESTIGATIONS

O.HES

% serum ceruloplasmin * urinary copper for wilson+s

disease * serum alpha'antitr(psin is done in young patients

% serum iron, "erritin & total iron bindin* capacit( to

eclude hemochromatosis

ENDOSCO0-

% -sophagogastroscopy confirms presence of varices


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LAB INVESTIGATIONS

Liver biops( confirms the severity * type

of liver disease

+MA)+N)

% .ltrasound of upper abdomen detects cirrhotic

changes in liver,portal vein dilatation *splenomegaly


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MANAGEMENT

'here is no treatment that will arrest or

reverse cirrhotic changes

/nce established hepatic cirrhosis isirreversible

Complications li0e ascites, bleeding 1from

esophageal varices * malabsorptionLiver transplantation is the treatment of

choice


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DIFFERENTIAL DIAGNOSIS

D9D o" one t(pe o" cirrhosis "rom other

D9D o" hepatome*al(

D9D o" splenome*al(

D9D o" ascites

D9D o" hematemesisD9D o" encephalopath(


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PROGNOSIS

$epending upon % -tiology

% Presence of complications % Stage at which diagnose


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Bilirubin, Albumin and 0rothrombin

time +N#Useful indicators of liver synthetic

function

In primary care when associated withliver disease abnormalities should raise

concern

Thrombocytopenia is a sensitiveindicator of liver fibrosis


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)edical )anagement)edical )anagement

Based on symptoms

A. Antacids

B. )itamins

C. Potassium sparin diuretics

. Colchicine


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Nursing )anagement Nursing )anagement

Promotin rest

Provide s+in care

%educin ris+ of in$ury

!mprovin nutritional status


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)onitering * )anaging)onitering * )anaging

potential complications potential complicationsBleedin 0 -emorrhae

-epatic encephalopathy

*luid volume e(cess


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Promoting home * communityPromoting home * community

based care based careTeachin patient self care

Continuin care

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