CIRRHOSIS OF

LIVER
Presented by Sehrish Shaqoor
BScN 2nd yr

CIRRHOSIS-DEFINITION
Cirrhosis is a chronic, progressive
and
diffuse liver disease, characterisized by
replacement of normal tissues with diffuse
fibrosis that disrupt the structure and function of
liver.

Histologically, cirrhosis is an irreversible

alteration of the liver architecture, consisting of
hepatic fibrosis and areas of nodular regeneration

Known as Liver Death

ETIOLOGY
COMMON

Chronic hepatitis due to hepatitis B,C & D viruses

Alcohol
LESS

COMMON

Metabolic disease

Hemochromatosis (excessive deposition of iron in the liver)

Wilsons disease ( excessive deposition of copper in liver)
alpha-1 antitrypsin deficiency
Cystic fibrosis
Glycogen storage disease

ETIOLOGY
BILIARY OBSTRUCTION

Primary biliary cirrhosis

Secondary biliary cirrhosis resulting from stricture,
stone or neoplasm
Primary sclerosing cholangitis
DRUGS

Methyldopa
Isoniazid
Methotrexate

ETIOLOGY
HEPATIC

CONGESTION

Cardiac failure
Budd-chiari syndrome
OTHERS

Cryptogenic cirrhosis of unknown etiology

Autoimmune hepatitis

Types
There are three types of liver cirrhosis.
1. Alcoholic cirrhosis
Scar tissue surrounds
portal area.
Cause;
Chronic alcoholism
2. Postnecrotic cirrhosis
Broad band of scar tissue

Cont
Cause;

Acute viral hapetitis

3. Billiary cirrhosis
scarring in liver around bile duct
Cause;
Billiary obstraction
Infection

Pathogenesis:
Bridging

fibrosis loss of architecture.

Obstruction to blood flow & shunts.
Portal hypertension spleen, varices
Liver failure , Jaundice, Ascites, edema, bleeding,
jaundice.
Hormone imbalance , testes atrophy etc..

Pathogenesis:
Livers

response to injury hepatocyte

regeneration and collagen formation
Regeneration occurs with distorted
architecture in the form of nodules
When the collagen synthesis rate exceeds
the degradation rate cirrhosis results
Virtually all cases of chronic liver disease
lead to cirrhosis

CLINICAL FEATURES
NON-SPECIFIC

Weakness
Fatigability
Weight loss
Muscle cramps
Anorexia
Nausea
Occasional vomiting
Abdominal pain

SPECIFIC
Portal hypertension
Hepatic insufficiencys

Clinical Manifestations of
Cirrhosis
Compensated
Fever
Ankle edema
Spleenomegaly
Abdominal pain
Palmer erythema
Epistaxis
Hepatomegaly

Decompensated
Ascites
Jaundice
Weakness
Purpura
Hypotention
White nails
Weight loss

LAB INVESTIGATIONS
LFTS

Elevated ALT &AST

Reduced albumin
Prolonged prothombin time

LAB INVESTIGATIONS
SERUM

ELECTROLYTES

Reduced serum sodium

Resulting in dilutional hyponatremia
BLOOD

CP

Anemia due to hypersplenism or blood loss

Decreased TLC or may be increased in infection or
normal
Reduced platelet count

LAB INVESTIGATIONS
OTHERS

serum ceruloplasmin & urinary copper for wilsons

disease & serum alpha-1-antitrypsin is done in young
patients
serum iron, ferritin & total iron binding capacity to
exclude hemochromatosis
ENDOSCOPY

Esophagogastroscopy confirms presence of varices

LAB INVESTIGATIONS
Liver biopsy

confirms the severity & type

of liver disease
IMAGING

Ultrasound of upper abdomen detects cirrhotic

changes in liver,portal vein dilatation &
splenomegaly

MANAGEMENT
There

is no treatment that will arrest or

reverse cirrhotic changes
Once established hepatic cirrhosis is
irreversible
Complications like ascites, bleeding (from
esophageal varices) & malabsorption
Liver transplantation is the treatment of
choice

DIFFERENTIAL DIAGNOSIS
D/D

of one type of cirrhosis from other

D/D of hepatomegaly
D/D of splenomegaly
D/D of ascites
D/D of hematemesis
D/D of encephalopathy

PROGNOSIS
Depending

upon

Etiology
Presence of complications
Stage at which diagnose

Bilirubin, Albumin and Prothrombin

time (INR)
Useful

indicators of liver synthetic

function
In primary care when associated with
liver disease abnormalities should raise
concern
Thrombocytopenia is a sensitive
indicator of liver fibrosis

Medical Management
Based on symptoms
A. Antacids
B. Vitamins
C. Potassium sparing diuretics
D. Colchicine

Nursing Management
Promoting

rest
Provide skin care
Reducing risk of injury
Improving nutritional status

Monitering & Managing

potential complications
Bleeding

& Hemorrhage
Hepatic encephalopathy
Fluid volume excess

Promoting home & community

based care
Teaching

patient self care

Continuing care