Anatomy and

Physiology
of the Liver
 The liver is a large
highly vascular
organ located
It weighs between behind the ribs in
1200 to 1500g in the
average adult and is the upper portion
Has 1500
divided ml
into two of the abdominal
oflobes
blood
(right 5flow
to 6 cavity.
times larger than the
per minute.
left lobe and left
lobe)
Lobules is composed of
cells (hepatocytes) each
lobule is consist of a
central vein surrounded
by 6 hepatic portal veins
and 6 hepatic arteries.

Lobules is composed of
cells (hepatocytes) each
lobule is consist of a
central vein surrounded
by 6 hepatic portal veins
and 6 hepatic arteries.
The blood that perfuses the liver
comes from two sources:
Portal vein- Approximately
80% of the blood supply ,
which drains the GI tract
and is rich in nutrients but
lacks oxygen.

Hepatic artery- The

remainder of the blood
supply enters this way, and
is rich in oxygen.
 Terminal branches of these two blood
vessels join to form common capillary
beds, which constitutes the sinusoids of
the liver and are called central vein

CENTRAL
VEIN
 Phagocytic cells in the liver lining the
walls of the sinusoids and are also found
in the spleen, bone marrow, lymph nodes
and lungs these are called kupffer cells
 The smallest bile
ducts called
canaliculi are located
between the lobules
of the liver, is a thin
tube that collects bile
secreted by
hepatocytes and
carry them to larger
bile ducts and form
the common hepatic
duct.
Functions
of the
liver
Cirrhosis is a chronic
disease characterized by
replacement of normal
liver tissue with diffuse
fibrosis that disrupts the
structure and function of
the liver. The disease
typically develops slowly
and has a progressive,
prolonged, destructive
course resulting in end
stage liver disease.
 Glucose Ammonia
metabolism conversion

Protein Fat
Metabolism Metabolism

Vitamin and
Bile formation
Iron storage

Bilirubin
excretion
By: Lovella Mae Balo
Divine Sumagang
Ciara Pamela Torda
There are
three types of
cirrhosis or
scarring of the
liver:
 Alcoholic Cirrhosis- the scar tissue
characteristically surrounds the portal areas. This is
most frequently caused by chronic alcoholism and
is the most common type of cirrhosis.
Post necrotic cirrhosis- in which there are broad
band of scar tissue this is a late result of previous
bout of acute viral hepatitis
 Biliary Cirrhosis-
scarring occurs in the
liver around the bile
ducts. This type of
cirrhosis usually
results from chronic
biliary obstruction and
infection, this is the
least common.
Etiology of
Cirrhosis
 Nutritional deficiency

Excessive alcohol intake

Exposure to a chemicals (carbon

tetrachloride, chlorinated
naphthalene, arsenic or phosphorus)

Infectious schistosomiasis
Pathophysiology
of cirrhosis
 Cirrhosis is characterized by widespread
fibrotic (scarred) bands of connective tissue
that change the livers normal make up.
 Cirrhosis is characterized by widespread
fibrotic (scarred) bands of connective tissue
that change the livers normal make up.
As cirrhosis develops
the tissue becomes
nodular. These
nodules can block
bile ducts and
normal blood flow
throughout the liver.
In early disease the
liver is usually
enlarged, firm and
hard. As the pathologic
process continues, the
liver shrinks in size,
resulting in decreased
liver functions, which
can occur in weeks to
years.
Some patients with cirrhosis have
no symptoms until serious
complication occur. The impaired
liver function results in elevated
serum liver enzymes.
Complications
of Cirrhosis
 Portal Hypertension-
a persistent increase
in pressure within the
portal vein greater
than 5mmHg, results
from increased
resistance or
obstruction of the
flow of blood through
the portal vein and its
branches.
 Infection and Peritonitis- Bacterial
peritonitis may develop in patients with
cirrhosis and ascites in the absence of
intra-abdominal source of infection or an
abscess. This condition is referred as
Spontaneous Bacterial Peritonitis (SBP).
Antibiotic therapy is effective in the
treatment of recurrent episodes of SBP.
One complication is hepatorenal syndrome, a
form of renal failure unresponsive to
administration of fluid or diuretics agents.
 Gastrointestinal Varices- The obstruction to
blood flow through the liver caused by fibrotic
changes also result in the formation of
collateral blood vessel in the GI system and
shunting of blood from the portal vessels into
blood vessels with lower pressure.
 Edema- A reduced plasma albumin
concentration predisposes the patient to the
formation of edema.
Vitamin deficiency and Anemia- Because of
inadequate formation use and storage of
certain vitamins signs of deficiency is common,
particularly hemorrhagic phenomena
associated with vitamin K
Mental Deterioration- Deterioration of mental
and cognitive function with impending hepatic
encephalopathy and hepatic coma.
Signs and
symptoms
Compensated cirrhosis- the liver is scarred
but can still perform essential functions
without causing major symptoms
Intermittent mild fever
Vascular spiders
Palmar erythema
Unexplained epistaxis
Ankle edema
Vague morning indigestion
Flatulent dyspepsia
Abdominal Pain
Firm, enlarged liver
Splenomegaly
 Decompensated cirrhosis- liver functions is
impaired with obvious manifestation of
liver failure.
Ascites
Jaundice
Weakness
Muscle wasting
Weight Loss
Continuous mild
fever
 Clubbing of fingers
Purpura
Spontaneous Bruising
Epistaxis
Hypotension
Sparse body hair
White Nails
Gonadal Atrophy
LABORATORY
TEST and
DIAGNOSTIC
TEST
LABORATORY TEST
1. Serum Albumin level Decrease

A normal albumin range is 3.5 to 5.5 g/dL

It means that you have liver disease or an inflammatory
disease.
In which the body does not properly absorb and digest
protein.
2. Serum Globulin level Increase

Normal concentration of globulins in

human blood is about 2.3-3.5 g/dL.
3. Serum Alkaline Phosphatase; AST, ALT, and GGT levels Increase

Alkaline phosphatase- Varies with method;

Adults- 30-120 U/L
ALT = Alanine aminotransferase- It plays a crucial role in
metabolism, the process that turns food into energy.
Normal ALT between 8-40 U/mL
AST = Aspartate aminotransferase Normal AST is reported
between 10 to 40 U/mL
GGT = Gamma Glutamyltransferase 0-30 U/L
4. Serum Cholinesterase level - Decrease
The Cholinesterase Blood Test is a test to evaluate
the levels of AChE and BChE in blood to detect
deficiencies.
Acetylcholinesterase (AChE) - is present in the
meeting place between neurons and muscle cells.
This is called the neuromuscular junction.
Butyrylcholinesterase (BChE) - the other kind of
cholinesterase, is found in the blood, liver, and heart.
5. Bilirubin level Increase

It measures the ability of the liver to conjugate

and excrete bilirubin. Results are abnormal in
liver disease and are associated with jaundice
clinically.
6. PTT Prolonged

Normal range is 100% or 12-16 seconds

It will not return to normal with vitamin K in sever liver cell
damage.
DIAGNOSTIC TEST

Ultrasound scanning is used to

measure the difference in density
of parenchymal cells and scar
tissue. CT, MRI, and radioisotope
liver scans give information
about liver size and hepatic
blood flow and obstruction.
Diagnosis is confirmed by liver
biopsy. Arterial blood gas
analysis may reveal a ventilation-
perfusion imbalance and
hypoxia.
Medical
Management
 Antacids or H2 receptors antagonist are
prescribed to decrease gastric distress and
minimize the possibility of GI bleeding.
Vitamins and nutritional supplements promote
healing of damaged liver cells and improve the
patients general nutritional status.
Potassium sparing diuretics such as
spironolactone or triamterene (Dyrenium) may
be indicated to decrease ascites.
An adequate diet and avoidance of alcohol are
essential.
Nursing
management
 Monitor vital signs, intake and output and
electrolyte levels to determine fluid volume status.
Maintain some periods of rest wtih legs elevated
to mobilize edema and ascites.Alternate rest
periods with ambulation.
To assess fluid retention, measure and record
abdominal girth every shift. Weight the patient
daily and document his weight.
Administer diuretics,potasium and protein or
vitamin supplements as ordered. Restrict sodium
and fluid intake as ordered.
Assess the patients level of consciousness often
and observe closely for changes in behavior or
personality.
CIRRHOSIS
NURSING
DIAGNOSIS AND
INTERVENTIONS
 Nursing Diagnosis: Imbalanced nutrition: less
than body requirements related to abdominal
distention and discomfort and anorexia
Goal: Positive nitrogen balance, no further
loss of muscle mass; meets nutritional
requirements
Nursing Diagnosis: Chronic pain and discomfort related to enlarged tender
liver and ascites
Goal: Increased level of comfort
Nursing Interventions
1. Maintain bed rest when patient
experiences abdominal discomfort.
2. Administer antispasmodic and
analgesic agents as prescribed.
3. Observe, record, and report
presence and character of pain and
discomfort.
4. Reduce sodium and fluid intake if
prescribed.
5. Prepare patient and assist with
paracentesis.
6. Encourage the use of distracting
activities such as music, reading, or
meditation.
Rationale
1. Reduces metabolic demands and
protects the liver.
2. Reduces irritability of the GI tract
and decreases abdominal pain and
discomfort.
3. Provides baseline to detect further
deterioration of status and to
evaluate interventions.
4. Minimizes further formation of
ascites.
5. Removal of ascites fluid may
decrease abdominal discomfort.
6. Distraction may limit the perception
of pain.
 Nursing Diagnosis: Fluid volume
excess related to ascites and edema
formation
Goal: Restoration of normal fluid
volume
 Other nursing diagnosis includes:
Activity intolerance related to fatigue, lethargy, and malaise
Ineffective breathing pattern related to ascites and restriction
of thoracic excursion
Disturbed body image related to changes in appearance,
sexual dysfunction, and role function
Chronic pain and discomfort related to enlarged tender liver
and ascites
Confusion related to abdominal liver function and increased
serum ammonia level
Risk for injury related to altered clotting mechanisms and
altered level of consciousness
Risk for imbalanced body temperature ; hyperthermia related
to inflammatory process of cirrhosis or hepatitis
Gastrointestinal bleeding and hemorrhage
Hepatic encephalopathy
Health
teachings
Nutrition Therapy:
Consume a diet that adheres to the guidelines set by your physician,
nurse or dietician
If you have excessive fluid in your abdomen, follow the low sodium di
et prescribed for you
Eat small frequent meals that are nutritionally well balanced
Include in your diet daily supplemental liquids and a multivitamin

Drug therapy
Take the diuretics or preventive beta blocker prescribed for you, if yo
u experience muscle weakness, irregular heartbeat or lightheadednes
s contact your health care provider right away.
Take the medications prescribed for you that help prevent gastric inte
stinal bleeding.
Alcohol Abstinence
Do not consume any alcohol
Seek support services for help if needed