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 10%
 Biliary disease 5-10%
 Primary hemochromatosis 5%
 Cryptogenic cirrhosis 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 Hepatocyte
wbc pain
damage

fatigue liver
fever
Inflammation
Nausea Alterations in anorexia
vomiting blood and
lymph flow
 Liver
necrosis

liver Liver fibrosis

failure And scarring
Decrease ADH Palmar Spider Loss of
edema Erythema angiomas Body hair
Dec.androgen/
Estrogen p.
Testicular
Dec.met.of CHON Gyneco Menstrual
Plasma atrophy
And Carb./ mastia changes
CHON
Dec.Fat
Edema
Hypoglycemia Acites

Vit.k absop. Bleeding

tendencies
bile
Clay-colored
Bilirubin excretion stool
Dark urine
In urine
hyperbilirubinemia jaundice
Bilirubin metabolism
 ascites
edema
Esophageal
varices
hemorrhoids
bleeding
Superficial
Liver fibrosis Portal HPN
Abdominal
varices

splenomegaly
bleeding
Delayed
Wound
Anemia
healing
Thrombocytopenia infection
leukopenia
 Increase
serum Alterations
ammonia In Foul breath
sleep

Inability to
Hepatic
Liver failure Metabolize
encephalopathy
ammonia
Confusion to
Hepatic
Respiratory coma
Asterexis 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