Transcript Liver Cirrhosis

HEPATIC CIRRHOSIS
HEPATIC CIRRHOSIS
Cirrhosis is a chronic disease characterized by
replacement of normal liver tissue with diffuse
fibrosis that disrupts the structure and function of
the liver. There are three types of cirrhosis or
scarring of the liver:
1. Alcoholic cirrhosis, in which the scar tissue
characteristically surrounds the portal areas. This is
most frequently due to chronic alcoholism and is the
most common type of cirrhosis.
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2. Post necrotic cirrhosis, in which there are broad
bands of scar tissue as a late result of a previous
bout of acute viral hepatitis. (eg, hepatitis A, B, C, D,
or E)
3.
Biliary cirrhosis, in which scarring occurs in the liver
around the bile ducts. This type usually is the result
of chronic biliary obstruction and infection; it is
much less common than the other two types.
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PATHOPHYSIOLOGY

Although several factors have been implicated in the
etiology of cirrhosis, alcohol consumption is
considered the major causative factor. Cirrhosis
occurs with greatest frequency among alcoholics.
Although nutritional deficiency with reduced protein
intake contributes to liver destruction in cirrhosis.
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PATHOPHYSIOLOGY

Other factors may play a role, including exposure to
certain chemicals or infectious . Twice as many men
as women are affected. Most patients are between 40
and 60 years of age.
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CLINICAL MANIFESTATIONS
LIVER ENLARGEMENT
 PORTAL OBSTRUCTION AND ASCITES
 INFECTION AND PERITONITIS
 FEVER
 EDEMA

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VITAMIN DEFICIENCY AND ANEMIA
 JAUNDICE (Hepatocellular jaundice) is caused
by the inability of damaged liver cells to clear
normal amounts of bilirubin from the blood

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ESOPHAGEAL VARICES
Paracentesis
Paracentesis
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ASSESSMENT AND DIAGNOSTIC FINDINGS

The extent of liver disease and the type of treatment are
determined after reviewing the laboratory findings. Because the
functions of the liver are complex, there are many diagnostic
tests that may provide information about liver function.
In severe parenchymal liver dysfunction,
1)The serum albumin level tends to decrease
2) Enzyme tests indicate liver cell damage :serum alkaline
phosphatase, (aspartate aminotransferase) AST, ALT, and
(gamma glutamyl transferase) GGT levels increase
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ASSESSMENT AND DIAGNOSTIC FINDINGS

Bilirubin tests are performed to measure bile excretion or bile
retention; elevated levels can occur with cirrhosis and other
liver disorders. Prothrombin time is prolonged.

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.
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MEDICAL MANAGEMENT

The management of the patient with cirrhosis is usually based
on the presenting symptoms. For example, antacids 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 general nutritional status.
Potassium-sparing diuretics (spironolactone) may be indicated
to decrease ascites, if present.
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MEDICAL MANAGEMENT

Preliminary studies indicate that colchicine, an anti
inflammatory agent used to treat the symptoms of
gout, may increase the length of survival in patients
with mild to moderate cirrhosis. Colchicine is believed
to reverse the fibrotic processes in cirrhosis, and this
has improved survival
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