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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