Cirrhosis of the Liver

DEFINITION
 Cirrhosis is a consequence of chronic
liver disease characterized by
replacement of liver tissue by fibrosis,
scar tissue and regenerative nodules
(lumps that occur as a result of a
process in which damaged tissue is
regenerated),leading to loss of liver
function.
 CAUSES

 alcoholism,

 hepatitis B and C,
 fatty liver disease,

 Some cases are idiopathic, i.e.,

of unknown cause.
 Pathophysiology
 Slow, insidious, progressive, chronic
 Fibrous bands replace normal liver
structure
 Cell degeneration occurs
 Liver attempts to regenerate cells
but cells are abnormal and
disorganized
 Causes abnormal blood and lymph
flow
 Results in more fibrous tissue
formation
Normal Liver
 Types of Cirrhosis

 Laennec’s
(alcoholic)

 Postnecrotic

 Biliary

 Cardiac
 Laennec’s Cirrhosis

 Most common type of cirrhosis

 Also called alcoholic or portal
 Alcohol causes inflammation to liver
cells
 Leads to fatty deposits and
hepatomegaly
 Scarring formed and liver cells
destroyed
 Malnutrition and more alcohol
accelerate the damage
Postnecrotic Cirrhosis
 Caused by viral
hepatitis or
hepatotoxins
 Scar tissue destroys
liver lobes
 Liver initially enlarges
but then shrinks in size
 10 – 30% of all
cirrhoses
 Biliary Cirrhosis

 Caused by chronic biliary

obstruction or stasis of bile,
biliary inflammation, or
hepatic fibrosis
 Excessive bile leads to liver
cell destruction and
formation of nodules in the
lobes
 5 – 10% of all cirrhoses
Cardiac Cirrhosis
 Seen with right sided heart failure
 Liver is engorged with venous blood
 Becomes enlarged, edematous, and
dark
 Venous congestion results in anoxia
 Cell necrosis results
 Diagnostic Data

  AST, ALT, LDH, Alk phos

  bilirubin, ammonia,
  coagulation studies
 Serum protein levels depend on
disease
  with acute liver disease

  with chronic liver disease

 More Diagnostics

 Abdominal x-ray
 Upper GI series
 Angiography
 Abdominal CT
 EGD
 Liver biopsy
 Nuclear scan
Signs and Symptoms
 Neurological
Asterixis Paraesthesias
 LOC Sensory
disturbances
Behavorial changes Cognitive
changes
 Skin
Spider angiomas Palmar erythma
Jaundice Pruitis
 hair production caput medusa
 pigmentation Bruising
White Nails
Caput Medusae
Spider Angiomas
Palmar Erythema
 More Signs and Symptoms

 GI
Abdominal pain Anorexia
Ascites Diarrhea
Clay colored stools Fetor
hepaticus
Gastritis GI bleeding
N/V Varices
Malnutrition
“White Nails”
 More Signs and Symptoms

 Cardiovascular
Dysrhythmias Portal hypertension
Collateral circulation Fatigue
Peripheral edema
 Endocrine
Gynecomastia Amenorrhea
 aldosterone, ADH, estrogens,
glucocorticoids
More Signs and Symptoms
 Respiratory
Dyspnea Hypoxia

 Blood
Anemia DIC
Thrombocytopenia  WBCs
Hypokalemia Hypocalcemia
Hypo/Hypernatremia
Hypomagnesia
 More Signs and Symptoms
 Immune
 Susceptibility to infections
Leukopenia
 Renal
 Urinary output
 Complications
 Portal hypertension
 Ascites
 Varices
 Coagulation defects
 Jaundice

 PSE (portal systemic

encephalopathy)
 Hepatorenal syndrome
 Treatment

 Diet
  Sodium (< 2 grams)
 Carbohydrate, moderate fats
  Protein
 Unless PSE present then  protein
 Fluid restriction (total of ≤ 1500cc/day)
 Vitamin supplements
 Treatment Continued
 Medications
 Diuretics

 Electrolyte replacement

 Antacids

 Must be low sodium – Riopan

 Lactulose

 Facilitates evaculation of
ammonia
 Neomycin

 Eliminates intestinal flora = 

protein breakdown
 Levadopa

 For PSE – repairs damaged

neurotransmitters
 More Treatments
 Ascites control
 Paracentesis

 Shunts

 Le Veen Shunt - drains ascites fluid

into superior vena cava
 Denver Shunt – subcutaneous pump
that is manually compressed
 Post op care: same as with any
abdominal surgery, watch for fluid
volume overload and bleeding
disorders, measure abdominal girth
every shift
Le Veen Shunt
 More Treatments
 Hemorrhage from varices
 Esophagogastric balloon tamponade
 Sengstaken-Blakemore tube – balloon inflates in esophagus and
puts pressure on varices
 Blood transfusions
 Medications
 Beta blockers to decrease HR and BP
 Pitressin (vasopressin) IV or into superior mesenteric artery (via
endoscopy)
 Sclerotherapy
 Sclerosing agents injected into varices during EGD
 Transjugular intrahepatic portal systemic shunt (TIPS)
 Shunt between portal and hepatic vein to  pressure =  bleeding
 Other portal system shunts – poor prognosis
Sclerosing Procedure
Blakemore Tube
Another Blakemore Tube
 More Treatments
 PSE
 Low protein diet

 May need TPN

 Control GI bleeding

 Medications

 Neuro checks

 Look for signs and symptoms of the stages

of PSE
 Home Care
 Diet
  calories, vitamins, protein
(unless PSE)
  sodium

 Medications
 Diurectics

 Antacids, H2-receptor
antagonists
 No OTC medications

 No alcohol consumption
  activity – rest periods
 Home care equipment