Cirrhosis of Liver

1
Cirrhosis of Liver

• Chapter 42

2
Cirrhosis of Liver

• A chronic, progressive disease
• Extensive degeneration destruction to the liver
  parenchymal cells
• Cell necrosis ? scar tissue ? nodular structure ?
  impedes blood flow ? hypoxia
• Men women 21
• Most common cause - ETOH

3
Pathophysiology

• Alcoholic cirrhosis accumulation of fat and
  scar formation in the liver cells
• Postnecrotic cirrhosis broad bands of scar
  tissue resulted from viral, toxic, or autoimmune
  hepatitis
• Biliary cirrhosis diffuse fibrosis with
  jaundice from chronic biliary obstruction
• Cardiac cirrhosis from long-standing right
  sided heart failure

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Clinical Manifestations

• Early
• GI disturbances, dull pain in RUQ/epigastrium,
  fever, malaise, enlargement of liver spleen
• Late
• Jaundice, skin lesions (spider angiomas, palmar
  erythema), hematologic problems, endocrine
  disturbances, peripheral neuropathy

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Complications Portal Hypertension

• Compression
• Portal vein,hepatic veins, sinusoids
• Obstruction of portal blood flow
• Portal Hypertension
• Venous pressure, splenomegaly, collateral
  circulation, ascites, systemic hypertension,
  esophageal varices

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Complications Esophageal Varices

• To reduce portal hypertension
• Collateral circulation develops in lower
  esophagus, anterior abdominal wall, parietal
  peritoneum, rectum
• Varicosities develop where collateral systemic
  circulations communicate ? esophageal gastric
  varices, caput medusae, hemorrhoids

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Complications Peripheral Edema

• ? albumin synthesis
• ? colloidal oncotic pressure
• ? portocaval pressure
• Peripheral edema (ankle presacral)

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Fluid Balance
http//www.cvphysiology.com/Microcirculation/M010.
htm
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Complications - Ascites

• Accumulation of serous fluid in peritoneum
• Protein from sinusoids ? lymph space ? leak water
  and protein into the peritoneal cavity
• Hypoalbuminemia ? ? colloidal oncotic pressure
• Hyperaldosteronism ? ? Na reabsorption
• Abdominal distention,striae, weight gain
• Dehydration
• Hypokalemia

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Complications Hepatic Encephalopathy

• Bacterial enzymatic deamination of amino acids
  in the intestines ? ammonia without liver
  detoxification? crosses blood-brain barrier ?
  toxic neuro symptoms
• Euphoria, irritability, confusion, slurred
  speech, slow deep respiration, hyperactive
  reflexes, positive Babinskis reflex
• Asterixis, fetor hepaticus, deep coma

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Complications Hepatorenal Syndrome

• Portal hypertension ? splanchnic systemic
  vasodilation ? ? arterial blood volume ? renal
  vasoconstriction ? renal failure

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connection.lww.com/ Products/morton/Ch41.asp
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Diagnosis

• Liver enzymes elevation alkaline phosphatase,
  AST, SGOT, GGT
• ? total protein, albumin ? globulin
• ? cholesterol levels
• Prolonged PT
• Bilirubin metabolism abnormalities
• Liver biopsy
• Liver scan

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Management

• Rest
• Ascites Sodium/fluid restriction,diuretics,
• Paracentesis
• Peritoneovenous shunt continuous reinfusion of
  ascitic fluid into the venous system
• Nutrition hi cal, hi CHO, mod/lo fat, low
  protein if symptomatic

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Management- Drugs

• Hemostasis vasopressin
• ? portal venous pressure Propranolol
• Acidify stool, trap ammonia Lactulose
• ?bacterial flora Neomycin sulfate
• ?gastric acidity Cimetidine
• Diuretics Spironolactone, lasix, etc,
• Magnesium replacement MgSO4
• Correct clotting abnormalities Vitamin K

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Nursing Management

• Ascites
• Bleeding esophageal varices
• Hepatic encephalopathy