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
