Cirrhosis and Liver Failure

  1. Cirrhosis
    • chronic, progressive
    • widespread fibrosis & nodule formation
    • alter/destroyed hepatocytes unable to be fully regenerated
    • leaves liver scarred, nodular and inefficient
  2. cirrhosis 2
    • 9th leading cause of death in US
    • 4th when considering only 34-54 to
    • highest incidence b/t 40-60 yrs
    • 2x as common in men than women
  3. Cirrhosis
    • alcoholic (Laennec's portal, micronodular)
    • postnecrotic
    • billary
    • cardiac
    • cause can't always be identity- sometimes overlapping
  4. alcoholic cirrhosis
    • alcohol- primary risk factor
    • - increased risk: if daily drinking, poor nutrition
    • with excessive alcohol, fat accumulates in hepatocytes¬† (infiltration of fat, replace hepatocyte)
    • with abstinence at this level, changes may be reversible
    • if not, widespread scarring occurs- not reversible, loss of function, necrosis- sepsis
    • (daily drinking is a greater risk- not what u drinking. adding with poor nutrition)
  5. Postnecrotic cirrhosis
    • most common worldwide form
    • massive loss of liver cells with irregular patterns of regenration
    • - broad bands of scar tissue
    • complication of hepatitis (esp B & C)
    • liver becomes small and nodular
    • most common reason is hepatitis
    • virus cause scar tissue
    • hep + alc- inc risk
    • not + alc- inc risk
  6. Bilary Cirrhosis
    • result of chronic obstructed bile flow and infection (cholangitis)- infection/inflamm common bile duct
    • damage hepatocytes
    • inflammatory process causescell necrosis and scar tissue formation
    • - diffuse fibrosis and scarring of liver
    • less common than other forms
  7. Cardiac cirrhosis
    • chronic liver disease from severe, long term right side heart failure
    • progressive fibrosis due to prolonged venous blood retention
    • - hepatic vein
    • congested hepatopathy- venous congestion in liver which causes fibrosis. cause inflammation cell contents leak out = end in scar tissue
  8. Cirrohosis 3
    • final stage in many liver injury
    • extensive hepatocyte necrosis & scarring
    • results in changes in vascular, bile, lymphatic flow- r/t to fibrosis
    • liver becomes nodular
    • attempts to regenerate may work at first but eventually are exhausted
  9. cirrhosis 4
    • liver is left scarred, nodular, unable to function properly
    • 2 clinical problems
    • - decreased liver function
    • - portal hypertension (severe cirrhosis)- can't get blood into liver so it backs up
  10. cirrhosis 5
    • onset usually insidious
    • slow progression initially
    • may be reversed if insults stop early enough
    • - liver can regenerate itself
  11. cirrohosis
    early s/s
    • GI: anorexia, dyspepsia, flatuence, n/v. change in bowel patterns
    • - changes in cho, protein fat metabolism
    • Pain: dull, heavy RUQ or epigastric area
    • - stretching/swelling of liver capsule, spasm of billary ducts (maybe obstructed at sphrincter), vascular spasms
    • fever, malaise, weight loss
    • enlarged firm liver
    • - liver is enlarged with fat
  12. cirrhosis
    advance symptoms
    • many system wide manifestation
    • often are severe and due to:
    • liver failure- inability to synthesis, and clotting factors
    • portal htn
  13. cirrhosis
    other advance symptoms
    • jaudice/pruritis
    • - dec ability to conjugate and execrete bilirubin
    • - bile salts deposit in skin
    • peripheral edema
    • - reduced plasma albumin
    • - often generalized, more likely LE
    • ascites
    • - fluid in the peritoneal space due to reduced plasma protein with changes in hydrostatic pressure
  14. cirrhosis
    advance symptoms
    skin lesions
    • spider angiomas: small dilated blood vessels with a bright read center and spiderlife branches
    • - occur on nose, cheeks, upper truck and neck
    • - due to inc circulating estrogen
    • Palmer erthema: redness that blanches with pressure on palms
    • due to incre circulating estrogen
  15. Cirrhosis
    advance symptoms
    hematologic problems
    • thrombocytopenia, anemia, leukopenia
    • - due to splenomegaly from back up of blood from portal vein into the spleen
    • - the spleen incr activity and incre removal of blood cell from circulation
    • - other causes: poor nutrition, poor absorbtion of FA, bleeding (chronic alcohol use dec absorption of vitamins, mineral, nutrients
    • alcohol dec absorption of nutrition
  16. hematological problems
    • leukopenia
    • - incre removal of blood cells by spleen
    • - decre production, function and movement of wbc
    • - incr risk of infection
  17. advanced symptoms
    coagulation problems
    • liver's inability to produce prothrombin and other clotting factors
    • epitaxis, purpura, petechiae, easy bruising, gingival bleeding, heavy menses
  18. advanced symptoms
    vitamin and mineral deficiency
    • Vita K
    • folic acid, thiamine
    • Fe, calcium, vita D
    • chronic alcoholism: decr absorption of FA, vita B12, B6, thiamine, vita C
    • venous congestion and add alcohol (down absorption)
  19. Advance symptoms
    endocrine changes
    • due to liver's inability to metabolize and inactivate hormones- excessive estrogen
    • - men- skin lesions and gynecomastia, loss of axillary and pubic hair, testicular atrophy, impotence
    • - women- amenorrgea, vaginal bleeding in older women
    • failure to metabolize aldosterone- hyperaldosteronism (Na/H2O retention with postassium loss)-- edema
  20. Advance symptoms
    peripheral neuropathy
    • esp w/alcoholic cirrhosis
    • likely due to thiamine, folic acid and vita b12 def
    • most likely sensory deficits
Card Set
Cirrhosis and Liver Failure
liver problems