Liver Disorders

ASHOK BISHNOI

Mr ASHOK BISHNOILecturer JINR

LIVER Weight in male

1600gm & in female 1300gm, wedge shape

It is largest gland in body

Reddish brown in color 4 lobes, Right, left,

Caudate, Quadrate. Blood supply by

Hepatic arteries Situated in right upper

quadrate region.

ASHOK BISHNOI

Normal Liver

Metabolism – Carbohydrate, Fat & Protein

Secretary – bile

Excretory – Bilirubin, drugs, toxins

Synthesis – Albumin, coagulation factors

Storage – Vitamins, carbohydrates etc.

Detoxification – toxins, ammonia, etc.

ASHOK BISHNOI

Liver Functions:

Liver Cirrhosis

ASHOK BISHNOI

The word "cirrhosis" is a neologism that derives from Greek kirrhos, meaning "tawny" (the orange-yellow colour of the diseased liver).

While the clinical entity was known before, it was René Laennec who gave it the name "cirrhosis" in his 1819 work in which he also describes the stethoscope.

ASHOK BISHNOI

Introduction

“It is a chronic liver disease of the liver characterized by inflammation & fibrosis resulting in drastic structural change & significant loss of liver function in which extensive degeneration & destruction of the liver parenchymal cell”

ASHOK BISHNOI

Definition:-

ASHOK BISHNOI

Cirrhosis

1.Alcoholic cirrhosis- Most common, due to chronic alcoholism. Scar tissue characteristically surrounds the portal area.

ASHOK BISHNOI

Types:-

Alcoholic Fatty Liver

2.Postnecrotic cirrhosis- due to results of acute viral hepatitis, post intoxication with industrial chemicals.

3.Biliary cirrhosis- Scaring occurs around bile duct in liver, Results from chronic biliary obstruction & infection.

4.Cardiac cirrhosis- Associated with severe right sided long term heart failure.

HANU BISHNOI

Alcoholic liver disease (ALD). Viral hepatitisObstruction of bile ductUse of drug eg. IsoniazidWilson's diseaseAlpha 1-antitrypsin deficiencyRight sided heart failureExposure of chemicals

(arsinic,Phosphorus)

ASHOK BISHNOI

Causes:-

Due to etiological factor

Nausea, WBC,Fatigue Inflammation Pain, Fever Anorexia

Liver necrosis

ADH Androgen & estrogens level liver fibrosis liver failure Metabolism of protein portal H.T inability to metabolize

Fat metabolism Hypoglycaemia ammonia to urea Vit.K absorption Malnutrition hepatic encephalopathy Bilirubin metabolism confusion to hepatic coma

deathASHOK BISHNOI

Pathophysiology:-

Spider angiomata or spider nevi. Palmar erythema ( Exaggerations of normal speckled mottling

of the palm, due to altered sex hormone metabolism. )

Gynecomastia ( Benign proliferation of glandular tissue of male breasts

presenting with a rubbery or firm mass extending concentrically from the nipples)

Hypogonadism(Manifested as impotence, infertility, loss of sexual

drive, and testicular atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function)

Enlargement of liverSplenomegalyAscitesCaput medusa

ASHOK BISHNOI

Signs and symptoms

Fetor hepaticus(Musty odor in breath due to increased dimethyl sulfide)

Jaundice Indigestion AnaemiaOther;- Weakness, fatigue, anorexia, weight

loss.

HANU BISHNOI

ASHOK BISHNOI

Ascitis in Cirrhosis

HANU BISHNOI

Cirrhosis Clinical Features

ASHOK BISHNOI

Porta-systemic anastomosis: Prominent abdominal veins.

ASHOK BISHNOI

SPIDER ANGIOMA

ASHOK BISHNOI

Gynaecomastia in cirrhosis

ASHOK BISHNOI

History Physical examination LFT Liver biopsy Liver scan Ultrasound scaning Abdominal X-Ray CBC Serum electrolyte MRI

ASHOK BISHNOI

Diagnostic evaluation:-

Esophago-gastrodudenoscopy Serum albumin Prothrombin time- increases since the

liver synthesizes clotting factors

ASHOKBISHNOI

ASHOK BISHNOI

Technique for palpating the liver. The examiner places onehand under the right lower rib cage and presses downward with light pressure with the other hand.

ASHOK BISHNOI

MRI Cirrhosis

Medical management:- Rest Sodium restricted High CHO. Protein& low fat diet. Administer diuretic eg. Lasix Antacid Antibiotic Corticosteroid Alcohol restriction

ASHOK BISHNOI

Management:-

Peritoneovenous shunt

Liver transplantation

ASHOK BISHNOI

Surgical management:-

Activity intolerance R/T fatigueAltered nutrition less than body requirment R/T anorexia.

Impaired skin integrity R/T edema ,poor nutrition.

Risk for injury R/T clotting machnism

ASHOK BISHNOI

Nursing Diagnosis

Promoting rest Improving nutritional status Providing skin care Reducing risk of injury Monitoring & managing Potential complications Bleeding & hemorrhage Hepatic encephalopathy Fluid Volume excess Promoting home & self care Client teaching.

ASHOK BISHNOI

Nursing Interventions

Learn from the mistakes of others. You can't live long enough to make them all yourself…!

HANU BISHNOI