LIVER CIRRHOSIS

PRESENTED BY :-ASHA.P
M.PHARM[PHARMACY PRACTICE]
LIVER CIRRHOSIS
➢ Cirrhosis is a chronic, progressive disease characterized by widespread
fibrosis & nodule formation.Cirrhosis occurs when the normal flow of
blood,bile & hepatic metabolites is altered by fibrosis.
CLASSIFICATION

➢ ALCOHOLIC CIRRHOSIS
➢ POST NECROTIC CIRRHOSIS
➢ BILIARY CIRRHOSIS
➢ CARDIAC CIRRHOSIS
ALCOHOLIC CIRRHOSIS
➢ Most common type of liver cirrhosis caused by chronic alcoholism.
➢ Fibrosis occurs mainly around central veins and portal areas.
➢ Disease progression starts with fatty liver then to alcoholic hepatitis then
to alcoholic cirrhosis.
➢ Men are more likely to have alcoholic cirrhosis.

POST NECROTIC CIRRHOSIS

➢ Macronodular cirrhosis,toxin-induced cirrhosis.
➢ Broad bands of scar tissue caused by acute viral hepatitis,post
intoxication with industrial chemicals.
BILIARY CIRRHOSIS
➢ Scarring occurs around bile ducts and lobes of the liver,results from chronic
biliary obstruction and infection.

CARDIAC CIRRHOSIS
➢ It is rare,associated with long term severe right sided heart failure.
CAUSES
➢ Chronic hepatitis C & B :- Infection with the virus causes inflammation
and low grade damage to the liver can lead to cirrhosis.
➢ Alcohol abuse
➢ Fatty liver associated with obesity and diabetes.
➢ Primary biliary cirrhosis :-complain of fatigue, pruritus.
➢ Autoimmune hepatitis:- this is caused by the immunologic damage to
the liver causing inflammation,scarring and cirrhosis.
➢ Hemochromatosis
➢ Wilson’s disease
➢ Galactosemia
➢ Drugs or toxins :- medication such as methotrexate,acetaminophen.
SIGNS & SYMPTOMS
➢ fatigue
➢ Loss of appetite
➢ Edema
➢ Weight loss
➢ Itchy skin
➢ Jaundice
➢ Liver size may be enlarged or shrunken
➢ UGI bleeding
SIGNS & SYMPTOMS
➢ ASCITES :-Accumulation of fluid in the peritoneal cavity

➢ SPIDER ANGIOMA:- Enlarged blood vessel in skin due to high estrogen level
➢ PALMAR ERYTHEMA :- RED PALMS
PATHOPHYSIOLOGY
STAGES OF LIVER DAMAGE
DIAGNOSIS
LAB DATA
➢ Complete blood count.
➢ Serum electrolytes.
➢ Liver function test :- Aminotransferases, alkaline phosphatase,bilirubin levels
are elevated & low levels of albumin.
➢ Prolonged Prothrombin time.
IMAGING
➢ Ultrasound is used for evaluation of cirrhosis,it may show a small and nodular
liver.
➢ Abdominal CT scan
➢ MRCP
➢ MRI
BIOPSY
MRI
COMPLICATIONS
➢ Portal hypertension :-
● Edema
● Ascites
● GI bleeding
➢ Hepatic encephalopathy
➢ Hepatocellular carcinoma
MANAGEMENT
TREATMENT GOALS

➢ Slow the progress of cirrhosis

➢ To prevent and treat complications
TREATMENT
TREATMENT OF ASCITES & EDEMA
➢ Diuretics therapy :- combination of spironolactone and furosemide can
reduce or eliminate the Edema and Ascites.
➢ Paracentesis :- removal of fluid from peritoneal cavity through a small surgical
incision
➢ Administration of albumin
➢ TIPS:-Performed by radiologist who inserts a stent into portal vein,this stent
serves as an intrahepatic shunt between the system circulation and portal
vein.
TREATMENT OF BLEEDING FROM VARICES
➢ Propranolol,nadolol,decreases portal vein pressure and reduces bleeding
➢ Sclerotherapy
➢ TIPS
TREATING UNDERLYING CAUSES
➢ Treatment for hepatitis cirrhosis involves antiviral and corticosteroids
drugs.eg:-Interferon & betamethasone
➢ Cirrhosis caused by wilson’s disease is treated with chelation therapy
to remove copper eg:- D-Penicillamine
➢ Hepatic encephalopathy is treated with lactulose and antibiotics
SURGERY
➢ Liver transplantation :- removing the liver and replacing it with
healthy donor organ