The chronic, progressive disease of the liver characterized by inflammation, fibrosis, and degeneration of the liver. Destroyed liver cells are replaced by scar tissue, resulting in architectural changes and malfunction of the liver.
Laênnec’s Cirrhosis
Associated with alcohol abuse and malnutrition; characterized by an accumulation of fat in the liver cells, progressing to widespread scar formation.
Postnecrotic Cirrhosis
Severe inflammation of the liver results in massive necrosis as a complication of viral hepatitis.
Cardiac Cirrhosis
Resultant from right-sided heart failure causing portal hypertension; manifested by hepatomegaly with some fibrosis.
Biliary Cirrhosis
Cirrhosis as an outcome of obstruction of the biliary tract (often the common bile duct). This also results in chronic impairment of bile excretion.
Assessment Findings
- Anorexia, Weakness, and Weight Loss as a result of dysfunctional metabolism of nutrients and storage of fat-soluble vitamins (ADEK).
- Fever in response to tissue injury.
- Jaundice, pruritus, and tea-colored urine all resulting from increased bilirubin in the blood.
- Hemophilia as a result of the inability to store Vitamin K and dysfunctional production of clotting factors in the liver.
- Decreased libido, impotence, hair loss/thinning, testes atrophy, gynecomastia in men from increased peripheral conversion of androgens to estrogen
- Hirsutism, acne, deepening of the voice, and virilism in women due to increased androgen.
Pathology
- Portal Hypertension: plasma shifts into interstitial spaces within the liver due to the increased pressure. This fluid shifts out of the Glisson’s capsule and accumulates in the peritoneal cavity (ascites).
- Dysfunctional Protein Metabolism results in hypoalbuminemia, decreasing oncotic pressure, resulting in fluid shifting out of the inferior vena cava and into the peritoneal cavity.
- Impaired Adrenal Cortex Hormone Excretion (Hyperaldosteronism) results in retention of sodium and fluids.
- Esophageal Varices secondary to pressure applied by portal venous hypertension.
- Internal hemorrhoids, leg varicosities, and dependent edema all resulting from venous stasis which increases hydrostatic pressure.
Portal Hypertension Complications
- Hepatomegaly: an initial sign form portal hypertension, but recedes as liver parenchyma is replaced by scar tissue, resulting in shrinkage of the liver.
- Splenomegaly: increased back pressure from the blood results in blood backing up in the spleen.
- Hypersplenism: increased RBC breakdown (moderate anemia), neutropenia, thrombocytopenia.
- Caput Medusae: dilated veins over the abdomen.
- Spider Angioma: talengiectasia; dilated capillaries over the face and anterior trunk due to increased estrogen. Peripheral conversion of androgens produce estrogen. Also observed in pregnancy.
- Palmar Erythema: redness of the palms as a result of heightened estrogen levels.
- Ascites