CIRRHOSIS

ALCOHOLIC LIVER INJURY:

Alcoholic Liver disease - Patterns Fatty change, Acute hepatitis Chronic hepatitis Cirrhosis, Chronic Liver failure

All reversible except cirrhosis stage.

PATHOPHYSIOLOGY

Irreversible chronic injury of the hepatic parenchyma

Extensive fibrosis - distortion of the hepatic architecture

Formation of regenerative nodules

ETIOLOGY OF CIRRHOSIS

Alcoholic liver disease Viral hepatitis Biliary disease Primary hemochromatosis Wilson’s, 1AT def

CLINICAL FEATURES

Spider neavi Palmar erythema Nail changes Gynecomastia Testicular atrophy

CLINICAL MANIFESTATIONS

Muehrcke's nails

Terry’s nails

CLINICAL MANIFESTATIONS

Fetor hepaticus Jaundice Parotid gland

enlargement Flapping tremors

Hepatomegaly Splenomegaly Caput medusa

LABORATORY STUDIES AST/ALT ALP, gamma GT PT/INR S albumin USS scan Liver biopsy

MORPHOLOGIC CLASSIFICATION

Micronodular cirrhosis Nodules less than 3 mm in diameter Believed to be caused by alcohol

Macronodular cirrhosis

Nodules larger than 3 mmBelieved to be secondary to chronic viral

hepatitis

MICRONODULAR CIRRHOSIS

MACRONODULAR CIRRHOSIS

COMPLICATIONS

Ascites Spontaneous Bacterial Peritonitis Hepatorenal syndrome Variceal hemorrhage Hepatopulmonary syndrome Hepatic Encephalopathy Hepatocellular carcinoma

ASCITES

Accumulation of fluid within the peritoneal cavity

Due to several factors including portal hypertension, low protein levels, fluid retention etc.

ASCITIS IN CIRRHOSIS

ASCITES

Dietary sodium restriction Diuretics aspiration

HEPATORENAL SYNDROME

acute renal failure coupled with advanced hepatic disease

characterized by:Oliguriaprogressive rise in the plasma creatinine

VARICEAL HEMORRHAGE

Due to portal hypertension Can be lethal if not treated early

HEPATIC ENCEPHALOPATHY

neuropsychiatric abnormalities seen in patients with liver dysfunction sleep pattern variation Altered conciousness

HEPATOCELLULAR CARCINOMA

Patients with cirrhosis have a markedly increased risk of developing hepatocellular carcinoma

LIVER TRANSPLANTATION

Liver transplantation is the definitive treatment for patients with decompensated cirrhosis

GYNAECOMASTIA IN CIRRHOSIS