1. Liver pathology: CIRRHOSIS
Ivana Marić
Mentor: A. Žmegač Horvat

2. Consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leading to progressive loss of liver function

3. Aetiology Alcohol Chronic hepatitis B Chronic hepatitis C Other:
Haemochromatosis
Non-alcoholic fatty liver disease
Primary biliary cirrhosis
Sclerosing cholangitis
Autoimmune hepatitis
Cystic fibrosis...

4. Pathology MICRONODULAR CIRRHOSIS
Uniform, small nodules up to 3 mm in diameter
Often caused by alcohol damage

5. Pathology MACRONODULAR CIRRHOSIS Large nodules
Often seen following hepatitis B infection

6. Cirrhosis with complicatons of encephalopathy, ascites or variceal haemorrhage – DECOMPENSATED CIRRHOSIS
Cirrhosis without any of these complications – COMPENSATED CIRRHOSIS

7. Signs and symptoms Jaundice Fatigue Weakness Loss of appetite Itching
Easy bruising

8. Investigations
Liver biochemistry (usually slight elevation of serum alkaline phosphatase and aminotransferase)
Liver function - serum albumin and prothrombin
Serum electrolytes
Serum alpha-fetoprotein
Endoscopy

9. Investigations
Ultrasound CT

10. Management Irreversible disease, frequently progresses
Correcting the underlying cause (abstinence from alcohol)
Screening for hepatocellular carcinoma
Liver transplantation
5-year survival rate approximately 50%

11. Complications
PORTAL HYPERTENSION

12. Symptoms:
Gastrointestinal bleeding from oesophageal or (less commonly) gastric varices
Ascites
Hepatic encephalopathy

13. VARICEAL HAEMORRHAGE
30% of patients with varices bleed from them often massive bleeding; 50% mortality
Therapy: endoscopic therapy:
sclerotherapy
variceal band ligation
pharmacological treatment
balloon tamponade
TIPS
surgery

14. ASCITES Presence of fluid in the peritoneal cavity Therapy: diuretics
paracentesis

15. PORTOSYSTEMIC ENCEPHALOPATHY
Toxic substances (ammonia) bypass the liver via collaterals and gain access to the brain
Symptoms: lethargy
mild confusion
anorexia
reversal of sleep pattern
disorientation
coma

16. HEPATORENAL SYNDROME
Development of acute renal failure in patients with advanced liver disease
Splanchnic vasodilatation - fall in systemic vascular resistance, vasoconstriction of renal circulation, reduced renal perfusion
Oliguria, rising serum creatinine, low urine sodium

18. References:
Kumar&Clark: Clinical medicine