1. CIRRHOSISPathophysiology&Complications

2. What is Cirrhosis?

3. Definition: Nodular formation Hepatic necrosis and degeneration combined with hepatic regeneration and fibrosis leading to Nodular formation Cirrhosis

5. Normal liver functions Carbohydrate Metabolism Hypo- or hyperglycemia Fatty Acids Metabolism Lipid Transport Hyper- or hypolipidemia Proteins Metabolism Serum Albumin Vitamin K–Dependent Blood Coagulation Proteins Bilirubin Metabolism Bile Production Fat-Soluble Vitamins Detoxification Drugs and hormones Providing continual source of energy for entire body Regulation of storage and modulate availability of systemic nutrients Subject to hormonal modulation by endocrine organs (Pancreas, adrenal gland, and thyroid, neuronal regulation)

7. 1. Atrterial System 3. Venous System 2. Capillary System

8. 1. Atrterial System 3. Venous System 2. Capillary System 2. First Visceral Capillary System 3. Visceral Venous System 4. Second Visceral Capillary System 5. Venous System

9. Normal Liver Histology CV PV 6 mmHg 2-3 mmHg

15. None = 0 Portal Fibrosis = 1 Bridging Fibrosis = 3 Cirrhosis = 4

16. What is patophysiology of Cirrhosis?

17. Causes (Etiology of chronic necrosis) +Host (Liver reaction) Lead to Cirrhosis & complications Cirrhosis

54. What is clinical manifestation of Cirrhosis?

55. Clinical manifestations: - No symptoms (routine examination) 40% - Impaired hepatocellular function (Liver failure) - Portal hypertension - Clinical manifestation of underlying disease Cirrhosis

58. What is natural history of Cirrhosis?

62. How do you make diagnosis of cirrhosis?

63. Clinical work up: 1.Nature (Causes, Diseases) 2.Severity (Fibrosis, Complications) Cirrhosis

64. Diagnostic approach: 1.Liver function tests (PT, Pr., Alb, Bili, PLT) 2.Liver damage tests (AST>ALT, Alk.Ph) 3.Liver ultrasound (nodularity, decrease in size, portal vein enlargment, prominent left lobe) 4.Etiological diagnostic tests 5.Liver biopsy 6.Surveillance tests (AFP, sonography, endoscopy, pracentesis, creatinine) Cirrhosis

72. What is general clinical management of cirrhosis?

73. Clinical management: 1.Etiological treatment 2.Prophylactic treatment 3.Pre-transplantation care 4.Liver transplantation Cirrhosis