1. C IRRHOSIS

2. A LCOHOLIC L IVER I NJURY : Alcoholic Liver disease - Patterns Fatty change, Acute hepatitis Chronic hepatitis Cirrhosis, Chronic Liver failure All reversible except cirrhosis stage.

3. P ATHOPHYSIOLOGY Irreversible chronic injury of the hepatic parenchyma Extensive fibrosis - distortion of the hepatic architecture Formation of regenerative nodules

4. E TIOLOGY OF C IRRHOSIS Alcoholic liver disease Viral hepatitis Biliary disease Primary hemochromatosis Wilson’s,  1AT def

5. C LINICAL FEATURES Spider neavi Palmar erythema Nail changes Gynecomastia Testicular atrophy

6. C LINICAL M ANIFESTATIONS Muehrcke's nails Terry’s nails

7. C LINICAL M ANIFESTATIONS Fetor hepaticus Jaundice Parotid gland enlargement Flapping tremors Hepatomegaly Splenomegaly Caput medusa

10. L ABORATORY S TUDIES AST/ALT ALP, gamma GT PT/INR S albumin USS scan Liver biopsy

11. M ORPHOLOGIC C LASSIFICATION Micronodular cirrhosis Nodules less than 3 mm in diameter Believed to be caused by alcohol Macronodular cirrhosis Nodules larger than 3 mm Believed to be secondary to chronic viral hepatitis

12. M ICRONODULAR CIRRHOSIS

13. M ACRONODULAR C IRRHOSIS

14. C OMPLICATIONS Ascites Spontaneous Bacterial Peritonitis Hepatorenal syndrome Variceal hemorrhage Hepatopulmonary syndrome Hepatic Encephalopathy Hepatocellular carcinoma

15. A SCITES Accumulation of fluid within the peritoneal cavity Due to several factors including portal hypertension, low protein levels, fluid retention etc.

16. A SCITIS IN C IRRHOSIS

17. A SCITES Dietary sodium restriction Diuretics aspiration

18. H EPATORENAL SYNDROME acute renal failure coupled with advanced hepatic disease characterized by: Oliguria progressive rise in the plasma creatinine

19. V ARICEAL HEMORRHAGE Due to portal hypertension Can be lethal if not treated early

20. H EPATIC E NCEPHALOPATHY neuropsychiatric abnormalities seen in patients with liver dysfunction sleep pattern variation Altered conciousness

21. H EPATOCELLULAR C ARCINOMA Patients with cirrhosis have a markedly increased risk of developing hepatocellular carcinoma

22. L IVER T RANSPLANTATION Liver transplantation is the definitive treatment for patients with decompensated cirrhosis

24. G YNAECOMASTIA IN CIRRHOSIS