1. CIRRHOSIS

2. CIRRHOSIS Term was 1st coined by Laennec in 1826
Cirrhosis is the end result of many chronic liver diseases.
DEFINITION: It is defined histologically as presence of fibrosis and regenerative nodules in the liver

3. Causes Alcohol 60-70% Chronic viral hepatitis(B or C) 10%
Non alcoholic fatty liver disease
Immune
primary sclerosing cholangitis
autoimmune liver disease
Primary Biliary cirrrhosis

4. Cont… Genetic haemochromatosis alpha-antitrypsin deficiency
wilson’s disease.
Cryptogenic %
Drug induced

5. Cirrhosis: Pathophysiology
Primary event is injury to hepatocellular elements
Destruction of hepatocytes, bile duct cells, vascular endothelial cells
Repair through cellular proliferation and regeneration
Formation of fibrous scar
Prevents normal flow of nutrients to hepatocytes and increases vascular resistance

6. Cirrhosis: Pathophysiology
Initially, fibrosis may be reversible if inciting events are removed
With sustained injury, process of fibrosis becomes irreversible and leads to cirrhosis
Cirrhotic levels of alcohol in:
males >60-80g/day for 10yrs
females 20-40g/day for 10yrs.

7. Normal liver Cirrhotic liver

8. Classification of Cirrhosis
WHO divided cirrhosis into 3 categories based on morphological characteristics of the hepatic nodules
Micronodular
Macronodular
Mixed

9. Micronodular Cirrhosis
Nodules are <3 mm in diameter
Relatively uniform in size
Distributed throughout the liver
Liver is of uniform size or mildly enlarged
Reflect relatively early disease

10. Micro nodular cirrhosis

11. Macronodular & Mixed Cirrhosis
Nodules are >3 mm in diameter and vary considerably in size
Usually contain portal tracts and efferent veins
Liver is usually normal or reduced in size
Mixed pattern if both type of nodules are present in equal proportions

12. Macronodular cirrhosis

13. Clinical features Hepatomegaly Jaundice Ascites Circulatory changes
1)spider naevi
2)palmar erythema
3)cyanosis
Endocrine changes
loss of libido,hair loss
men- gynaecomastia ,
testicular atrophy,impotence
female-breast atrophy,
irregular menses,amenorrhoea

14. PALMAR ERYTHEMA
SPIDER NAEVI

15. Haemorrhagic tendency bruises,purpura,epistaxis,menorrhagia
Portal hypertension
splenomegaly,collateral vessels,variceal bleeding,fetor hepaticus.
Hepatic encephalopathy
Other features- pigmentation,clubbing.

16. Investigation Complete blood picture -anemia
- leucopenia and thrombocytopenia
-acanthocytosis
Liver function tests
-hyperbilirubinaemia
- A:G ratio reversal
-transaminases-AST and ALT raised.
-alkaline phosphatase may be mildly raised
Prothrobin time-prolonged
Hepatitis B and C markers
Blood ammonia- is raised
Respiratory alkalosis

17. Metabolic abnormalities
glucose intolerance
hyponatraemia
hypokalaemia
hypomagnesaemia
hypophosphataemia
Ultrasonic examination
liver size and echotexture alteration
splenic size
collaterals
ascites
size of portal vein.
Liver biopsy confirms the diagnosis

18. Treatment
Treatment of underlying cause,removal of causitive agents like drugs,alcohol.
High protein diet, minimum 1g/kg/day
kcal/day
Multivitamin supplementation
Specific treatment of complications
Liver transplantation

19. Prognosis-Child-Pugh classification
SCORE 1 2 3
Encephalopathy
none
mild
marked
Bilirubin
<34
34-50
>50
Albumin
>35
28-35
<28
Prothrobin
time
<4
4-6
>6
Ascites
<7-child’s A, 7-9-child’s B, >9-child’s C

20. COMPLICATIONS Portal hypertension Ascites Bacterial peritonitis
Hepatic encephalopathy
Renal failure
Portal vein thrombosis
Hepatocellular carcinoma

21. Thank You