Cirrhosis

1
Cirrhosis
2
Definition

• Chronic, diffuse, irreversible disorder of the
  liver characterized by loss of the normal liver
  architecture and replacement by regenerating
  nodules.

3
Normal Liver
4
Micronodular cirrhosis
5
Macronodular Cirrhosis
6
Normal Liver Histology
CV
PT
7
Liver Biopsy Cirrhosis
8
Liver Biopsy Cirrhosis
9
Etiological classification of Cirrhosis

• A. Congenital cirrhosis
• Congenital syphilis.
• Hemochromatosis.
• Wilson disease.
• a1 antitrypsin deficiency.

10

• B. Acquired cirrhosis
• 1. Post-hepatitic (viral).
• 2. Alcoholic.
• 3. Biliary cirrhosis.
• 4. Cirrhosis caused by circulatory disorders e.g.
  chronic right sided heart failure.

11
Complications of Cirrhosis

• 1. Liver cell Failure.
• 2. Portal hypertension.
• 3. Hepatocellular carcinoma.

12
1. Liver cell failure
13

• 1. Jaundice Hepatocelluar jaundice.
• 2. Hypo proteinaemia due to decreased formation
  of plasma proteins. Contributes in generalized
  edema formation and ascitis.
• 3. Vitamin deficiency Vit. A, K, B12, folic
  acid.
• 4. Coagulation defect due deficiency of
  fibrinogen, factors V, VII, IX, X.

14

• 5. Anemia due to repeated hemorrhage,
  hypersplenism, B12 and folic acid deficiency.
• 6. Hypoglycemia due to defects in carbohydrate
  metabolism.

15

• 7. Hormone disturbances
• Increased serum aldosterone leads to salt
  water retention.
• Increased estrogen leads to
• Gynaecomastia.
• Hypogonadism (testicular atrophy and loss of
  libido in males).
• Menstrual disturbances in females.
• Palmer erythema (local vasodilation).
• Spider angiomas of skin Each angioma is a
  central, pulsating, dilated arteriole from which
  small vessels radiate

16
Gynaecomastia
17
Palmer erythema
18
Spider angioma
19

• 8. Ascites Due to salt water retention, portal
  hypertension and hyporpteinaemia.

20
Ascites
21

• 9. Hepatic encephalopathy
• Neurological disturbances (apathy,
  disorientation, asterixis i.e. flapping tremors
  and coma) due to toxic amonia which are formed in
  intestine and not detoxified in liver so pass
  directly to brain.

22

• 10. Foetor hepaticus a characteristic bad
  (musty) odor smelled from the body and mouth of
  the patients due to formation of mercaptans by
  the action of gastrointestinal bacteria on the
  sulfur-containing amino acid methionine.

23
2. Portal hypertension
24

• Effects of Portal hypertension
• 1. Varices esophageal varices, piles.
• 2. Splenomegaly due to splenic congestion.
• 3. Ascites which is accumulation of transudate
  in the peritoneal cavity.

25
Thanks