Liver pathology: CIRRHOSIS

Liver pathology: CIRRHOSIS

Liver pathology: CIRRHOSIS Ivana Mari Mentor: A. mega Horvat 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 Aetiology

Alcohol Chronic hepatitis B Chronic hepatitis C Other:

Haemochromatosis Non-alcoholic fatty liver disease Primary biliary cirrhosis Sclerosing cholangitis Autoimmune hepatitis Cystic fibrosis... Pathology MICRONODULAR

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

Large nodules Often seen following hepatitis B infection Cirrhosis with complicatons of encephalopathy, ascites or variceal haemorrhage DECOMPENSATED CIRRHOSIS

Cirrhosis without any of these complications COMPENSATED CIRRHOSIS Signs and symptoms Jaundice Fatigue

Weakness Loss of appetite Itching Easy bruising Investigations Liver biochemistry (usually slight elevation of serum alkaline phosphatase and

aminotransferase) Liver function - serum albumin and prothrombin Serum electrolytes Serum alpha-fetoprotein Endoscopy Investigations Ultrasound

CT Management Irreversible disease, frequently progresses Correcting the underlying cause (abstinence from alcohol) Screening for hepatocellular carcinoma Liver transplantation

5-year survival rate approximately 50% Complications PORTAL HYPERTENSION Symptoms: Gastrointestinal bleeding from oesophageal or (less commonly) gastric varices

Ascites Hepatic encephalopathy 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 ASCITES

Presence of fluid in the peritoneal cavity Therapy: diuretics paracentesis 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

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 /watch?v=pmBBT4veCRc References: Kumar&Clark: Clinical medicine

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