Liver pathology: CIRRHOSIS Ivana Marić Mentor: A. Žmegač 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

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References: www.wikipedia.com Kumar&Clark: Clinical medicine