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Liver pathology: CIRRHOSIS

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1 Liver pathology: CIRRHOSIS
Ivana Marić Mentor: A. Žmegač Horvat

2 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

3 Aetiology Alcohol Chronic hepatitis B Chronic hepatitis C Other:
Haemochromatosis Non-alcoholic fatty liver disease Primary biliary cirrhosis Sclerosing cholangitis Autoimmune hepatitis Cystic fibrosis...

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

5 Pathology MACRONODULAR CIRRHOSIS Large nodules
Often seen following hepatitis B infection

6 Cirrhosis with complicatons of encephalopathy, ascites or variceal haemorrhage – DECOMPENSATED CIRRHOSIS Cirrhosis without any of these complications – COMPENSATED CIRRHOSIS

7 Signs and symptoms Jaundice Fatigue Weakness Loss of appetite Itching
Easy bruising

8 Investigations Liver biochemistry (usually slight elevation of serum alkaline phosphatase and aminotransferase) Liver function - serum albumin and prothrombin Serum electrolytes Serum alpha-fetoprotein Endoscopy

9 Investigations Ultrasound CT

10 Management Irreversible disease, frequently progresses
Correcting the underlying cause (abstinence from alcohol) Screening for hepatocellular carcinoma Liver transplantation 5-year survival rate approximately 50%


12 Symptoms: Gastrointestinal bleeding from oesophageal or (less commonly) gastric varices Ascites Hepatic encephalopathy

13 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

14 ASCITES Presence of fluid in the peritoneal cavity Therapy: diuretics

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

16 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


18 References: Kumar&Clark: Clinical medicine

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