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: 1.Congenital syphilis. 2.Hemochromatosis. 3.Wilson disease. 4.α1 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