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Liver pathology:Liver pathology:CIRRHOSISCIRRHOSIS
Ivana MarićIvana MarićMentor: A. Žmegač HorvatMentor: A. Žmegač Horvat
Consequence of Consequence of chronic chronic liver disease disease characterized by characterized by replacement of liver replacement of liver tissue by fibrosis, scar tissue by fibrosis, scar tissue and tissue and regenerative nodules regenerative nodules leading to progressive leading to progressive loss of liver function loss of liver function
AetiologyAetiology AlcoholAlcohol Chronic hepatitis BChronic hepatitis B Chronic hepatitis CChronic hepatitis C Other:Other: HaemochromatosisHaemochromatosis Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease Primary biliary cirrhosisPrimary biliary cirrhosis Sclerosing cholangitisSclerosing cholangitis Autoimmune hepatitisAutoimmune hepatitis Cystic fibrosis...Cystic fibrosis...
PathologyPathology
MICRONODULAR MICRONODULAR CIRRHOSISCIRRHOSIS
Uniform, small Uniform, small nodules up to 3 mm in nodules up to 3 mm in diameterdiameter
Often caused by Often caused by alcohol damagealcohol damage
PathologyPathology
MACRONODULAR CIRRHOSISMACRONODULAR CIRRHOSIS Large nodulesLarge nodules Often seen following hepatitis B infectionOften seen following hepatitis B infection
Cirrhosis with complicatons of Cirrhosis with complicatons of encephalopathy, ascites or variceal encephalopathy, ascites or variceal haemorrhage – haemorrhage – DECOMPENSATED DECOMPENSATED CIRRHOSISCIRRHOSIS
Cirrhosis without any of these Cirrhosis without any of these complications – complications – COMPENSATED COMPENSATED CIRRHOSISCIRRHOSIS
Signs and symptomsSigns and symptoms
JaundiceJaundice FatigueFatigue WeaknessWeakness Loss of appetiteLoss of appetite ItchingItching Easy bruisingEasy bruising
InvestigationsInvestigations
Liver biochemistry (usually slight elevation Liver biochemistry (usually slight elevation of serum alkaline phosphatase and of serum alkaline phosphatase and aminotransferase)aminotransferase)
Liver function - serum albumin and Liver function - serum albumin and prothrombinprothrombin
Serum electrolytesSerum electrolytes Serum alpha-fetoprotein Serum alpha-fetoprotein EndoscopyEndoscopy
InvestigationsInvestigations
UltrasoundUltrasound CTCT
ManagementManagement
Irreversible disease, frequently progressesIrreversible disease, frequently progresses Correcting the underlying cause Correcting the underlying cause
(abstinence from alcohol)(abstinence from alcohol) Screening for hepatocellular carcinomaScreening for hepatocellular carcinoma Liver transplantationLiver transplantation 5-year survival rate approximately 50%5-year survival rate approximately 50%
ComplicationsComplications
PORTAL HYPERTENSIONPORTAL HYPERTENSION
Symptoms:Symptoms: Gastrointestinal bleeding from Gastrointestinal bleeding from
oesophageal or (less commonly) gastric oesophageal or (less commonly) gastric varicesvarices
AscitesAscites Hepatic encephalopathyHepatic encephalopathy
VARICEAL HAEMORRHAGEVARICEAL HAEMORRHAGE
30% of patients with varices bleed from them 30% of patients with varices bleed from them often massive bleeding; 50% mortalityoften massive bleeding; 50% mortality
Therapy: endoscopic therapy:Therapy: endoscopic therapy:
sclerotherapysclerotherapy
variceal band ligationvariceal band ligation
pharmacological treatmentpharmacological treatment
balloon tamponadeballoon tamponade
TIPSTIPS
surgerysurgery
ASCITESASCITES Presence of fluid in Presence of fluid in
the peritoneal cavitythe peritoneal cavity Therapy: diureticsTherapy: diuretics
paracentesisparacentesis
PORTOSYSTEMIC ENCEPHALOPATHYPORTOSYSTEMIC ENCEPHALOPATHY Toxic substances (ammonia) bypass the Toxic substances (ammonia) bypass the
liver via collaterals and gain access to the liver via collaterals and gain access to the brain brain
Symptoms: lethargySymptoms: lethargy
mild confusionmild confusion
anorexiaanorexia
reversal of sleep patternreversal of sleep pattern
disorientationdisorientation
comacoma
HEPATORENAL SYNDROMEHEPATORENAL SYNDROME Development of acute renal failure in Development of acute renal failure in
patients with advanced liver diseasepatients with advanced liver disease Splanchnic vasodilatation - fall in systemic Splanchnic vasodilatation - fall in systemic
vascular resistance, vasoconstriction of vascular resistance, vasoconstriction of renal circulation, reduced renal perfusionrenal circulation, reduced renal perfusion
Oliguria, rising serum creatinine, low urine Oliguria, rising serum creatinine, low urine sodiumsodium
http://http://www.youtube.comwww.youtube.com/watch?v=pmBBT4veCRc/watch?v=pmBBT4veCRc
References:References:
www.wikipedia.comwww.wikipedia.com Kumar&Clark: Clinical medicineKumar&Clark: Clinical medicine