Liver pathology:CIRRHOSISIvana MariMentor: 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

AetiologyAlcoholChronic hepatitis BChronic hepatitis COther: Haemochromatosis Non-alcoholic fatty liver disease Primary biliary cirrhosis Sclerosing cholangitis Autoimmune hepatitis Cystic fibrosis...

Pathology

MICRONODULAR CIRRHOSISUniform, small nodules up to 3 mm in diameterOften caused by alcohol damage

Pathology MACRONODULAR CIRRHOSISLarge nodulesOften 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 symptomsJaundiceFatigueWeaknessLoss of appetiteItchingEasy bruising

InvestigationsLiver biochemistry (usually slight elevation of serum alkaline phosphatase and aminotransferase)Liver function - serum albumin and prothrombinSerum electrolytesSerum alpha-fetoprotein Endoscopy

InvestigationsUltrasoundCT

ManagementIrreversible disease, frequently progressesCorrecting the underlying cause (abstinence from alcohol)Screening for hepatocellular carcinomaLiver transplantation5-year survival rate approximately 50%

ComplicationsPORTAL HYPERTENSION

Symptoms:Gastrointestinal bleeding from oesophageal or (less commonly) gastric varicesAscitesHepatic encephalopathy

VARICEAL HAEMORRHAGE

30% of patients with varices bleed from them often massive bleeding; 50% mortalityTherapy: endoscopic therapy: sclerotherapy variceal band ligation pharmacological treatment balloon tamponade TIPS surgery

ASCITESPresence of fluid in the peritoneal cavityTherapy: diuretics paracentesis

PORTOSYSTEMIC ENCEPHALOPATHYToxic 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 SYNDROMEDevelopment of acute renal failure in patients with advanced liver diseaseSplanchnic vasodilatation - fall in systemic vascular resistance, vasoconstriction of renal circulation, reduced renal perfusionOliguria, rising serum creatinine, low urine sodium

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References:www.wikipedia.comKumar&Clark: Clinical medicine