1.What is Liver Cirrhosis ? Causes of Liver cirrhosis

cirrhosis of Liver

1. Liver Cirrhosis C/Liver damage from variety of causes leading to permanent scarring & Liver failure Dr.P.N.Karamchand.MD(Hom) 3

2. Normal Liver

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4. Liver Cirrhosis It’s an irreversible Structural Changes of Liver- Dr.P.N.Karamchand.MD(Hom) 6

5. Liver Cirrhosis Histologically Diffuse fibrosis with “Nodular Degeneration” Dr.P.N.Karamchand.MD(Hom) 7

6. Cirrhosis 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 8 Liver Cirrhosis

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8. Infections- V-B-S Viral hepatitis - 50% –(26%- C ) Alcohol – 21-% Auto- immune Biliary Obstructions- PBC Veno occlusive disease Metabolic disorders like Haemochromatosis Wilson’s d/s, α 1Anti Trypsin Deficiency Hepato Toxic Drugs & Toxins Cryptogenic -30 % Dr.P.N.Karamchand.MD(Hom) 10 Liver Cirrhosis- Causes

9. Pathogenesis If there’s only A/c Insults- liver can regenerate easily & quickly. But if there’s continuous insults , liver will loos its ability to regenerate is lost -> Fibrosis/Scarring. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 11

10. Pathogenesis Hepatic Injury -> Increased levels of the Cytokine & Transforming Growth Factor beta- 1  over activation of -> Stellate cells+ -> Quiescent fat storing cells -> Activated myofibroblast Synthesis & Deposition of Type-1 COLLAGEN  FIBRSOSIS / SCARRING . 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 12

11. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 13 Secret of Cirrhosis

12. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 15 ??? Deposition of Collagens, Glycoproteins, Proteoglycans on the components of the extracellular matrix within the liver  Fibrosis

13. Stages of Fibrosis Dr.P.N.Karamchand.MD(Hom) Minimal Early Advanced Cirrhosis Healthy Fibro Scan Interpretations

14. Collagen

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17. Classification/ Types of Cirrhosis Micro -Nodular <3mm-(Alcoholic) M a cro -Nodular >3mm-Post hepatitis Mixed - Nodular- - Biliary cirrhosis. OR Compensated Liver cirrhosis and Decompensated Liver cirrhosis. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 22

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19. C/F depends Based on:- Degree Hepato cellular Dysfunction Degree of Portal Hypertension (Stage /Extent of Pathology) & General features + 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 24

20. Signs and symptoms Some patients with cirrhosis are completely asymptomatic and have a reasonably normal life expectancy. Other individuals have a multitude of the most severe symptoms of end-stage liver disease and a limited chance for survival. Common signs and symptoms may…..

21. symptoms of cirrhosis No symptoms in the early stages ??? Weakness Fatigue Loss of appetite Nausea Vomiting 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 26

22. symptoms of cirrhosis Weight loss Abdominal pain and bloating when fluid accumulates in the abdomen Itching Spiderlike blood vessels on the skin 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 27

23. Cirrhosis – Stage 1 Skin- Dark Complexion Slight Swelling of legs o/E:- Shrunken Liver Structural Changes 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 29

24. Stage 2 ↑ Portal Pressure  PHTN  ( TIPS = T rans jugular I ntrahepatic P orto systemic S hunt) development of GE Varices +Splenomegaly 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 30

25. Stage 3  Complication Clinically  Abd. Bloating Gaining Weight Ascites 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 31

26. Stage 4  Complication Clinically  Ascites + Hematemesis Melena 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 32

27. Stage 5  Multi Complication Clinically =LF Ascites +Bleeding +Jaundice Hepatic Encephalopathy (SB: ↑3.5 + SBP HRSTransplant (MELD Score ↑15-18:NH3 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 33

28. Hepatic Encephalopathy Stage 1 Stage 2 Stage 3 Stage4 Mild Confusion Lethargy Somnolent – but Arousable Coma Agitation Disorientation Slurred speech Irritability Inappropriate behavior Confused Sleep Disorder Drowsiness Aggressive Decreased Attension ->TRANSPLANTATION 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 34