Cirrhosis of liver

Cirrhosis of liver according to Ayurveda with treatment.

1. CIRRHOSIS OF LIVER DR. FALGUNI JOSHI P.G. SCHOLAR GUIDED BY – DR. RAVI SHARMA

2. Add a Slide Title - 5 Cirrhosis -derived from the Greek word scirrhus, which means orange or tawny Is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules.

3. INTRODUCTION The liver weighs 1–1.8 kg and performs many important functions. In the developed world, the most common cause of liver disease is alcohol abuse, and cirrhosis causes many deaths. Cirrhosis is a complication of many liver diseases . It is a chronic condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver .

4. Cirrhosis is characterised by diffuse hepatic fibrosis and nodule formation, and is an important cause of morbidity and premature death. It is a 12 th leading cause of death according to NIH. Worldwide, the most common causes are viral hepatitis, alcohol. Cirrhosis is the most common cause of portal hypertension and its complications.

5. CAUSES

6. types Micronodular cirrhosis, characterized by small nodes about 1mm in diameter . Seen in alcoholic cirrhosis . Macronodular cirrhosis, characterized by larger nodules of various sizes. Areas of previous collapse of the liver architecture are evidenced by large fibrous scars [6]

7. Pathophysiology The cardinal features of cirrhosis is an increase in fibrous tissue. Progressive and widespread death of liver cells, and inflammation loss of the normal liver architecture. Following liver injury, stellatre cells in the space of Disse are activated by cytokines produced by kupffer cells and hepatocytes. This transforms the stellate cell into a myofibroblast like cell, capable of producing collagen, proinflammatory cytokines and other mediators.

8. which promote hepatocyte damage and cause tissue fibrosis. Destruction of the liver architecture causes distortion and loss of the normal hepatic vasculature with the development of nodules, cirrhosis evolves slowly over years to decades, and normally continues to progress even after removal of the aetiological agent

9. CLINICAL FEATURES

10. signs Hepatomegaly - common in alcoholic liver disease and haemochromatosis. Reduced liver size- due to progressive hepatocyte destruction & fibrosis. The liver is often hard, irregular and non-tender. Jaundice - is mild when it first appears & is primarily due to a failure to excrete bilirubin. Palmar erythema - in disease’s early condition. One or two small spider telangiectasia are found. Endocrine changes in men- loss of male hair distribution and testicular atrophy. Gynaecomastia

11. In advance condition - 1. Easy bruising – 2. Splenomegaly and collateral vessel formation. 3. Hepatic encephalopathy 4. Ascites 5. Finger and toe clubbing. Dupuytren’s contracture Chronic liver failure

12. diagnosis Blood tests - enzymes alanine transaminase (ALT) and aspartate transferase (AST) in blood, Gamma-glutamyl transpeptidase, serum alkaline phosphatase, serum bilirubin, prothrombin time. As these will be raised if there is inflammation of the liver (hepatitis). Scans - (CT) scan or a magnetic resonance imaging A transient elastography scan is similar to an ultrasound scan carried out during pregnancy and is sometimes known as a Fibroscan . These scans can produce detailed images of liver or check liver stiffness to identify any scarring.

13. Management Management of cirrhosis is by treatment of the underlying cause and its complications, or by liver transplantation in selected cases of advanced cirrhosis. Surveillance should include endoscopy to screen for esophageal varices every 2 yrs., and USG to detect hepatocellular carcinoma.

14. Bed rest Diet – 2000 calories with about 100gm proteins. Fat & carbohydrates according to patient tolerance. Salt is restricted in – ascites, edema supplemented Vit B complex. Diuretics – spironolactone( aldosterone antagonist)- 100mg/dl ,frusemide 80mg Management

15. Corticosteroid and immunosuppressants – in post hepatitis cirrhosis. Antifibrotic agents like colchicine & propylthiouracil. Interferons – in viral hepatitis B,C. Trans jugular intrahepatic Porto-systemic shunts(TIPS) Artificial liver transport hepatocyte transplant and orthoptic liver transplant. Management

16. IN AYURVEDA The liver is called Yakrit in Ayurveda. Pitta is the predominant humor of the liver. Most liver disorders are aggravated conditions of Pitta. Excessive bile production or a blockage in the flow of bile usually indicates high pitta, which in turn affects the Agni or enzyme activities responsible for absorption, digestion and metabolism. Kumbha Kamala is the classical description o f cirrhosis of liver in Ayurveda.

17. “|| Kaalantarath khareebhutah kruchrasyaat khumba kamala ||” (च.चि.16/37) It is a neglected or untreated stage of jaundice or hepatitis, when becomes chronic, produces dry or roughness to the Liver ( kharathva or rookshatva ). It can become incurable if not attended immediately.

18. चिकित्सा मृदु विरेचन पथ्य अन्न सेवन – पुराण शालि चावल, गेंहू, यूष के लिए मूंग, मसूर, जांगल पशु, पक्षियों के माँस रस का सेवन | औषध योग – स्नेहन के लिये हरिद्रादि घृत – हल्दी, त्रिफला, निम्ब, बला, मधुक स्नेहन बाद विरेचन – त्रिफला स्वरस, दारूहल्दी स्वरस, गुडूची, नीम की पत्ती का स्वरस, बिना गरम किए हूर शीतल स्वरस मे मधू मिला कर पिलाना |

19. औषध योग नवायस लौह – मधु व घृत से मंडूर वटक दार्व्यादिलेह कामलानाशक योग – लौहरज़, हरड़, हल्दी एकत्र मिलाकर मधू+घी से - हरड़ के चूर्ण को गुड+मधु से चाटना त्रिफलादि योग – त्रिफला, हरिद्राद्वय, कुटकी, लौहरज, मधू+घी से चाटना धात्र्यवलेह – 1 कर्ष धात्र्यरिष्ट

20. पथ्य आहार विहार सूखी मूली का यूष या कुलथी के यूष के साथ आहार सेवन बिजौरा नींबू के रस में मधु, पीपर, मरिच, सौंठ प्रत्येक का चूर्ण बना कर पीना