Complete presentation on Cirrhosis.pptx

Cirrhosis ppt

1. LIVER CIRRHOSIS

2. Introduction Cirrhosis of the liver is a diffuse disease having the following 4 features It involves the entire liver The normal lobular architecture of hepatic parenchyma is disorganised There is formation of nodules separated from one another by irregular bands of fibrosis Hepatocellular necrosis of varying etiology

3. Cirrhosis of the liver can occur because of many factors but the chief worldwide contributors are alcohol abuse and viral hepatitis

4. Etiology Predisposing factors include Drinking patterns Malnutrition Infections Genetic Factors: altered rates of elimination of ethanol due to genetic polymorphism of enzymes.

5. PATHOGENESIS Cell undergoes death due to any of etiological causes (Necrosis ). Healing the necrotic place by fibrosis Deficiency of blood supply to some areas Hypoxic necrosis due to decreased blood supply Healing of necrotic area

6. Some area retain the blood supply by anastomosis Tries to replace the lost cell by regeneration Regenerated nodule Compress Decreased blood supply

7. Continuous formation of Fibrosis and regenerated nodules Obstruction in biliary flow Portal hypertension

8. Fibrogenesis Lymphokines and monokines Mediators of fibrosis Fibrosis The mechanism is by increased synthesis of all types of collagen and increase in the number of collagen producing cells Proliferation of fat storing cells Transformation of these cells into myofibroblasts and fibrocytes

9. MORPHOLOGICAL CLASSIFICATION Micronodular Macronodular Mixed

10. ETIOLOGICAL CLASSIFICATION Alcoholic cirrhosis Post -necrotic cirrhosis hepatitis, drugs. Biliary cirrhosis due to biliary obstruction Malnutrition Indian childhood cirrhosis Genetic disorder Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency Cardiac cirrhosis

11. Post-necrotic cirrhosis It is characterized by large and irregular nodules with broad bands of connective tissue and occurring most commonly after previous viral hepatitis. Etiology: Viral hepatitis: Hepatitis B and C are known to cause post necrotic cirrhosis Drugs and chemical hepatotoxins: phosphorus, carbon tetrachloride, paracetamol Others: certain infections e.g. parasitic infections Idiopathic:

12. Biliary cirrhosis It is defined as a chronic disorder characterized by clinical, biochemical and morphological features of long continued cholestasis of intrahepatic or extrahepatic origin It is of two types Primary biliary cirrhosis: in which the destructive process of unknown etiology affects intrahepatic bile ducts Secondary biliary cirrhosis: resulting from prolonged mechanical obstruction of the extrahepatic biliary passages

13. Etiology: Primary biliary cirrhosis : Auto immune Familial incidence Secondary biliary cirrhosis. Extrahepatic cholestasis, cancer of biliary tree and head of pancreas.

14. Clinical features Dark urine Pale stools Jaundice Skin pigmentation

15. Pigment cirrhosis in haemochromatosis It is an iron-storage disorder in which there is excessive accumulation of iron in parenchymal cells with eventual tissue damage and functional insufficiency of organs such as liver, pancreas, heart and pituitary gland

16. Genetic abnormalities Intestinal mucosal level causing excessive iron absorption Post absorption excretion level leading to excessive accumulation of iron Tissue injury due to lipid peroxidation of cell organelles due to excess iron

17. Cirrhosis in wilson’s disease It is an autosomal recessive inherited disease of copper metabolism , characterized by toxic accumulation of copper in many tissues like the liver, brain and eye Hence this accumulation leads to cirrhosis of liver