Liver Cirrhosis - Pathophysiology , Clincal Features , Complications

Liver Cirrhosis - Pathophysiology, Clinical Features, Complications, Lab findings,

1. Liver Cirrhosis Abraham Mallela Roll Number 92

2. Introduction Cirrhosis : Irreversible Result of various disorders Finally functions of liver are impaired Can occur at any age Most important cause of premature death

3. Definition Cirrhosis is a slowly progressing disease in which the healthy liver tissue is replaced with scar tissue , eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients , hormones , drugs , and other toxins.

4. Etiology Alcoholism Chronic Viral Hepatits Hepatits B Hepatits C Autoimmune Hepatitis Non Alcoholic Stereohepatitis

5. Biliary Cirrhosis Primary Biliary Cirrhosis Primary sclerosing Cholangitis Autoimmune Cholangiopathy Cardiac Cirrhosis Cryptogenic Cirrhosis

6. Inherited Metabolic Liver Disease Hemochromatosis Wilson’s Alpha 1 Antitrypsin Deficiency Cystic Fibrosis

7. Pathophysiology 2 types of cirrhosis Micro nodular cirrhosis Macro nodular cirrhosis

8. Micro Nodular : Small nodules , 1mm in diameter Mostly seen in alcoholic cirrhosis Macro Nodular : Large nodules with large fibrous scars

9. Changes in liver during cirrhosis: Progressive and widespread death of liver cells Associated with inflammation and fibrosis Loss of normal liver functions Loss of normal hepatic architecture Loss of hepatic vasculature

10. Development of portosytemic shunts Formations of nodules instead of lobules Development of cirrhosis is mostly gradual and progressive. Unless etiological agent is removed

11. Epidemiology Can occur at any age Prolonged morbidity Younger adults Important cause for premature death

12. 10 to 20 % of heavy drinkers develop within 10 years In patients with Hepatitis B or C - 5 year survival rate is 71 to 85% In 2/3rds of patients - symptomless & normal life Liver cirrhosis is detected when abdomen is opened for any other surgery.

13. Clinical Features & Complications To be discussed by Sowmya

14. CLINICAL FEATURES & COMPLICATIONS OF CIRRHOSIS SREE SOWMYA ROLL NO. 93

15. MOSTLY THE PATIENTS ARE ASYMPTOMATIC DIAGNOSIS IS MADE BY ULTRASONOGRAM OR INCIDENTALLY DURING ANY SURGERIES SOME PATIENTS PRESENT WITH ISOLATED HEPATOMEGALY, SPLENOMEGALY, SIGNS OF PORTAL HYPERTENSION or HEPATIC INSUFFICIENCY FREQUENT COMPLAINTS INCLUDE WEAKNESS, FATIGUE, MUSCLE CRAMPS , WEIGHT LOSS & NON SPECIFIC DIGESTIVE SYMPTOMS SUCH AS ANOREXIA , NAUSEA , VOMITING , & UPPER ABDOMINAL DISCOMFORT

16. THE MAIN CLINICAL FEATURES ARE : HEPATOMEGALY JAUNDICE ASCITES

17. CIRCULATORY CHANGES SPIDER TELANGIECTASIA PALMAR ERYTHEMA CYANOSIS

18. ENDOCRINE CHANGES LOSS OF LIBIDO LOSS OF HAIR MEN GYNECOMASTIA TESTICULAR ATROPHY IMPOTENCE WOMEN IRREGULAR MENSIS AMENNORRHEA BREAST ATROPHY

19. HAEMORRHAGIC TENDENCIES BRUISES PURPURA EPISTAXIS MENORRHAGIA

20. PORTAL HYPERTENSION SPLENOMEGALY COLLATERAL VESSELS VARICEAL BLEEDING FETAR HEPATICUS

21. HEPATIC ENCEPHALOPATHY PIGMENTATION DIGITAL CLUBBING PAROTID & LACRIMAL GLAND ENLARGEMENT DUPUYTREN’S CONTRACTURE

22. COMPLICATIONS OF CIRRHOSIS : PORTAL HYPERTENSION GASTROESOPHAGEAL VARICES SPLENOMEGALY HYPERSPLENISM ASCITES SPONTANEOUS BACTERIAL PERITONITIS HEPATORENAL SYNDROME TYPE 1 & 2 HEPATIC ENCEPHALOPATHY HEPATOPULMONARY SYNDROME PORTOPULMONARY HYPERTENSION

23. MALNUTRITION COAGULOPATHY FACTOR DEFICIENCY FIBRINOLYSIS THROMBOCYTOPENIA BONE DISEASE OSTEOPENIA OSTEOPOROSIS OSTEOMALACIA HEMATOLOGIC ABNORMALITIES ANAEMIA HEMOLYSIS THROMBOCYTOPENIA NEUTROPENIA

24. Laboratory Findings & Diagnosis To be discussed by Sneha ‹#›

25. CIRRHOSIS OF LIVER Lab Findings and Diagnosis Sneha Raj .P Roll No 94

26. Laboratory findings In alcoholic cirrhosis.. Incase of advanced liver disease Anaemia Haemolytic anaemia with spur cells – zieve’s syndrome Platelet count is decreased

27. Serum total bilirubin – normal or elevated Direct bilirubin – mildly elevated Prothrombin time – prolonged Serum sodium levels – normal

28. Serum aminotransferases ALT – elevated AST – elevated AST>ALT i.e, in 2:1 ratio Liver biopsy confirms the diagnosis

29. Incase of primary biliary cirrhosis cholestatic liver enzyme abnormalities with gamma glutamyltranspeptidase & ALP Amino transferases – mildly elevated Immunoglobulins mainly IgM – elevated Hyperbilirubinemia is seen

30. Thrombocytopenia Leukopenia & Anaemia These are seen in patients with Portal HTN & hyperspleenism

31. Differential diagnosis: Budd chiari syndrome Acute liver failure Alcoholic hepatitis Sarcoidosis Tricuspid regurgitation schistosomiasis

32. Cerebral hemorrhage Seizures Rarely, meningitis encephalitis wilson’s disease