liver failure chronic for clinical officers.pptx

Chronic liver failure

1. Chronic liver failure pathogenesis and complications Tr. Ruva John Bosco

2. Pattern of liver injury Degeneration  Necrosis and apoptosis  inflammation  Regeneration /fibrosis 4/27/2015 RJB 2

3. Degeneration and intracellular accumulation Toxic and immunologic insult  Cell swelling  Degeneration  Feathery and balloning 4/27/2015 RJB 3

4. Degeneration and intracellular accumulation Accumulation of Fe , Cu, triglycerides  Steatosis  Microvascular and macrovesicular 4/27/2015 RJB 4

5. Liver abnormalities 4/27/2015 RJB 5

6. INFLAMMATION Influx of acute and chronic inflammatory cells Collection of quiescent lymphocytes in portal tract Kupffer cell engulf the apoptotic cell fragments 4/27/2015 RJB 6

7. Regeneration Longer life span Mitoses, thickening of hepatocyte cord , disorganization of parenchyma DUCTULAR REACTION If connective tissue framework is intact almost perfect liver restitution may occur 4/27/2015 RJB 7

8. Fibrosis Irreversible hepatic damage Sites of collagen deposition Nodule formation cirrhosis 4/27/2015 RJB 8

9. Portal hypertension and varices Portal pressure >12 mm of hg Pre, intra and post hepatic cause Portosystemic shunting to lower portal pressure Development of collateral circulation Recurrents bouts of haemorrhage 4/27/2015 RJB 9

10. Hepatorenal disease Renal failure without any intrinsic or functional cause of renal failure Sodium retention, Decreased renal perfusion Decrease GFR Ability to concentrate urine retained 4/27/2015 RJB 10

11. Hepatopulmonary syndrome Chronic liver disease + hypoxemia+ IPVD   (Intrapulmonary vascular dilatations) Ventilation perfusion mismatch Limitation of oxygen diffusion Increase synthesis of NO 4/27/2015 RJB 11

12. Management Borrow from acute form Liver cirrhosis given before. Handle the cause and complications arising. 4/27/2015 RJB 12