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CIRRHOSIS
ALCOHOLIC LIVER INJURY:
Alcoholic Liver disease - Patterns Fatty change, Acute hepatitis Chronic hepatitis Cirrhosis, Chronic Liver failure
All reversible except cirrhosis stage.
PATHOPHYSIOLOGY
Irreversible chronic injury of the hepatic parenchyma
Extensive fibrosis - distortion of the hepatic architecture
Formation of regenerative nodules
ETIOLOGY OF CIRRHOSIS
Alcoholic liver disease Viral hepatitis Biliary disease Primary hemochromatosis Wilson’s, 1AT def
CLINICAL FEATURES
Spider neavi Palmar erythema Nail changes Gynecomastia Testicular atrophy
CLINICAL MANIFESTATIONS
Muehrcke's nails
Terry’s nails
CLINICAL MANIFESTATIONS
Fetor hepaticus Jaundice Parotid gland
enlargement Flapping tremors
Hepatomegaly Splenomegaly Caput medusa
LABORATORY STUDIES AST/ALT ALP, gamma GT PT/INR S albumin USS scan Liver biopsy
MORPHOLOGIC CLASSIFICATION
Micronodular cirrhosis Nodules less than 3 mm in diameter Believed to be caused by alcohol
Macronodular cirrhosis
Nodules larger than 3 mmBelieved to be secondary to chronic viral
hepatitis
MICRONODULAR CIRRHOSIS
MACRONODULAR CIRRHOSIS
COMPLICATIONS
Ascites Spontaneous Bacterial Peritonitis Hepatorenal syndrome Variceal hemorrhage Hepatopulmonary syndrome Hepatic Encephalopathy Hepatocellular carcinoma
ASCITES
Accumulation of fluid within the peritoneal cavity
Due to several factors including portal hypertension, low protein levels, fluid retention etc.
ASCITIS IN CIRRHOSIS
ASCITES
Dietary sodium restriction Diuretics aspiration
HEPATORENAL SYNDROME
acute renal failure coupled with advanced hepatic disease
characterized by:Oliguriaprogressive rise in the plasma creatinine
VARICEAL HEMORRHAGE
Due to portal hypertension Can be lethal if not treated early
HEPATIC ENCEPHALOPATHY
neuropsychiatric abnormalities seen in patients with liver dysfunction sleep pattern variation Altered conciousness
HEPATOCELLULAR CARCINOMA
Patients with cirrhosis have a markedly increased risk of developing hepatocellular carcinoma
LIVER TRANSPLANTATION
Liver transplantation is the definitive treatment for patients with decompensated cirrhosis
GYNAECOMASTIA IN CIRRHOSIS