CirrhosisCirrhosis

* Definition:* Definition:Chronic, diffuse, irreversible disorder of the liver

characterized by loss of the normal liver architecture

and replacement by regenerating nodules.

Normal Liver

Micronodular cirrhosis

Macronodular Cirrhosis

Normal Liver Histology

CV

PT

Liver Biopsy – Cirrhosis

Liver Biopsy – Cirrhosis:

* Etiological classification of Cirrhosis:* Etiological classification of Cirrhosis:

A. Congenital cirrhosis:A. Congenital cirrhosis:

1. Congenital syphilis.

2. Hemochromatosis.

3. Wilson disease.

4. α1 antitrypsin deficiency.

B. Acquired cirrhosis:B. Acquired cirrhosis:

1. Post-hepatitic (viral).

2. Alcoholic.

3. Biliary cirrhosis.

4. Cirrhosis caused by circulatory disorders e.g.

chronic right sided heart failure.

* Complications of Cirrhosis: * Complications of Cirrhosis:

1. Liver cell Failure.

2. Portal hypertension.

3. Hepatocellular carcinoma.

1. Liver cell failure1. Liver cell failure

1. Jaundice: Hepatocelluar jaundice.

2. Hypo proteinaemia: due to decreased

formation of plasma proteins. Contributes in

generalized edema formation and ascitis.

3. Vitamin deficiency: Vit. A, K, B12, folic acid.

4. Coagulation defect: due deficiency of

fibrinogen, factors V, VII, IX, X.

5. Anemia: due to repeated hemorrhage,

hypersplenism, B12 and folic acid deficiency.

6. Hypoglycemia: due to defects in

carbohydrate metabolism.

7. Hormone disturbances:

Increased serum aldosterone leads: to salt & water retention.

Increased estrogen leads to:

• Gynaecomastia.

• Hypogonadism (testicular atrophy and loss of libido in

males).

• Menstrual disturbances in females.

• Palmer erythema (local vasodilation).

• Spider angiomas of skin: Each angioma is a central,

pulsating, dilated arteriole from which small vessels radiate

GynaecomastiaGynaecomastia

Palmer erythemaPalmer erythema

Spider angioma Spider angioma

8. Ascites: Due to salt & water retention, portal

hypertension and hyporpteinaemia.

Ascites Ascites

9. Hepatic encephalopathy:

Neurological disturbances (apathy,

disorientation, asterixis i.e. flapping tremors and

coma) due to toxic amonia which are formed in

intestine and not detoxified in liver so pass

directly to brain.

10. Foetor hepaticus: a characteristic bad

(musty) odor smelled from the body and mouth of

the patients due to formation of mercaptans by

the action of gastrointestinal bacteria on the

sulfur-containing amino acid methionine.

2. Portal hypertension2. Portal hypertension

Effects of Portal hypertension:

1. Varices: esophageal varices, piles.

2. Splenomegaly due to splenic congestion.

3. Ascites which is accumulation of transudate in

the peritoneal cavity.

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