Liver pathology:Liver pathology:CIRRHOSISCIRRHOSIS

Ivana MarićIvana MarićMentor: A. Žmegač HorvatMentor: A. Žmegač Horvat

Consequence of Consequence of chronic chronic liver disease disease characterized by characterized by replacement of liver replacement of liver tissue by fibrosis, scar tissue by fibrosis, scar tissue and tissue and regenerative nodules regenerative nodules leading to progressive leading to progressive loss of liver function loss of liver function

AetiologyAetiology AlcoholAlcohol Chronic hepatitis BChronic hepatitis B Chronic hepatitis CChronic hepatitis C Other:Other: HaemochromatosisHaemochromatosis Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease Primary biliary cirrhosisPrimary biliary cirrhosis Sclerosing cholangitisSclerosing cholangitis Autoimmune hepatitisAutoimmune hepatitis Cystic fibrosis...Cystic fibrosis...

PathologyPathology

MICRONODULAR MICRONODULAR CIRRHOSISCIRRHOSIS

Uniform, small Uniform, small nodules up to 3 mm in nodules up to 3 mm in diameterdiameter

Often caused by Often caused by alcohol damagealcohol damage

PathologyPathology

MACRONODULAR CIRRHOSISMACRONODULAR CIRRHOSIS Large nodulesLarge nodules Often seen following hepatitis B infectionOften seen following hepatitis B infection

Cirrhosis with complicatons of Cirrhosis with complicatons of encephalopathy, ascites or variceal encephalopathy, ascites or variceal haemorrhage – haemorrhage – DECOMPENSATED DECOMPENSATED CIRRHOSISCIRRHOSIS

Cirrhosis without any of these Cirrhosis without any of these complications – complications – COMPENSATED COMPENSATED CIRRHOSISCIRRHOSIS

Signs and symptomsSigns and symptoms

JaundiceJaundice FatigueFatigue WeaknessWeakness Loss of appetiteLoss of appetite ItchingItching Easy bruisingEasy bruising

InvestigationsInvestigations

Liver biochemistry (usually slight elevation Liver biochemistry (usually slight elevation of serum alkaline phosphatase and of serum alkaline phosphatase and aminotransferase)aminotransferase)

Liver function - serum albumin and Liver function - serum albumin and prothrombinprothrombin

Serum electrolytesSerum electrolytes Serum alpha-fetoprotein Serum alpha-fetoprotein EndoscopyEndoscopy

InvestigationsInvestigations

UltrasoundUltrasound CTCT

ManagementManagement

Irreversible disease, frequently progressesIrreversible disease, frequently progresses Correcting the underlying cause Correcting the underlying cause

(abstinence from alcohol)(abstinence from alcohol) Screening for hepatocellular carcinomaScreening for hepatocellular carcinoma Liver transplantationLiver transplantation 5-year survival rate approximately 50%5-year survival rate approximately 50%

ComplicationsComplications

PORTAL HYPERTENSIONPORTAL HYPERTENSION

Symptoms:Symptoms: Gastrointestinal bleeding from Gastrointestinal bleeding from

oesophageal or (less commonly) gastric oesophageal or (less commonly) gastric varicesvarices

AscitesAscites Hepatic encephalopathyHepatic encephalopathy

VARICEAL HAEMORRHAGEVARICEAL HAEMORRHAGE

30% of patients with varices bleed from them 30% of patients with varices bleed from them often massive bleeding; 50% mortalityoften massive bleeding; 50% mortality

Therapy: endoscopic therapy:Therapy: endoscopic therapy:

sclerotherapysclerotherapy

variceal band ligationvariceal band ligation

pharmacological treatmentpharmacological treatment

balloon tamponadeballoon tamponade

TIPSTIPS

surgerysurgery

ASCITESASCITES Presence of fluid in Presence of fluid in

the peritoneal cavitythe peritoneal cavity Therapy: diureticsTherapy: diuretics

paracentesisparacentesis

PORTOSYSTEMIC ENCEPHALOPATHYPORTOSYSTEMIC ENCEPHALOPATHY Toxic substances (ammonia) bypass the Toxic substances (ammonia) bypass the

liver via collaterals and gain access to the liver via collaterals and gain access to the brain brain

Symptoms: lethargySymptoms: lethargy

mild confusionmild confusion

anorexiaanorexia

reversal of sleep patternreversal of sleep pattern

disorientationdisorientation

comacoma

HEPATORENAL SYNDROMEHEPATORENAL SYNDROME Development of acute renal failure in Development of acute renal failure in

patients with advanced liver diseasepatients with advanced liver disease Splanchnic vasodilatation - fall in systemic Splanchnic vasodilatation - fall in systemic

vascular resistance, vasoconstriction of vascular resistance, vasoconstriction of renal circulation, reduced renal perfusionrenal circulation, reduced renal perfusion

Oliguria, rising serum creatinine, low urine Oliguria, rising serum creatinine, low urine sodiumsodium

http://http://www.youtube.comwww.youtube.com/watch?v=pmBBT4veCRc/watch?v=pmBBT4veCRc

References:References:

www.wikipedia.comwww.wikipedia.com Kumar&Clark: Clinical medicineKumar&Clark: Clinical medicine