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LIVER CIRRHOSIS

LIVER CIRRHOSIS. THE ANATOMY OF THE PORTAL VENOUS SYSTEM. LIVER CIRRHOSIS. Diffuse disorganization of normal hepatic structure by regenerative nodules that are surrounded by fibrotic tissue. NORMAL. Liver Functions. Metabolism – Carbohydrate, Fat & Protein

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LIVER CIRRHOSIS

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  1. LIVER CIRRHOSIS

  2. THE ANATOMY OF THE PORTAL VENOUS SYSTEM

  3. LIVER CIRRHOSIS • Diffuse disorganization of normal hepatic structure by regenerative nodules that are surrounded by fibrotic tissue.

  4. NORMAL Liver Functions Metabolism – Carbohydrate, Fat & Protein Secretory – bile, Bile acids, salts & pigments Excretory – Bilirubin, drugs, toxins Synthesis – Albumin, coagulation factors Storage – Vitamins, carbohydrates etc. Detoxification – toxins, ammonia, etc.

  5. Normal Liver - Microscopy

  6. Micronodular Cirrhosis

  7. Macronodular Cirrhosis

  8. PATHOMORPHOLOGY

  9. PATHOMORPHOLOGY

  10. Liver Biopsy – Cirrhosis

  11. LIVER CIRRHOSISCLASSIFICATION (etiologic) • Viral • Alcoholic • Toxic • Autoimmune • Metabolic • Сongestive • Biliary • Cryptogenic

  12. LIVER CIRRHOSISCLASSIFICATION

  13. LIVER CIRRHOSISCLASSIFICATION

  14. LIVER CIRRHOSISCLASSIFICATION

  15. CLASSIFICATION according to Child - Turcotte and Pugh

  16. LIVER CIRRHOSISСOMPLICATIONS • HEPATIC ENCEPHALOPATHY • VARICEAL BLEEDING • ASCITES • HEPATORENAL SYNDROME • PORTAL VEIN TROMBOSIS • BACTERIAL PERITONITIS • HEPATOCARCINOMA

  17. LIVER CIRRHOSISCLINICAL SYNDROMES • Astenic syndrome • Pain syndrome • Dyspeptic syndrome • Cholestatic syndrome • Syndrome of jaundice • Portal Hypertension

  18. Spider naevus in liver cirrhosis in the ventral side of theleft shoulder

  19. Palmar erythema in liver cirrhosis

  20. Gynaecomastia in liver cirrhosis

  21. Xanthelasmas in biliary cirrhosis as a result of primarybiliary cholangitis

  22. Vein dilatation in the abdominal wall of a cirrhotic patient suffering from ascites and jaundice

  23. ASCITES

  24. Jaundice

  25. Ascitis in Cirrhosis

  26. Micronodular cirrhosis:

  27. Micronodular cirrhosis:

  28. Alcoholic Hepatitis

  29. Macronodular Cirrhosis

  30. Liver Biopsy – Cirrhosis

  31. Liver Biopsy – Cirrhosis:

  32. Nutmeg Liver-Cardiac Sclerosis

  33. Clinical Features Hepatocellular failure. Malnutrition, low albumin & clotting factors, bleeding. Hepatic encephalopathy. Portal hypertension. Ascites, Portal systemic shunts, varices, splenomegaly.

  34. Bleeding in Liver disease: vitamin K – in liver gamma-carboxyglutamic acid – for coagulation factors II, VII, IX, and X. Liver disease  factor VII is the first to go  so the defect will appear initially in the extrinsic pathway, i.e., abnormal PT. When severe it affects both pathways.

  35. CirrhosisClinical Features

  36. Gynaecomastia in cirrhosis

  37. Porta-systemic anastomosis: Prominent abdominal veins.

  38. MRI Cirrhosis

  39. Complications: Congestive splenomegaly. Bleeding varices. Hepatocellular failure. Hepatic encephalitis / hepatic coma. Hepatocellular carcinoma.

  40. Hepatocellular Carcinoma

  41. LIVER CIRRHOSISPLAN of INVESTIGATIONS • Total blood count, Blood group and Rhesus factor • Biochemical analysis (Glucose, Bilirubin, ALT, AST, GGT, Alkaline phosphatase, Albumin, ﻻ-globulins, Cholesterol, Liver tests, Sodium, Potassium, Urea, Creatinine) • Urinanalysis, Diastase of urine • Coagulogram • Markers of Viral Hepatitis(chain polimerase reaction, immunoenzyme analysis) • Immunogram • ECG, Endoscopy, USD, CT, EEG • Diagnostic paracentesis • Needle liver biopsy

  42. Diagnostic paracentesis.

  43. Endoscopy reveals large, tortuous esophageal varices thathave a characteristic bluish color

  44. ESOPHAGEAL VARICES

  45. Normal liver with portal vein (VP), inferior vena cava (VC) and right branch of the portal vein (RHA). Subcostal plane: 1 - left branch of VP; 2 - right branch of hepatic vein; 3 - cranial diaphragm

  46. Liver cirrhosis with ascites (longitudinal section): the left lobe of liver is rounded and plump; intrahepatic vessels are reduced. Irregular and inhomogeneous structure. Clear undulatory limitation (arrow) on the underside due to nodular transformation.Wide hypoechoic fringe due to ascites

  47. Post mortem specimen of cirrhotic liver and enlarged spleen Post mortem specimen of banded oesophageal varix

  48. Monitoring of patients with ascites TREATMENT

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