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Liver pathology: CIRRHOSIS

Liver pathology: CIRRHOSIS. Ivana Marić Mentor: A. Žmegač Horvat. Consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leading to progressive loss of liver function. Aetiology. Alcohol Chronic hepatitis B

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Liver pathology: CIRRHOSIS

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  1. Liver pathology:CIRRHOSIS Ivana Marić Mentor: A. Žmegač Horvat

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

  3. Aetiology • Alcohol • Chronic hepatitis B • Chronic hepatitis C • Other: Haemochromatosis Non-alcoholic fatty liver disease Primary biliary cirrhosis Sclerosing cholangitis Autoimmune hepatitis Cystic fibrosis...

  4. Pathology MICRONODULAR CIRRHOSIS • Uniform, small nodules up to 3 mm in diameter • Often caused by alcohol damage

  5. Pathology MACRONODULAR CIRRHOSIS • Large nodules • Often seen following hepatitis B infection

  6. Cirrhosis with complicatons of encephalopathy, ascites or variceal haemorrhage – DECOMPENSATED CIRRHOSIS • Cirrhosis without any of these complications – COMPENSATED CIRRHOSIS

  7. Signs and symptoms • Jaundice • Fatigue • Weakness • Loss of appetite • Itching • Easy bruising

  8. Investigations • Liver biochemistry (usually slight elevation of serum alkaline phosphatase and aminotransferase) • Liver function - serum albumin and prothrombin • Serum electrolytes • Serum alpha-fetoprotein • Endoscopy

  9. Investigations • Ultrasound • CT

  10. Management • Irreversible disease, frequently progresses • Correcting the underlying cause (abstinence from alcohol) • Screening for hepatocellular carcinoma • Liver transplantation • 5-year survival rate approximately 50%

  11. Complications PORTAL HYPERTENSION

  12. Symptoms: • Gastrointestinal bleeding from oesophageal or (less commonly) gastric varices • Ascites • Hepatic encephalopathy

  13. VARICEAL HAEMORRHAGE • 30% of patients with varices bleed from them often massive bleeding; 50% mortality • Therapy: endoscopic therapy: sclerotherapy variceal band ligation pharmacological treatment balloon tamponade TIPS surgery

  14. ASCITES • Presence of fluid in the peritoneal cavity • Therapy: diuretics paracentesis

  15. PORTOSYSTEMIC ENCEPHALOPATHY • Toxic substances (ammonia) bypass the liver via collaterals and gain access to the brain • Symptoms: lethargy mild confusion anorexia reversal of sleep pattern disorientation coma

  16. HEPATORENAL SYNDROME • Development of acute renal failure in patients with advanced liver disease • Splanchnic vasodilatation - fall in systemic vascular resistance, vasoconstriction of renal circulation, reduced renal perfusion • Oliguria, rising serum creatinine, low urine sodium

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

  18. References: • www.wikipedia.com • Kumar&Clark: Clinical medicine

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