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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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