CIRRHOSIS Pathophysiology Complications What is Cirrhosis LIVER CIRRHOSIS

CIRRHOSIS Pathophysiology & Complications

What is Cirrhosis?

LIVER CIRRHOSIS DEFINITION Cirrhosis consists of fibrosis of the hepatic parenchyma, resulting in nodule formation. It represents the consequences of a sustained wound-healing response to chronic liver injury from a variety of causes

LIVER CIRRHOSIS ETIOLOGY Alcoholism Cardiac cirrhosis Chronic viral hepatitis Inherited metabolic liver disease Hepatitis B Hemochromatosis Hepatitis C Wilson's disease Autoimmune hepatitis α 1 Antitrypsin deficiency Nonalcoholic steatohepatitis Cystic fibrosis Biliary cirrhosis Primary biliary cirrhosis Primary sclerosing cholangitis Autoimmune cholangiopathy Cryptogenic cirrhosis

Normal liver functions Carbohydrate Metabolism Hypo- or hyperglycemia Fatty Acids Metabolism Lipid Transport Hyper- or hypolipidemia Proteins Metabolism Serum Albumin Vitamin K–Dependent Blood Coagulation Proteins Bilirubin Metabolism Bile Production Fat-Soluble Vitamins Detoxification Drugs and hormones Providing continual source of energy for entire body Regulation of storage and modulate availability of systemic nutrients Subject to hormonal modulation by endocrine organs (Pancreas, adrenal gland, and thyroid, neuronal regulation)

What is pathophysiology of Cirrhosis?

Cirrhosis Causes (Etiology of chronic necrosis) + Host (Liver reaction) Lead to Cirrhosis & complications

What is clinical manifestation of Cirrhosis?

Cirrhosis Clinical manifestations: - No symptoms (routine examination) 40% - Impaired hepatocellular function (Liver failure) - Portal hypertension - Clinical manifestation of underlying disease

What is natural history of Cirrhosis?

How do you make diagnosis of cirrhosis?

Cirrhosis Diagnostic approach: 1. Liver function tests (PT, . , Alb, Bili, PLT) 2. Liver damage tests (AST>ALT, Alk. Ph) 3. Liver ultrasound (nodularity, decrease in size, portal vein enlargment, prominent left lobe) 4. Etiological diagnostic tests 5. Liver biopsy 6. Surveillance tests (AFP, sonography, endoscopy, pracentesis, creatinine)

What is general clinical management of cirrhosis?

Cirrhosis Clinical management: 1. Etiological treatment 2. Prophylactic treatment 3. Pre-transplantation care 4. Liver transplantation

MALIGNANT TRANSFORMATION • Rapid, unexplained weight loss • Unexplained fever • Pain in the right Hypochondrium • Rapid enlargement of liver / one of the nodules • Hepatic Rub / Hepatic Bruit • Hemorrhagic ascitic fluid • Malignant cells in cytology of Ascitic fluid • Confirmation by USG / CT / AFP / Biopsy