Liver pathology CIRRHOSIS Ivana Mari Mentor A mega

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

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

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

Pathology MACRONODULAR CIRRHOSIS Ø Large nodules Ø Often seen following hepatitis B infection

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

Signs and symptoms Ø Jaundice Ø Fatigue Ø Weakness Ø Loss of appetite Ø Itching Ø Easy bruising

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

Investigations Ø Ultrasound Ø CT

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

Complications PORTAL HYPERTENSION

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

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

ASCITES Presence of fluid in the peritoneal cavity Ø Therapy: diuretics paracentesis Ø

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

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

Ø http: //www. youtube. com/watch? v=pm. BBT 4 ve. CRc

References: Ø www. wikipedia. com Ø Kumar&Clark: Clinical medicine