Download - Chronic liver failure
![Page 1: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/1.jpg)
Chronic liver failure pathogenesis and complications
Pratyush kumar
![Page 2: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/2.jpg)
Pattern of liver injury
Degeneration
Necrosis and apoptosis
inflammation
Regeneration /fibrosis
![Page 3: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/3.jpg)
Degeneration and intracellular accumulation
Toxic and immunologic insult
Cell swelling
Degeneration
Feathery and balloning
Accumulation of Fe , Cu, triglycerides
Steatosis
Microvascular and macrovesicular
![Page 4: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/4.jpg)
Necrosis and Apoptosis
Ischemic coagulative necrosis
• Mummified cells
• poor staining
• lysed nuclei
Apoptotic cell death
• Shrunken cells,pyknosis
• , intensely eosinophilic
• fragmented nuclei
Lytic necrosis
• Osmotically swell
• rupture
![Page 5: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/5.jpg)
• Centrilobular necrosis
• Periportal and midjonal necrosis are rare
• Bridging necrosis
• Submassive necrosis
• Massive necrosis
![Page 6: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/6.jpg)
![Page 7: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/7.jpg)
INFLAMMATION
Influx of acute and chronic inflammatory cells
Collection of quiescent lymphocytes in portal tract
Kupffer cell engulf the apoptotic cell fragments
![Page 8: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/8.jpg)
Regeneration
• Longer life span
• Mitoses,thickening of hepatocyte cord,disorganization of parenchyma
• DUCTULAR REACTION
• If connective tissue framework is intact almost perfect iver restitution may occur
![Page 9: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/9.jpg)
Fibrosis
• Irreversible hepatic damage
• Sites of collagen deposition
• Nodule formation
• cirrhosis
![Page 10: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/10.jpg)
Portal hypertension and varices
• Portal pressure >12 mm of hg
• Pre,intra and post hepatic cause
• Portosystemic shunting to lower portal pressure
• Development of collateral circulation
• Recurrents bouts of haemorrhage
![Page 11: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/11.jpg)
Complications
• Hepatic encephalopathy
– Disorder of neurotransmission in cns and neuromuscular system
– Increased level of ammonia
– Confusion to coma
– Edema and astrocytic reaction
![Page 12: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/12.jpg)
• Hepatorenal disease
– Renal failure without any intrinsic or functional cause of renal failure
– Sodium retention,
– Decreased renal perfusion
– Decrease GFR
– Ability to concentrate urine retained
![Page 13: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/13.jpg)
• Hepatopulmonary syndrome
– Chronic liver disease +hypoxemia+IPVD
– Ventilation perfusion mismatch
– Limitation of oxygen diffusion
– Increase synthesis of NO
![Page 14: Chronic liver failure](https://reader034.vdocuments.us/reader034/viewer/2022052321/554af510b4c9059f798b4d12/html5/thumbnails/14.jpg)
Thank you