CirrhosisCirrhosis
* Definition:* Definition:Chronic, diffuse, irreversible disorder of the liver
characterized by loss of the normal liver architecture
and replacement by regenerating nodules.
Normal Liver
Micronodular cirrhosis
Macronodular Cirrhosis
Normal Liver Histology
CV
PT
Liver Biopsy – Cirrhosis
Liver Biopsy – Cirrhosis:
* Etiological classification of Cirrhosis:* Etiological classification of Cirrhosis:
A. Congenital cirrhosis:A. Congenital cirrhosis:
1. Congenital syphilis.
2. Hemochromatosis.
3. Wilson disease.
4. α1 antitrypsin deficiency.
B. Acquired cirrhosis:B. Acquired cirrhosis:
1. Post-hepatitic (viral).
2. Alcoholic.
3. Biliary cirrhosis.
4. Cirrhosis caused by circulatory disorders e.g.
chronic right sided heart failure.
* Complications of Cirrhosis: * Complications of Cirrhosis:
1. Liver cell Failure.
2. Portal hypertension.
3. Hepatocellular carcinoma.
1. Liver cell failure1. Liver cell failure
1. Jaundice: Hepatocelluar jaundice.
2. Hypo proteinaemia: due to decreased
formation of plasma proteins. Contributes in
generalized edema formation and ascitis.
3. Vitamin deficiency: Vit. A, K, B12, folic acid.
4. Coagulation defect: due deficiency of
fibrinogen, factors V, VII, IX, X.
5. Anemia: due to repeated hemorrhage,
hypersplenism, B12 and folic acid deficiency.
6. Hypoglycemia: due to defects in
carbohydrate metabolism.
7. Hormone disturbances:
Increased serum aldosterone leads: to salt & water retention.
Increased estrogen leads to:
• Gynaecomastia.
• Hypogonadism (testicular atrophy and loss of libido in
males).
• Menstrual disturbances in females.
• Palmer erythema (local vasodilation).
• Spider angiomas of skin: Each angioma is a central,
pulsating, dilated arteriole from which small vessels radiate
GynaecomastiaGynaecomastia
Palmer erythemaPalmer erythema
Spider angioma Spider angioma
8. Ascites: Due to salt & water retention, portal
hypertension and hyporpteinaemia.
Ascites Ascites
9. Hepatic encephalopathy:
Neurological disturbances (apathy,
disorientation, asterixis i.e. flapping tremors and
coma) due to toxic amonia which are formed in
intestine and not detoxified in liver so pass
directly to brain.
10. Foetor hepaticus: a characteristic bad
(musty) odor smelled from the body and mouth of
the patients due to formation of mercaptans by
the action of gastrointestinal bacteria on the
sulfur-containing amino acid methionine.
2. Portal hypertension2. Portal hypertension
Effects of Portal hypertension:
1. Varices: esophageal varices, piles.
2. Splenomegaly due to splenic congestion.
3. Ascites which is accumulation of transudate in
the peritoneal cavity.
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