Pressure exceeding greater than 22 mm Hg in the portal vein or a pressure difference between the portal vein and the hepatic vein of greater than 12 mm Hg will result in portal hypertension. Measuring portal pressure involves inserting a catheter into the portal vein. The internal jugular, femoral, or medial antecubital vessels are the best way to access the hepatic and portal veins.
Introduction• The term cirrhosis was first used by ReneLaennec (1781-1826) to describe theabnormal liver color of individuals withalcohol induced liver disease.• Derived from Greek word Kirrhos meansYellowish brown color.
Definition• Cirrhosis is defined as a diffuse processcharacterised by fibrosis and the conversionof normal liver architecture into structurallyabnormal nodules.
Morphology• Its three main morphologic characteristicsare:• 1.Bridging fibrous septa• 2. Parenchymal nodules- micro & macro• 3. Disruption of the architecture of the entireliver.
Cont..• ↓ bile in gastrointestinal tract – light colored stool• ↑ urobilinogen – Dark Urine• ↓ vit K absorption- bleeding tendency• ↓ metabolism of protein, carbohydrate, fats→hypoglycemia,• ↓ plasma protein- ascites and edema• ↓androgen and estrogen detoxification(↓hormone metabolism)- ↑ estrogen and androgenshormone – Gynecomastia, loss of body hair,menstrual dysfunction, spider angioma, palmererythema, testicular atrophy
Cont..• ↓ Aldesterone metabolism so ↑ levels – sodiumand water retention-- edema• Biochemical alteration - ↑ AST, ALT levels, ↑bilirubin, low serum albumin, prolong prothombintime, elevated alkaline phosphatase.• Liver failure• Hepatic encephalopathy• Hepatic coma• Death
Clinical manifestationsEarly manifestations• No symptoms• GI disturbances: anorexia, dyspepsia,flatulence, weakness, fatigue, nausea,vomiting, weight loss, abdominal pain,bloating, diarrhea, constipation• Abdominal pain, dull and heavy feeling• Fever, lassitude, weight loss, enlargement ofliver and spleen.
Cont…Later manifestations:Results from liver failure and portalhypertension• Jaundice• Peripheral edema• Ascites• Others: Skin lesion, hematological disorders,endocrine disturbances, and peripheralneuropathy• Advanced stage: small and nodular liver
Complications• The ultimate mechanism of deaths in mostcirrhotic patients is• (1) progressive liver failure,• (2) a complication related to portalhypertension, or• (3) the development of hepatocellularcarcinoma.
ComplicationPortal hypertension• The nodules and scar tissue can compresshepatic veins within the liver.• This causes the blood pressure within the liver tobe high, a condition known as portalhypertension.• Portal venous pressure is more than 15mmHg or20 cm of water (normal 5-10mm Hg)
Cont…• Is characterized by ↑venous pressure in theportal circulation, spleenomegaly, large collateralvein, ascites, systemic hypertension, andesophageal varices.• The common area to form collateral channels arein the lower esophagus( the anastomosis of theleft gastric vein and azygos vein), the parietalperitoneum, rectum.• High pressures within blood vessels of the liveroccur in 60% of people who have cirrhosis.