Liver Cirrhosis - Pathophysiology, Clinical Features, Complications, Lab findings,

1. Liver Cirrhosis
Abraham Mallela
Roll Number 92

2. Introduction
• Cirrhosis :
• Irreversible
• Result of various disorders
• Finally functions of liver are impaired
• Can occur at any age
• Most important cause of premature death

3. Definition
• Cirrhosis is a slowly progressing disease in which the healthy liver
tissue is replaced with scar tissue , eventually preventing the liver
from functioning properly. The scar tissue blocks the flow of blood
through the liver and slows the processing of nutrients , hormones ,
drugs , and other toxins.

4. Etiology
• Alcoholism
• Chronic Viral Hepatits
• Hepatits B
• Hepatits C
• Autoimmune Hepatitis
• Non Alcoholic Stereohepatitis

5. • Biliary Cirrhosis
• Primary Biliary Cirrhosis
• Primary sclerosing Cholangitis
• Autoimmune Cholangiopathy
• Cardiac Cirrhosis
• Cryptogenic Cirrhosis

6. • Inherited Metabolic Liver Disease
• Hemochromatosis
• Wilson’s
• Alpha 1 Antitrypsin Deficiency
• Cystic Fibrosis

7. Pathophysiology
• 2 types of cirrhosis
• Micro nodular cirrhosis
• Macro nodular cirrhosis

8. • Micro Nodular : Small nodules , 1mm in diameter
• Mostly seen in alcoholic cirrhosis
• Macro Nodular : Large nodules with large fibrous scars

9. • Changes in liver during cirrhosis:
• Progressive and widespread death of liver cells
• Associated with inflammation and fibrosis
• Loss of normal liver functions
• Loss of normal hepatic architecture
• Loss of hepatic vasculature

10. • Development of portosytemic shunts
• Formations of nodules instead of lobules
• Development of cirrhosis is mostly gradual and progressive.
• Unless etiological agent is removed

11. Epidemiology
• Can occur at any age
• Prolonged morbidity
• Younger adults
• Important cause for premature death

12. • 10 to 20 % of heavy drinkers develop within 10 years
• In patients with Hepatitis B or C - 5 year survival rate is 71 to 85%
• In 2/3rds of patients - symptomless & normal life
• Liver cirrhosis is detected when abdomen is opened for any other
surgery.

13. Clinical Features
&
Complications
To be discussed by Sowmya

14. CLINICAL FEATURES &
COMPLICATIONS OF
CIRRHOSIS
SREE SOWMYA
ROLL NO. 93

15. MOSTLY THE PATIENTS ARE ASYMPTOMATIC
DIAGNOSIS IS MADE BY ULTRASONOGRAM OR INCIDENTALLY DURING ANY
SURGERIES
SOME PATIENTS PRESENT WITH ISOLATED HEPATOMEGALY, SPLENOMEGALY, SIGNS
OF PORTAL HYPERTENSION or HEPATIC INSUFFICIENCY
FREQUENT COMPLAINTS INCLUDE WEAKNESS, FATIGUE, MUSCLE CRAMPS , WEIGHT
LOSS & NON SPECIFIC DIGESTIVE SYMPTOMS SUCH AS ANOREXIA , NAUSEA ,
VOMITING , & UPPER ABDOMINAL DISCOMFORT

16. THE MAIN CLINICAL FEATURES ARE :
HEPATOMEGALY
JAUNDICE
ASCITES

17. CIRCULATORY CHANGES
SPIDER TELANGIECTASIA
PALMAR ERYTHEMA
CYANOSIS

18. ENDOCRINE CHANGES
LOSS OF LIBIDO
LOSS OF HAIR
MEN
GYNECOMASTIA
TESTICULAR ATROPHY
IMPOTENCE
WOMEN
IRREGULAR MENSIS
AMENNORRHEA
BREAST ATROPHY

19. HAEMORRHAGIC TENDENCIES
BRUISES
PURPURA
EPISTAXIS
MENORRHAGIA

20. PORTAL HYPERTENSION
SPLENOMEGALY
COLLATERAL VESSELS
VARICEAL BLEEDING
FETAR HEPATICUS

21. HEPATIC ENCEPHALOPATHY
PIGMENTATION
DIGITAL CLUBBING
PAROTID & LACRIMAL GLAND ENLARGEMENT
DUPUYTREN’S CONTRACTURE

22. COMPLICATIONS OF
CIRRHOSIS :
PORTAL HYPERTENSION
GASTROESOPHAGEAL VARICES
SPLENOMEGALY
HYPERSPLENISM
ASCITES
SPONTANEOUS BACTERIAL PERITONITIS
HEPATORENAL SYNDROME TYPE 1 & 2
HEPATIC ENCEPHALOPATHY
HEPATOPULMONARY SYNDROME
PORTOPULMONARY HYPERTENSION

23. MALNUTRITION
COAGULOPATHY
FACTOR DEFICIENCY
FIBRINOLYSIS
THROMBOCYTOPENIA
BONE DISEASE
OSTEOPENIA
OSTEOPOROSIS
OSTEOMALACIA
HEMATOLOGIC ABNORMALITIES
ANAEMIA
HEMOLYSIS
THROMBOCYTOPENIA
NEUTROPENIA

24. Laboratory Findings
&
Diagnosis
To be discussed by Sneha
24

25. CIRRHOSIS OF LIVER
Lab Findings and
Diagnosis
Sneha Raj .P
Roll No 94

26. Laboratory findings
In alcoholic cirrhosis..
Incase of advanced liver
disease
• Anaemia
• Haemolytic anaemia with spur
cells – zieve’s syndrome
• Platelet count is decreased

27. • Serum total bilirubin – normal or
elevated
• Direct bilirubin – mildly elevated
• Prothrombin time – prolonged
• Serum sodium levels – normal

28. • Serum aminotransferases
• ALT – elevated
• AST – elevated
• AST>ALT i.e, in 2:1 ratio
• Liver biopsy confirms the diagnosis

29. Incase of primary biliary cirrhosis
• cholestatic liver enzyme
abnormalities with gamma
glutamyltranspeptidase & ALP
• Amino transferases – mildly elevated
• Immunoglobulins mainly IgM –
elevated
• Hyperbilirubinemia is seen

30. • Thrombocytopenia
• Leukopenia &
• Anaemia
• These are seen in patients with
Portal HTN & hyperspleenism

31. Differential diagnosis:
• Budd chiari syndrome
• Acute liver failure
• Alcoholic hepatitis
• Sarcoidosis
• Tricuspid regurgitation
• schistosomiasis

32. • Cerebral hemorrhage
• Seizures
• Rarely,
• meningitis
• encephalitis
• wilson’s disease