All the causes which lead to liver cirrhosis by elimo

1. Liver cirrhosis

3. Cirrhosis is defined as the histological development of
regenerative nodules surrounded by fibrous bands in
response to chronic liver injury, that lead to portal
hypertension and end stage of liver disease.
When cells are injured or damaged and die off usually that
dead tissue that was Previously full of the living cells
becomes Thickened with heaps and heaps of protein and
Forms scar tissue because it’s usually irreversible ( in its
advanced stage) cirrhosis is often referred toas end stage
or late stage liver Damage at which point the only

4. treatment Option maybe liver transplantation ,however
Reversed of cirrhosis ( in its early stages) Forms of liver
disease.
Following treatment of the underlying cause patients with
cirrhosis are susceptible to a variety of complications and
their life expectancy is markedly reduced

6. 1.viral hepatitis
2.alcohol use
1+2 together =exponential damage
3.metabolic cause
● non alcoholic fatty liver disease
● non alcoholic steatohepatitis
● hemochromatosis (iron build up )
● Wilson’s disease ( copper -build up )
a 1 antitrypsin deficiency
4.drug induced
methotrexate (direct +enhances other damages)
5.chronic autoimmune hepatitis

7. In India, the common causes are first alcohol then
hepatitis B

9. Introduction
The alcoholic liver disease covers a
spectrum of disorders beginning from the
fatty liver, progressing at times to
alcoholic hepatitis and culminating in
alcoholic cirrhosis, which is the most
advanced and irreversible form of liver
injury related to the consumption of
alcohol.
Typically a person has drunk heavily for at
least 8 years is more likely to get liver
cirrhosis.

10. the national institute on Alcohol Abuse
and alcoholism defines
Heavy drinking as drinking five or more
drinks in one day on at least five of the
past 30 days.
Even moderate amounts of alcohol can
have toxic effects when taken with
over-the-counter drugs containing
acetaminophen.
If you're taking over-the-counter drugs, be
Specially careful about drinking and don’t
use an alcoholic beverage to take your
Medication

11. Those who regularly drink more than the
recommended daily limits of alcohol
should not stop drinking without medical
support. Withdrawal from alcohol can be
life-threatening. Individuals should seek
help from a medical professional to safely
manage alcohol withdrawal.
The recommended daily limits are no
more than one drink a day for women and
no more than two drinks a day for men.
Women are more at risk for alcoholic liver
Disease .women don’t have as many
enzymes in the their stomachs to break

12. Alcohol particles. Because of this, more
alcohol is able to reach the liver and
make scar tissue .
Alcoholic liver disease can also have
some genetic factors. For example,
some people are born with a deficiency
in enzymes that help to eliminate
alcohol.
Obesity, a high-fat diet, and having
hepatitis C can also increase a person’s
likelihood they will have alcoholic liver
disease.

13. The first stage of alcoholic liver disease is
hepatic steatosis, which involves the
accumulation of small fat droplets under
liver cells approaching the portal tracts.
More advanced disease is characterized
by marked steatosis, hepatocellular
necrosis, and acute inflammation, known
as alcoholic hepatitis .
Fibrosis and its terminal or late
stage,cirrhosis refer to the deposition of
Abnormal amount of extracellular matrix
Matrix proteins,principally by Hscs

14. Symptoms of ALD
Early symptoms include fatigue,loss of
energy,loss of appetite,weight
loss,nausea,pain in abdomen,redness on
the
Palms etc.however ,as the condition
worsens,symptoms may include:
● Building up of fluids in the abdomen
(ascites)
● Yellowing of the skin or eyes (jaundice)
● Spider-like appearance of blood vessels
on the skin

15. ● Chest swelling and shrinking of the
testicles (in men )
● Easy bruising and bleeding
● Pale stool

16. Mechanism involved in alcoholic
steatosis
As the preceding section on ethanol
metabolism stated, ethanol and
acetaldehyde oxidations generate higher
levels of NADH, which alters the cellular
redox potential and enhances lipid
synthesis
However, ethanol-induced redox change
alone does not fully explain why the liver
rapidly accumulates fat

17. ethanol-induced steatosis is multifactorial

18. Treatment
Management of alcohol liver disease
depends on the extent of the disease.
Medical Treatment
● * Alcohol abstinence, enrollment to
detoxification programs
● * Nutritional support
● * Screening for hepatocellular carcinoma
with ultrasonography every six months
and screening for esophageal varices in
those with cirrhosis
● Chronic alcoholics are more prone to
develop hepatotoxicity from

19. acetaminophen, so dosing should not exceed
more than 2000 mg per day. An average
person can tolerate up to 4000 mg of
acetaminophen per day
● * Treatment of co-existing liver diseases
such as Hepatitis B and C viral infections
Surgical treatment
f liver damage is irreversible, definitive
treatment is a liver transplant in those who
have shown a commitment to continued
alcohol abstinence

20. Viral hepatitis

21. Inflammation of the liver of any cause is referred
to as hepatitis. It may be caused by viruses,
drugs, or alcohol, although the most common
cause is viruses, termed Viral hepatitis
There are several types of hepatitis viruses
including types A, B, C, D, E, and possibly G.
Types A, B, and C are the most common.
All hepatitis viruses can cause acute
hepatitis
Viral hepatitis types B and C can cause
chronic hepatitis.

22. Symptoms of acute viral hepatitis include fatigue,
flu-like symptoms, dark urine, light-colored
stools, fever, and jaundice; however, acute viral
hepatitis may occur with minimal symptoms that
go unrecognized. Rarely, acute viral hepatitis
causes fulminant hepatic failure.
The symptoms of chronic viral hepatitis often are
mild and nonspecific, and the diagnosis of
chronic hepatitis often is delayed

23. Chronic viral hepatitis is the principal cause
of chronic liver disease, cirrhosis, and
hepatocellular carcinoma in the world and
now ranks as the chief reason for liver
transplantation in adults.

24. Hepatitis B is a potentially
life-threatening liver infection caused by
the hepatitis B virus (HBV). It is a major
global health problem. It can cause
chronic infection and puts people at high
risk of death from cirrhosis and liver
Cancer.
Acute heapatits b infection lasts less Six
months and you should be recover Within
a few months

25. Most people who get hepatitis B as adults have
an Acute infection
Chronic hepatitis B infection lasts six Months or
longer .It lingers because your immune system
can't fight off the infection. Chronic hepatitis B
infection may last a lifetime, possibly leading to
serious illnesses such as cirrhosis and liver
cancer
Prevention
The hepatitis B vaccine is typically given
as three or four injections over six

26. months. You can't get hepatitis B from the
vaccine.

27. Treatment
The main goal of treatment of chronic
hepatitis B is to suppress HBV replication
and to induce remission of liver disease
before development of cirrhosis and
hepatocellular carcinoma
Treatment is usually offered if:
● your immune system is unable to control
the hepatitis B by itself
● there's evidence of ongoing liver damage

28. The main medicines for chronic hepatitis B
include peginterferon alfa 2-a and antiviral
medicines
Peginterferon alfa-2a
If your liver is working fairly well, the first
treatment offered is usually a medicine
called peginterferon alfa 2-a.
This stimulates the immune system to attack
the hepatitis B virus and regain control over it.
It's usually given by injection once a week for
48 weeks
Tests will be carried out during treatment to see
how well it's working.

29. Alternative medicines may be recommended if
it's not helping.
Antiviral medicines
If your liver is not working well, or
peginterferon alpha-2a is not suitable or not
working for you, your doctor may
recommend trying antiviral medication
instead.
This will usually be either tenofovir or
entecavir, both of which are taken as tablets.
Common side effects of these medicines
include feeling sick, vomiting and dizziness.

30. There may be few symptoms after
initial HCV infection. Many people
with hepatitis C don’t even know they
have the life-threatening disease.
HCV attacks the liver. Many people
exposed develop a chronic infection after
initial infection with HCV. Chronic HCV
infection slowly causes inflammation and
damage in the liver. Sometimes the
condition may not be diagnosed for 20 or

31. Or 30 years
Progressing to cirrhosis
Less than a quarter of people with HCV will
develop cirrhosis. But, certain factors can
increase your risk of cirrhosis, including:
● Alcohol use
● infection with HCV and another virus (such
as HIV or hepatitis B)

32. Anyone with chronic HCV infection
should avoid alcohol. Cirrhosis can also
accelerate in people older than 45 as
fibrosis and scarring increase.
Aggressively treating HCV infection in
younger people may help prevent
progression to cirrhosis.

33. Treatment
Hepatitis C can often be treated successfully by
taking medicines for several weeks.
Treatment for chronic hepatitis C Involved
● tablets to fight the virus
● a test to see if your liver is damaged
● lifestyle changes to prevent further
damage
During treatment, you should have blood tests to
check that your medicine is working.
Your doctor will also assess your liver for damage
(scarring), either with a blood test or a scan

34. called a fibroscan
At the end of your treatment, you'll have a blood
test to see if the virus has been cleared and a
second blood test 12 or 24 weeks after treatment
has stopped.
If both tests show no sign of the virus, this means
treatment has been successful.

35. Hepatitis c medicines
Hepatitis C is treated using direct acting
antiviral (DAA) tablets.
DAA tablets are the safest and most effective
medicines for treating hepatitis C In 90 percent of
people
The tablets are taken for 8 to 12 weeks. The
length of treatment will depend on which type of
hepatitis C you have.
Researchers have recently made significant
advances in treatment for hepatitis C using
new, "direct-acting" antiviral medications,
sometimes in combination with existing ones.

36. As a result, people experience better
outcomes, fewer side effects and shorter
treatment times — some as short as eight
weeks. The choice of medications and length
of treatment depend on the hepatitis C
genotype, presence of existing liver damage,
other medical conditions and prior
treatments.
If you have developed serious complications
from chronic hepatitis C infection, liver
transplantation may be an option.

37. In most cases, a liver transplant alone doesn't
cure hepatitis C. The infection is likely to
return, requiring treatment with antiviral
medication to prevent damage to the
transplanted liver.
Vaccinations
Although there is no vaccine for hepatitis C,
your doctor will likely recommend that you
receive vaccines against the hepatitis A and B
viruses. These are separate viruses that also
can cause liver damage and complicate the
course of chronic hepatitis C.

39. Definition
(NAFLD) is defined by macrovesicular
steatosis in ≥5% hepatocytes, in the absence
of a secondary cause such as alcohol or
drugs.
It encompasses a spectrum of disease from
non-alcoholic fatty liver (NAFL) through to
non-alcoholic steatohepatitis (NASH), fibrosis
and cirrhosis. NAFLD is now a leading cause
of chronic liver disease worldwide

41. Experts don't know exactly why some people
accumulate fat in the liver while others do not.
Similarly, there is limited understanding of
why some fatty livers develop inflammation
that progresses to cirrhosis.
NAFLD usually causes no signs and
symptoms. When it does, they may
include:
● Fatigue
● Pain or discomfort in the upper right

42. Drugs reported to cause fatty liver include
total parenteral nutrition, methotrexate
(Rheumatrex), griseofulvin (Grifulvin V),
tamoxifen (Nolvadex), steroids, valproate
(Depakote), and amiodarone (Cordarone)

45. To reduce your risk of NAFLD
Choose a healthy diet. Choose a healthy plant-based diet that's
rich in fruits, vegetables, whole grains and healthy fats.
Maintain a healthy weight. If you are overweight or obese,
reduce the number of calories you eat each day and get more
exercise. If you have a healthy weight, work to maintain it by
choosing a healthy diet and exercising.
Exercise. Exercise most days of the week. Get an OK
from your doctor first if you haven't been exercising
regularly.

46. Management of NAFLD
Current management for NAFLD includes diet and
lifestyle changes for achieving weight loss, management
of underlying metabolic risk factors and pharmacological
therapies, where there is evidence of NASH, or of
advanced fibrosis.
Diet and lifestyle changes
Patients with NAFLD have unhealthy lifestyle consisting in
both inappropriate diet and absence of physical activity
The usual diet of the NAFLD patient is characterized by
overconsumption of fructose, soft drinks, meat, saturated fat,
and underconsumption of fiber, fish omega-3 fatty acids,
some vitamins

47. The good news is that relatively small amounts of weight loss
result in significant reductions in liver fat with hepatic IR
improvement
Pharmacological Treatment
Insulin Sensitizers and Antioxidants
Lipid accumulation is due to increased flux of free fatty
acids from the adipose tissue driven by insulin resistance,
that represents the major risk factor for this condition

48. 2.vitamin E
Vitamin E has been investigated in the treatment of NASH
because of its anti-oxidant effect that can protect cellular
structure integrity against injury from lipid peroxidation
and oxygen-free radicals.
3.Silymarin
Silymarin is derived from the milk thistle plant Silybum
marianum and has been considered for a long time as an
herbal remedy for liver diseases

50. Nonalcoholic steatohepatitis (NASH) is
liver inflammation and damage
caused by a buildup of fat in the liver.
It is part of a group of conditions
called nonalcoholic fatty liver disease.
You may be told you have a "fatty
liver." Many people have a buildup of
fat in the liver, and for most people it
causes no symptoms and no problems
but for some people may get worse
and cause

51. NASH is similar to the kind of liver disease
that is caused by long-term, heavy drinking.
But NASH occurs in people who don't abuse
alcohol.
Symptoms
You may have no symptoms in the early
stages but As NASH progresses and liver
damage gets worse, you may start to have
symptoms such as:

52. ● Fatigue (feeling tired all the time).
● Weight loss for no clear reason
● General weakness
● An ache in the upper right part of your
belly.
ItIt may take many years for NASH to
become severe enough to cause
symptoms
No single test can diagnose NASH. Your
doctor will ask you about other health
problems you've had.

53. To see if fat is building up in your liver and to
rule out other diseases, your doctor may do
tests such as:
● Blood test
● An abdominal ultrasound
● A CT scan.
● An MRI scan
● Biopsy

54. Treatment
Treatment for NASH includes managing
conditions that increase your risk for NASH
or make it worse. You can:
Reduce your total cholesterol level.
Reach a healthy weight. Losing 3% to
10% of your total body weight can Make a
difference
Control diabetes
Stop or cut back on drinking alcohol.
Exercise regularly

56. Hemochromatosis is a disorder associated with
deposits of excess iron that causes multiple
organ dysfunction. Normally, iron absorption is
tightly regulated because the body is incapable
of excreting excess iron.
Hemochromatosis occurs when there are high
pathologic levels of iron accumulation in the
body.
Hemochromatosis has been called “bronze
diabetes”due to the discoloration of the skin
and associated disease of the pancreas.
Hereditary hemochromatosis is the most

57. common autosomal recessive disorder in
whites.
Types and causes
Primary hemochromatosis is hereditary, meaning it
runs in families
Secondary hemochromatosis happens because of
other conditions you have
These include
● Certain kinds of anemia
● Liver disease
● Getting a lot of blood transfusions

58. White people of northern European
descent are more likely to get
hereditary hemochromatosis. Men are
5 times more likely to get it than
women.

60. ● Pain in your joints,speciallly your knuckles
● Feeling tired
● Unexplained wight loss
● Skin that has a bronze or gray color
● Pain in your belly
● Loss of sex drive
● Loss of body hair
● Heart flutter
● Foggy memory

61. Sometimes people don’t get any symptoms of
hemochromatosis until other problems arise.
These include
● Liver problems,including cirrhosis
● Diabetes
● Abnormal heart beat
● Arthritis
● Erectile dysfunction
If you take a lot of vitamin C or eat a lot of
foods that contain it, you can make
hemochromatosis worse. That’s because
vitamin C helps your body absorb iron from

62. Treatment
Treatments for hemochromatosis include
therapeutic phlebotomy (fleh-BOT-o-me), iron
chelation (ke-LAY-shun) therapy, dietary
changes, and treatment for complications.
The goals of treating hemochromatosis
include:
● Reducing the amount of iron in your body to
normal levels
● Preventing or delaying organ damage from
iron overload

63. ● Treating complications of the disease
● Maintaining a normal amount of iron in your
body for the rest of your life

65. Definition
Wilson's disease is a rare inherited disorder
that causes copper to accumulate in your
liver, brain and other vital organs.
Most people with Wilson's disease are
diagnosed between the ages of 5 and 35,
but it can affect younger and older people,
as well.
Copper plays a key role in the development
of healthy nerves, bones

66. collagen and the skin pigment melanin.
Normally, copper is absorbed from your
food, and excess is excreted through a
substance produced in your liver Bile But in
people with Wilson's disease, copper isn't
eliminated properly and instead
accumulates, possibly to a life-threatening
level. When diagnosed early, Wilson's
disease is treatable, and many people with
the disorder live normal lives

67. Sign and symptoms
It Can have no symptoms, but people may
experience:
Fatigue, lack of appetite or abdominal pain
A yellowing of the skin and the whites of the
eye (jaundice)
Golden-brown eye discoloration
(Kayser-Fleischer rings)
Fluid buildup in the legs or abdomen
Problems with speech, swallowing or
physical coordination
Uncontrolled movements or muscle
stiffness

68. Cause
Wilson's disease is inherited as an
autosomal
Treatment
There are different types of treatment
medications for Wilson’s disease:
● chelating agents, which bind to copper
and help the body excrete it in the urine
● zinc, which preventsTrusted Source
copper absorption by the intestines

70. Drug-induced liver diseases are diseases
of the liver that are caused by
physician-prescribed medications,
over-the-counter medications, vitamins,
hormones, herbs, illicit ("recreational")
drugs, and environmental toxins.
Most cases of DILI are benign, and
improve after drug withdrawal. It is
important to recognize and remove the
offending agent as quickly as possible to
prevent the progression to chronic liver.

71. disease and/or acute liver failure.
Adverse drug reactions are an important
cause of liver injury that may require
discontinuation of the offending agent,
hospitalization, or even liver transplantation.
Among hepatotoxic drugs,
acetaminophen (paracetamol) is the most
often studied
However, a broad range of different
pharmacological agents can induce liver
damage,Depending on the duration of injury
and the histological location of damage,
drug-induced liver injury (DILI) is

72. categorized as acute or chronic, and either
as hepatitis, cholestatic, or a mixed pattern
of injury.
The hepatitis pattern is characterized by
hepatocyte necrosis and is associated with
a poor prognosis
There are three types of acute cholestatic
drug-induced injury
bland cholestasis is the result of
abnormal biliary secretion, and is not
accompanied by significant

73. hepatocellular damage; cholestatic
hepatitis (mixed type) refers to
cholestasis with concomitant hepatic
parenchymal damage; and the third form
of acute cholestasis is defined by the
presence of bile duct injury or
cholangiolitis.

74. Mechanism
mechanisms for drug induced liver injury
(DILI) may follow a three-step cascade of
Events
drugs or their metabolites cause cell
stress directly or through reactive
oxygen species (ROS) during drug
oxidation via cytochrome P450, impair
mitochondrial functions, trigger immune
reactions, and impair mitochondrial
functions that would initiate apoptosis or
necrosis leading to cell death.

75. Clinically, toxicity DILI commonly refers
to the idiosyncratic toxicity that occurs at
therapeutic doses, affects a few susceptible
individuals, and is not predictable.
Conversely, intrinsic toxicity is dose
dependent and thus predictable in
individuals given an overdose of certain
drugs such as acetaminophen.

76. Diagnosis
The diagnosis of drug-induced liver
diseases often is difficult. Patients may
not have symptoms of liver disease or
may have only mild, nonspecific
symptoms
Patients also may have other potential
causes of liver diseases such as
non-alcoholic fatty liver disease
The diagnosis of liver disease is based
on a patient's symptoms (such as loss of
appetite,nausea, fatigue, itching, and

77. dark urine), findings on the physical
examination (such as jaundice, enlarged
liver), and abnormal laboratory tests (such
as blood levels of liver enzymes or bilirubin
and blood clotting times). If a patient has
symptoms, signs, and abnormal liver tests,

78. Treatment
The most important treatment for
drug-induced liver disease is stopping
the drug that is causing the liver disease.
In most patients, signs and symptoms of
liver disease will resolve and blood tests
will become normal and there will be no
long-term liver damage. There are
exceptions, however.For example,
Tylenol overdoses are treated with oral
N-acetylcysteine to prevent severe liver

79. necrosis and failure. Liver
transplantation may be necessary for
some patients with acute liver failure.
Some drugs also can cause irreversible
liver damage and cirrhosis.

80. The 10 worst medication
For your liver
1.acetaminophen
It is one of the most common causes of
medication-related liver failure. Of the
liver failure cases attributed to
medications, more than a third are due to
acetaminophen.
To prevent liver damage, make sure to
limit your acetaminophen use to
under 2 grams a day, and remember

81. to read the ingredients on combination
medicine products. Many over-the-counter
products contain
acetaminophen—especially cold and flu
products like Nyquil and Dayquil—and that’s
where folks get into trouble.

82. 2.amoxicillin
It is an antibiotic commonly used to
treat infections of the sinuses,
throat, and lung airways
(bronchitis). Liver damage from this
antibiotic can occur shortly after
you start taking it and can be
prolonged. Signs of liver injury are
often detected even after patients
stop the medication.

83. 3.diclofenac
Any NSAID (non-steroidal
anti-inflammatory drug) can cause liver
injury, although it’s very rare. This class
of medications includes popular drugs
like ibuprofen and naproxen. But when it
comes to liver injury, diclofenac is the
NSAID with the highest risk. Liver injury
from diclofenac can happen weeks to
months after you start taking it and
affects susceptible individuals for
reasons we don’t yet know.

84. 4.amiodarone
It is a medication used to treat atrial
fibrillation, an irregular heartbeat
condition that can lead to blood clots,
stroke, and heart failure. After taking
amiodarone for weeks to months,
patients may have signs of liver cell
injury.

85. 5.allopurinol
Allopurinol (Zyloprim), often used to
prevent painful gout attacks, can cause
liver injury within days to weeks of the
start of treatment. If you are prescribed
this drug, your doctor may also
recommend that you get regular lab tests
to monitor the health of your liver.

86. 6. Anti-seizure medications
Anti-seizure medications are generally
a problem, as several anti-epileptic
medications can cause liver damage.
Dilantin (phenytoin) can cause liver
damage shortly after you start taking it,
which is why you will need regular lab
tests to monitor your liver functioning.
Carbamazepine and lamotrigine can
also cause liver injury, which may show
up after you’ve been taking either for
weeks to months.

87. 7. Isoniazid
If you have a positive tuberculosis (TB)
skin test, you might get a prescription for
3 to 6 months of isoniazid (a.k.a.
isonicotinylhydrazide or INH therapy).
INH is a well-known cause of acute liver
injury, which occurs weeks to months
after you start treatment. Since alcohol
can also cause liver damage, you should
not drink alcohol while taking INH.

88. 8.azathioprine
Azathioprine is a medication that
controls the immune system and is used
to treat autoimmune conditions like
Crohn’s disease and autoimmune
hepatitis. After weeks to months of
taking azathioprine, damage to the liver
can occur. I’ve seen this happen. Keep
an eye on the liver while taking this
medication.

89. 9.methotrexate
Methotrexate, used for many
conditions—including certain
cancers, rheumatoid arthritis, and
ectopic pregnancy—requires
regular lab tests to monitor the
liver. Liver toxicity is a relatively
common side effect of this
medication.

90. 10. Risperidone
Risperidone (Risperdal) and quetiapine
(Seroquel) are both used as
antipsychotics and antidepressants,
and have the potential to cause liver
damage. How? Bile, a fluid made by the
liver to help your body digest food, is
normally delivered to the gallbladder
for storage. But these medications can
block bile from being able to leave the
liver, leading to a condition known as
drug-induced cholestasis.

92. Alpha-1 antitrypsin deficiency is an inherited
disorder that may cause lung disease and
liver disease. The signs and symptoms of the
condition and the age at which they appear
vary among individuals.
People with alpha-1 antitrypsin deficiency
usually develop the first signs and symptoms
of lung disease between ages 20 and 50. The
earliest symptoms are shortness of breath
following mild activity, reduced ability to
exercise, and wheezing
About 10 percent of infants with alpha-1
antitrypsin deficiency develop liver disease,

93. About 10 percent of infants with alpha-1
antitrypsin deficiency develop liver disease,
which often causes yellowing of the skin and
whites of the eyes (jaundice).
Approximately 15 percent of adults with
alpha-1 antitrypsin deficiency develop liver
damage (cirrhosis) due to the formation of
scar tissue in the liver. Signs of cirrhosis
include a swollen abdomen, swollen feet or
legs, and jaundice.Individuals with alpha-1
antitrypsin deficiency are also at risk of
developing a type of liver cancer called
hepatocellular carcinoma.

94. Individuals with alpha-1 antitrypsin deficiency
are also at risk of developing a type of liver
cancer called hepatocellular carcinoma.
Causes
Mutations in the SERPINA1 gene cause
alpha-1 antitrypsin deficiency. This gene
provides instructions for making a protein
called alpha-1 antitrypsin, which protects
the body from a powerful enzyme called
neutrophil elastase. Neutrophil elastase is
released from white blood cells to fight

95. infection, but it can attack normal tissues
(especially the lungs) if not tightly controlled by
alpha-1 antitrypsin.
Environmental factors, such as exposure to
tobacco smoke, chemicals, and dust, likely
impact the severity of alpha-1 antitrypsin
deficiency.

96. Diagnosis
AAT deficiency usually is diagnosed after you
develop a lung or liver disease that is related
to the condition. But knowing the symptoms
and getting an early diagnosis is important to
help prevent serious disease, especially with
treatment and lifestyle changes.
Your doctor may recommend tests to confirm
a diagnosis of AAT deficiency. He or she also
may recommend tests to check for lung- or
liver-related conditions.

97. ● A blood test can check the level of AAT
protein in your blood. If the level is lower than
normal, it is likely that you have AAT
deficiency.
● A genetic test is the most certain way to
check for AAT deficiency and should be done
to confirm the results of the blood test and
find the mutation in the AAT gene. A genetic
counselor can help you understand what to
expect from a genetic test and what your
results mean.

98. Treatment
AAT deficiency currently has no cure, but there
are treatments to slow lung damage and treat its
complications. Treatment is best managed by a
team that includes a primary care doctor,
pulmonologist (lung specialist),
gastroenterologist (GI specialist), and geneticist
(specialist in genetic conditions). People who
have AAT deficiency and develop related liver or
skin diseases will be referred to doctors who
treat those diseases.

99. You may need a lifelong treatment called
augmentation therapy. In this treatment, you
receive the AAT protein, obtained from blood
donors, through a vein to raise levels of the
protein in your lungs. This helps slow down lung
damage. Side effects of this treatment are rare
and may include a mild fever, headaches,
nausea, and dizziness.
If you have complications from AAT deficiency,
you may also need:
● Medicines called inhaled bronchodilators and
inhaled steroids.

100. ● Oxygen therapy
● Pulmonary rehabilitation, which involves
treatment by a team of experts at a special
clinic. You will learn how to manage your
condition and function at your best
● A lung transplant, which may be an option if
you have very severe breathing problems
and have a good chance of surviving the
transplant surgery

102. Symptoms of cirrhosis according
to compensated and decompen-
Sated categories
There are two general categories of cirrhosis
which describe the level of liver function and
damage; compensated and decompensate
Compensated Cirrhosis
Compensated cirrhosis means the liver is
scarred but still able to

103. most its basic functions at some level.
The stage or grade of scarring depends on
how well the liver is able to function.
Ifthe cause for damage is not eliminated, like
having the Hepatitis C virus, or drinking
alcohol, drug use, etc… liver damage will
continue to progress and the patient will
begin to experience more severe break down
in liver function.
With compensated cirrhosis, the pressure in
the portal vein is not too high and theliver
still has enough healthy cells to perform its
function.

104. Symptoms of Compensated
cirrhosis
Patients can live for years without being aware
of liver damage with little to no symptoms.
common symptoms are:
● itching
● loss of appetite
● Fatigue
● stomach upset
● weight loss
● bruising
● swelling/retaining fluid in legs or

105. ● confusion (brain fog)
● Loss of muscle mass
Liver disease patients with compensated or
decompensated cirrhosis are also more at
risk for liver cancer

106. Decompensated cirrhosis
Liver damage and severe scarring can progress
to the point where the liver can no longer
function properly and the patient will begin to
experience more severe symptoms
Symptoms of Decompensated Cirrhosis
● Internal bleeding from large blood vessels
in the esophagus (varices)
● Fluid buildup in the abdomen (ascites
● Swelling in legs
● Hepatic encephalopathy with confusion
,sullred speech ,disoriented or

107. Brain fog
● Yellowing of eyes and skin (jaundice
● Severe fatigue
● Loss of appetite
● Continued weight loss or muscle mass
● Nausea
● Redness in the palms of hands
● Bruising

109. There are 2 primary ingredients
Hepatic fibrosis
Regenerating liver cells
In response to injury and loss, growth regulators induce
hepatocellular hyperplasia (producing regenerating nodules)
and arterial growth (angiogenesis).
Among the growth regulators are cytokines and hepatic growth
factors (eg, epithelial growth factor, hepatocyte growth factor,

110. transforming growth factor-alpha, tumor necrosis factor).
Insulin, glucagon, and patterns of intrahepatic blood flow
determine how and where nodules develop.
Angiogenesis produces new vessels within the fibrous sheath
that surrounds nodules. These vessels connect the hepatic
artery and portal vein to hepatic
venules, restoring the intrahepatic circulatory pathways
Such interconnecting vessels provide relatively low-volume,
high-pressure venous drainage that cannot accommodate as

111. much blood volume as normal. As a result, portal vein pressure
increases Such distortions in blood flow contribute to portal
hypertension,which increases because the regenerating
nodules compress hepatic venules.
The progression rate from fibrosis to cirrhosis and the
morphology of cirrhosis vary from person to person.
Presumably, the reason for such variation is the extent of
exposure to the injurious stimulus and the individual’s
response.

112. Complication
Portal hypertension is the most common serious
Complication of cirrhosis and it in turn cause
compelication are
● Gastrointestinal (GO) bleeding
● Ascites
● Acute kidney injury
● Pulmonary hypertension

113. ● Pulmonary hypertension
● Hepatopulmonary syndrome
Ascites fluid can become infected (spontaneous bacterial
peritonitis). Portopulmonary hypertension can manifest
with symptoms of heart failure. Complications of portal
hypertension tend to cause significant morbidity and
mortality.

114. Cirrhosis can cause other cardiovascular complications.
Vasodilation, intrapulmonary right-to-left shunting, and
ventilation/perfusion mismatch can result in hypoxia
(hepatopulmonary syndrome).
Progressive loss of hepatic architecture impairs function,
leading to hepatic insufficiency; it manifests as
coagulopathy

115. acute kidney injury (hepatorenal syndrome), and hepatic
encephalopathy.
Hepatocytes secrete less bile, contributing to cholestasis and
jaundice. Less bile in the intestine causes malabsorption of
dietary fat (triglycerides) and fat-soluble vitamins
Malabsorption of vitamin D may contribute to osteoporosis.
Undernutrition is common.

116. Blood disorders are common. Anemia usually results from
hypersplenism, chronic GI bleeding, folate deficiency
(particularly in patients with alcoholism), and hemolysis.
Cirrhosis results in decreased production of prothrombotic
and antithrombotic factors.
Hypersplenism and altered expression of thrombopoietin
contribute to thrombocytopenia. Thrombocytopenia and
decreased production of clotting factors can make clotting

117. Unpredictable
Increasing risk of both bleeding and thromboembolic disease
(even though international normalized ratio [INR] is usually
increased). Leukopenia is also common; it is mediated by
hypersplenism and altered expression of erythropoietin and
granulocyte-stimulating factors

119. n its early stages, cirrhosis usually doesn't
cause symptoms. You might not realize
you have it unless your
doctor finds signs of liver damage on a
blood test during a routine checkup.
f you do have symptoms like yellow skin
(jaundice), fatigue, and easy bruising or
bleeding,Blood tests and imaging scans
can show whether you have cirrhosis.

120. Physical examination
First, your doctor will ask about your
symptoms, your health, and your family's
health history. They’ll also look for
telltale signs of cirrhosis, like these:
A swollen belly
Liver size, sometimes enlarged and
sometimes normal or small
● Extra breast tissue (in men)
● Redness on your palms
● Yellow skin or eyes
● Red blood vessels on your skin

121. Blood test
If you have symptoms of cirrhosis or
you're at risk for the disease, your doctor
will take a sample of your blood. These
help spot signs of cirrhosis liver damage
Liver test measure levels of enzymes
and proteins your liver makes
Theses tests include
Alanine transaminase (ALT) and
aspartate transaminase (AST

122. Ff
These help your body break down protein
and amino acid. Levels of both ALT and AST
in your blood are usually low. High levels
can mean that your liver is leaking these
enzymes because it's damaged from
cirrhosis or another
Albumin test:Albumin is a protein that’s
made by the liver. When the liver is
damaged, the level of albumin in the blood
falls
Bilirubin level The liver normally
removes bilirubin from the blood and gets
rid of it in the stool. But when the liver isn’t

123. working properly,
bilirubin builds up in the blood and can cause
the skin and eyes to become yellow. This is
called jaundice..
Creatine
This is a waste product made by your
muscles. Your kidneys normally filter it out of
your blood.A high creatinine level is a sign of
kidney damage, which can happen in the late
stages of cirrhosis.
Prothrombin time or international
normalized ratio

124. Your liver makes substances that help your
blood clot. This test checks to see how well
your blood clots. If it clots too slowly,
cirrhosis could be a possible cause.
Sodium level test
If the sodium level in your blood is low, it
could be an indicator that you have cirrhosis.
A low level of sodium in the blood is called
hyponatremia.
Your doctor can use the results of these
tests to give you a Model for End-Stage
Liver Disease (MELD) score. This shows
how much your liver has been damaged,

125. and whether you need a liver transplant
A complete blood count (CBC)
This test checks your red and white blood
cells, as well as platelets, to get a picture of
your overall
Viral hepatitis blood test
hepatitis is caused by viruses that
damage your liver and can lead to
cirrhosis. These tests check your
blood for hepatitis A, B, and C.

126. Tests to check for autoimmune hepatitis,
Wilson's disease, hemochromatosis and other
diseases
Imagining test
Your doctor might order one or more of these
to see if you have scarring or other damage to
your liver:
Ct scan
Using X-rays and a computer, it makes
detailed pictures of your liver. You might get a
contrast dye before the test to help your
doctor see your liver more clearly

127. MRI This uses powerful magnets and radio
waves to make pictures of your liver. You
might get contrast dye before the test.
Ultrasound It uses sound waves to make
pictures of your liver
Endoscopy It can be used to look for
abnormal blood vessels called varices. These
form when cirrhosis scars block blood flow in
the portal vein that carries blood to your liver.

128. Over time, pressure builds up in this vein.
Blood backs up into blood vessels in the
stomach, intestines, or esophagus
Magnetic resonance elastography and
transient elastography
These newer tests look for stiffness in your
liver caused by cirrhosis scars. Your doctor
might use them instead of a liver biopsy,
because they're less invasive. But they’re not
yet widely available.

129. A liver biopsy is a medical procedure in which a small
amount of liver tissue is surgically removed so it can be
analyzed in a laboratory.
Liver biopsies are usually done to evaluate disease, such
as cirrhosis, or to detect infection, inflammation, or
cancerous cells
Your doctor may order a liver biopsy if blood or or
imaging tests indicate there are problems with your liver.

130. Some conditions that affect the liver and may require a biopsy
Include
● alcoholic liver disease
● autoimmune hepatitis
● chronic hepatitis (B or C)
● hemochromatosis (too much iron in the blood)
● nonalcoholic fatty liver disease

131. ● primary biliary cirrhosis (which leads to scarring on the
liver)
● primary sclerosing cholangitis (which affects the liver’s
bile ducts)
● Wilson’s disease

133. Treatment for cirrhosis depends on the cause and extent of
your liver damage. The goals of treatment are to slow the
progression of scar tissue in the liver and to prevent or treat
symptoms and complications of cirrhosis. You may need to be
hospitalized if you have severe
Treatment for the underlying cause of cirrhosis
● Treatment for alcohol dependency
● Weight loss.People with cirrhosis caused by nonalcoholic
fatty liver disease may become

134. healthier if they lose weight and control their blood sugar
● Medications to control hepatitis
● Medications to control other causes and symptoms of
cirrhosis
Treatment for complications of cirrhosis
Your doctor will work to treat any complications of cirrhosis,
including
Excess fluid in your body A low-sodium diet and medication
to prevent fluid buildup in the body

135. may help control ascites and swelling. More-severe fluid
buildup may require procedures to drain the fluid or surgery to
relieve pressure.
● Portal hypertension certain blood pressure medication
may control increased pressure in the veins that supply the
liver (portal hypertension ) and prevent sever bleeding
● Infection You may receive antibiotics or other treatments for
infections. Your doctor also is likely to recommend
vaccinations for influenza,pneumonia and hepatitis.
● Increased liver cancer risk Your doctor will likely
recommend periodic blood tests and ultrasound exams to

136. look for signs of liver cancer
● Hepatic encephalopathy you may be prescribed
medication to help reduce the build up of toxin in your blood
due to poor liver fuction

137. Addressing the patient’s nutritional needs is very
important in decompensated liver disease, as sarcopenia
is highly prevalent.All patients should have a nutritional
assessment, food chart and, if required, oral/nasogastric
nutritional supplements aiming to provide a total energy
intake of about 35–40 kcal/kg daily.
Refeeding syndrome is a common complication, so
phosphate, potassium and magnesium should be
monitored daily, and electrolytes replaced orally or

138. intravenously as appropriate. Pabrinex (intravenous
thiamine) should be prescribed if there is evidence of
inadequate nutrition, or in patients who consume
excessive alcohol, to reduce the risk of Wenrick’s
encephalopathy

139. Cirrhosis diet chart
Cirrhosis slow down by treating the factors causing it and by
following a cirrhosis diet chart
The essential point of a cirrhosis diet plan is to give up alcohol
even if alcohol isn't the cause of the The essential point of a
cirrhosis diet plan is to give up alcohol even if alcohol isn't
the cause of the ailment. This is because alcohol intake is

140. known to worsen liver damages
Other key points of the liver cirrhosis diet plan are as
follows
● Individuals with liver damage, tend to retain body fluid
(sodium) which makes it necessary for them to lower
their salt intake in their diet lest fluid builds-up in their
bellies. Reducing salt in the diet by using alternatives
such as lemon juice or herbs is advised. Consumption
of fresh foods over processed and fast foods is
recommended as the former has lower sodium content
than the latter.

141. ● Lower fat foods are highly recommended as a high-fat
diet is known to worsen cirrhosis by causing fatty liver
diseases which is another determinant of cirrhosis.
● High Protein Diet for Liver Cirrhosis: Protein is required
for a well-balanced and nutritious diet however for
individuals suffering from cirrhosis, protein needs to be
obtained from vegetable or plant sources (pulses and
lentils, soy, nuts) instead of animal sources
● It is strongly advised to avoid caffeinated beverages as
they tend to worsen liver damage.
Most patients with cirrhosis do not need to limit fluid
intake, unless your sodium level is less than 125 mmol/L.

142. Book Liver Cirrhosis:
A Toolkit for Patients
Author: Michael Volk, MD
Www.ncbi-nam.nih.gov
Www.stapearls.com
Www.emedicine.medscape.com
Www.mayoclinic.org
Www.nature.com
https://www.healthline.com/health/fatty-liver
https://medlineplus.gov/fattyliverdisease.html

143. https://www.healthline.com/health/wilsons-dise
ase
https://rarediseases.org/rare-diseases/wilson-d
isease/
https://www.medicalnewstoday.com/articles/32
3698
http://www.hepctrust.org.uk/information/impact
-hepatitis-c-liver/cirrhosis

144. https://www.uspharmacist.com/article/drugin
duced-liver-injury-an-overview
https://accesspharmacy.mhmedical.com/co
ntent.aspx?bookid=1861&sectionid=146079
169
https://www.webmd.com/digestive-disorders
/digestive-diseases-liver-biopsy
https://patient.info/digestive-health/abnormal
-liver-function-tests-leaflet/liver-biopsy