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Chronic liver failure
Chronic liver failure results from ongoing liver injury and inflammation that can lead to degeneration, necrosis, apoptosis, and regeneration or fibrosis over time. If damage is severe enough, this process can result in portal hypertension, varices, and complications such as hepatic encephalopathy, hepatorenal disease, and hepatopulmonary syndrome.
Chronic liver failure
- 1. Chronic liver failure pathogenesisand complications Pratyush kumar
- 2. Pattern of liverinjury Degeneration Necrosis and apoptosis inflammation Regeneration /fibrosis
- 3. Degeneration and intracellular accumulation Toxic and immunologic Accumulation of Fe , Cu, insult triglycerides Cell swelling Steatosis Degeneration Microvascular and macrovesicular Feathery and balloning
- 4. Necrosis and Apoptosis Ischemic Apoptotic cell Lytic necrosis coagulative death • Osmotically swell necrosis • Shrunken • rupture • Mummified cells cells,pyknosis • poor staining • , intensely • lysed nuclei eosinophilic • fragmented nuclei
- 5. • Centrilobular necrosis •Periportal and midjonal necrosis are rare • Bridging necrosis • Submassive necrosis • Massive necrosis
- 7. INFLAMMATION Influx of acuteand chronic inflammatory cells Collection of quiescent lymphocytes in portal tract Kupffer cell engulf the apoptotic cell fragments
- 8. Regeneration • Longer lifespan • Mitoses,thickening of hepatocyte cord,disorganization of parenchyma • DUCTULAR REACTION • If connective tissue framework is intact almost perfect iver restitution may occur
- 9. Fibrosis • Irreversible hepatic damage • Sites of collagen deposition • Nodule formation • cirrhosis
- 10. Portal hypertension andvarices • 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
- 11. Complications • Hepatic encephalopathy – Disorder of neurotransmission in cns and neuromuscular system – Increased level of ammonia – Confusion to coma – Edema and astrocytic reaction
- 12. • 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
- 13. • Hepatopulmonary syndrome – Chronic liver disease +hypoxemia+IPVD – Ventilation perfusion mismatch – Limitation of oxygen diffusion – Increase synthesis of NO
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