Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. ... As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis)

1. Cirrhosis OF liver
PRESENTED BY:
MR. ABHAY RAJPOOT

2. LIVER
 The liver is an essential organ that has many functions in the body, including
making proteins and blood clotting factors,
manufacturing triglycerides and cholesterol, glycogen synthesis, and bile
production.
 In humans, it is located in the right upper quadrant of the abdomen, below the
diaphragm.
 The liver is a large organ that sits on the right hand side of the belly.
 The liver is the body's largest internal organ.

4. INTRODUCTION
 The word "cirrhosis" is a neologism that derives from Greek kirrhos,
meaning "tawny" (the orange-yellow colour of the diseased liver).
 While the clinical entity was known before, it was René Laennec who
gave it the name "cirrhosis" in his 1819 work in which he also
describes the stethoscope.
 Cirrhosis is a consequence of chronic liver disease characterized by
replacement of liver tissue by fibrous scar tissue as well as regenerative
nodules (lumps that occur as a result of a process in which damaged
tissue is regenerated, leading to progressive loss of liver function.

5. DEFINITION
Cirrhosis of liver is a chronic, progressive disease characterized by widespread
fibrosis (scaring) & nodule formation. Cirrhosis occurs when the normal flow
of blood, bile, & hepatic metabolites is altered by fibrosis

6. TYPES
1. Alcoholic cirrhosis- Most common, due to chronic alcoholism. Scar tissue
characteristically surrounds the portal area.
2. Postnecrotic cirrhosis- There are broad bands of scar tissue due to late results
of acute viral hepatitis, postintoxication with industrial chemicals.
3. Biliary cirrhosis- Scaring occurs around bile duct in liver, Results from chronic
biliary obstruction & infection.
4. Cardiac cirrhosis- Associated with severe right sided long term heart failure,
fairly rare.

8. RISK FACTOR
 Drinking too much alcohol. Excessive alcohol consumption is a risk factor for
cirrhosis.
 Being overweight. Being obese increases your risk of conditions that may
lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic
steatohepatitis.
 Having viral hepatitis. Not everyone with chronic hepatitis will develop
cirrhosis, but it's one of the world's leading causes of liver disease

9. CAUSES
1. Alcoholic liver disease (ALD).
Alcoholic cirrhosis develops in 15% of individuals who drink heavily for
more than a decade. There is great variability in the amount of alcohol
needed to cause cirrhosis (as little as 3-4 drinks a day in some men and
2-3 in some women). Alcohol seems to injure the liver by blocking the
normal metabolism of protein, fats, and carbohydrates.
2 . Chronic hepatitis C.
Infection with this virus causes inflammation of and low grade damage
to the liver that over several decades can lead to cirrhosis.

10. 3. Chronic hepatitis B.
The hepatitis B virus is probably the most common cause of cirrhosis worldwide,
especially South-East Asia, but it is less common in the United States and the
Western world. Hepatitis B causes liver inflammation and injury that over several
decades can lead to cirrhosis. Hepatitis D is dependent on the presence of
hepatitis B, but accelerates cirrhosis in co-infection.

11. 4.Non-alcoholic steatohepatitis(NASH)
In NASH, fat builds up in the liver and eventually causes scar tissue. This
type of hepatitis appears to be associated with diabetes, protein
malnutrition, obesity, coronary artery disease, and treatment with
corticosteroid medications. This disorder is similar to that of alcoholic liver
disease but patient does not have an alcohol history
5.Primary biliary cirrhosis
May be asymptomatic or complain of fatigue, pruritus, and non-jaundice
skin hyperpigmentation with hepatomegaly. There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin.

12. 6. Primary sclerosing cholangitis
PSC is a progressive cholestatic disorder presenting with pruritus, steatorrhea,
fat soluble vitamin deficiencies, and metabolic bone disease. There is a strong
association with inflammatory bowel disease (IBD).
7. Autoimmune hepatitis
This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis
8. Hereditary hemochromatosis
Usually presents with family history of cirrhosis, skin
hyperpigmentation, diabetes mellitus, pseudogout, and/or
cardiomyopathy, all due to signs of iron overload

13. 9. Wilson's Autosomal recessive disorder characterized by low serum
ceruloplasmin and increased hepatic copper content on liver biopsy
10. Alpha 1-antitrypsin deficiency (AAT)
Autosomal recessive disorder. Patients may also have COPD, especially
if they have a history of tobacco smoking. Serum AAT levels are low.
11. Cardiac cirrhosis
Due to chronic right sided heart failure which leads to liver
congestion.

14. OTHER CAUSES
 Chronic alcohol abuse
 Chronic viral hepatitis (hepatitis B, C and D)
 Cystic fibrosis
 Poorly formed bile ducts (biliary atresia)
 Alpha-1 antitrypsin deficiency
 Inherited disorders of sugar metabolism (galactosemia or glycogen
storage disease)
 Genetic digestive disorder (Alagille syndrome)
 Liver disease caused by your body's immune system (autoimmune
hepatitis)
 Destruction of the bile ducts (primary biliary cirrhosis)
 Infection, such as syphilis or brucellosis

15. PATHOPHYSILOGY
Primary event is injury to hepatocellular elements
Initiates inflammatory response with cytokine release-
>toxic substances
Destruction of hepatocytes, bile duct cells, vascular endothelial
cells
Repair through cellular proliferation and regeneration
Formation of fibrous scar

16. SYMPTOMS
 Fatigue
 Loss of appetite
 Nausea
 Swelling in your legs, feet or ankles (edema)
 Weight loss
 Itchy skin
 Yellow discoloration in the skin and eyes (jaundice)
 Fluid accumulation in your abdomen (ascites)
 Spiderlike blood vessels on your skin
 Redness in the palms of the hands
 For women, absent or loss of periods not related to menopause
 For men, loss of sex drive, breast enlargement (gynecomastia)
 Confusion, drowsiness and slurred speech (hepatic encephalopathy

17. COMPLICATIONS
Complications of cirrhosis can include:
 High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis
slows the normal flow of blood through the liver, thus increasing pressure in the vein that
brings blood to the liver from the intestines and spleen.
 Swelling in the legs and abdomen. The increased pressure in the portal vein can cause
fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites
also may result from the inability of the liver to make enough of certain blood proteins,
such as albumin.
 Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to
and swelling of the spleen, and trapping of white blood cells and platelets. Decreased
white blood cells and platelets in your blood can be the first sign of cirrhosis.
 Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained
by the extra pressure, these smaller veins can burst, causing serious bleeding Infections. If
you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to
bacterial peritonitis, a serious infection.

18.  Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients,
leading to weakness and weight loss.
 Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis
isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can
then build up in the brain and cause mental confusion and difficulty concentrating. With
time, hepatic encephalopathy can progress to unresponsiveness or coma.
 Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a
blood waste product, from your blood. Jaundice causes yellowing of the skin and whites
of the eyes and darkening of urine.
 Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of
fractures.
 Increased risk of liver cancer. A large proportion of people who develop liver cancer
have pre-existing cirrhosis.
 Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure.
Researchers now believe this is a distinct complication in some people who have
cirrhosis, but they don't fully understand its causes.

19. DIAGNOSTIC EVALUATION
 Laboratory tests. Your doctor may order blood tests to check for signs of liver
malfunction, such as excess bilirubin, as well as for certain enzymes that may
indicate liver damage..
 Based on the blood test results, your doctor may be able to diagnose the
underlying cause of cirrhosis. He or she can also use blood tests to help identify
how serious your cirrhosis is.
 Imaging tests. Magnetic resonance elastography (MRE) may be recommended.
This noninvasive advanced imaging test detects hardening or stiffening of the
liver. Other imaging tests, such as MRI, CT and ultrasound, may also be done.
 Biopsy. A tissue sample (biopsy) is not necessarily needed for diagnosis. However,
your doctor may use it to identify the severity, extent and cause of liver damage.

20. PREVENTION
Reduce the risk of cirrhosis by taking these steps to care for your liver:
 Do not drink alcohol if you have cirrhosis. If you have liver disease, you should
avoid alcohol.
 Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables.
Select whole grains and lean sources of protein. Reduce the amount of fatty and
fried foods you eat.
 Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk
to your doctor about a weight-loss plan if you are obese or overweight.
 Reduce your risk of hepatitis. Sharing needles and having unprotected sex can
increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations

21. MEDICAL MANAGEMENT
 Treatment for alcohol dependency. People with cirrhosis caused by excessive
alcohol use should try to stop drinking. If stopping alcohol use is difficult, your
doctor may recommend a treatment program for alcohol addiction. If you have
cirrhosis, it is critical to stop drinking since any amount of alcohol is toxic to
the liver.
 Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease
may become healthier if they lose weight and control their blood sugar levels.
 Medications to control hepatitis. Medications may limit further damage to
liver cells caused by hepatitis B or C through specific treatment of these
viruses.
 Medications to control other causes and symptoms of cirrhosis. Medications
may slow the progression of certain types of liver cirrhosis. For example, for
people with primary biliary cirrhosis that is diagnosed early, medication may
significantly delay progression to cirrhosis.

22. SURGICAL MANAGEMENT
 PORTAL CAVAL SHUNT
A portacaval shunt (or portal caval shunt) is a treatment for portal hypertension.
A connection is made between the portal vein, which supplies 75% of the liver's
blood, and the inferior vena cava, the vein that drains blood from the lower two-
thirds of the body.
 SPLEENORENAL SHUNT
A splenorenal shunt refers to an abnormal collateral portosystemic
communication between the splenic vein and the left renal vein. It is one of the
features of portal hypertension.

23. PORTAL CAVAL SHUNT

24. SPLEENORENAL SHUNT

25. LIVER TRANSPLANTATION