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.

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
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. Post necrotic 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. 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 hepatitisB.
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.
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.

11. 5. Primary biliarycirrhosis
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.
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

12. 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.

13. 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

14. 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

15. 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 the 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)

16. COMPLICATIONS
 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 the 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.

17.  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.

20. PREVENTION
Reduce the risk of cirrhosis by taking these steps to care
for your liver:
 Do not drink alcohol
 Eat a healthy diet
 Maintain a healthy weight
 Reduce your risk of hepatitis.

21. MEDICAL MANAGEMENT
 Treatment for alcohol dependency. People with cirrhosis caused by
excessive alcohol use should try to stop drinking.
 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.

23. 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.

24. PORTAL CAVAL SHUNT

25. LIVER TRANSPLANTATION