This document provides an overview of cirrhosis of the liver. It begins by defining cirrhosis as the end stage of chronic liver disease, marked by diffuse involvement and disruption of the liver architecture with formation of nodules separated by fibrous bands. The causes of cirrhosis include alcoholic liver disease, viral hepatitis, genetic disorders. Clinically, cirrhosis presents with symptoms such as jaundice, ascites, peripheral edema and complications include hepatic coma, gastrointestinal bleeding and liver cancer. The progression of alcoholic liver disease from fatty liver to alcoholic hepatitis and finally cirrhosis is described along with the pathological changes at each stage.

1. CIRRHOSIS OF LIVER
By-
Ramya Deepthi P
Vijay Marie College of Nursing

2. INTRODUCTION
• CIRRHOSIS MARKS THE END OF
CHRONIC LIVER DISEASE. IT IS
AMONG THE TOP 10 CAUSES OF
DEATH IN THE WESTERN WORLD.
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3. Definition
Cirrhosis is defined by the following features-
1. Diffuse involvement of entire liver
2. Disruption of the normal architecture of
liver
3. Formation of new nodules which are
separated by irregular bands of fibrosis.
Nodule with less than 3mm is called
Micronodule and if several cms it is called
Macronodular cirrhosis.
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4. ETIOLOGY
• Alcoholic liver disease
• Chronic active cirrhosis
• Primary biliary cirrhosis
• Haemochromatosis
• Wilson’s disease
• Cystic fibrosis
• Alpha1 antitrypsin deficiency
• Galactosemia
• Glycogen storage disease
• Indian childhood cirrhosis
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5. Pathogenesis
Due to etiological factors such as Hepatitis, Fatty liver (Steatosis)
Development of scar tissue that replaces normal parenchyma
This fibrosis blocks the portal circulation f blood through the organ
therefore disturbing normal function.
Activation of hepatic stellate cells which increases fibrosis by producing
myofibroblasts.
Formation of macro and micro nodules sepearetd by fibrous tissue bands
(septa)
Decreased blood flow
Portal hypertension
ascites
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7. Types of cirrhosis
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8. Micronodular type of cirrhosis
• In this type, nodules are less than 3cms in
diameter with diffuse involvement of the
liver
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9. Macronodular Cirrhosis
• In this type, nodules are larger, usually
more than 3mm in diameter upto several
centimeters.
• Involvement is diffuse, but looks more
irregular than Micronodular type
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10. Mixed type of cirrhosis
• In this type, mixture of both 2 types are
seen. Only few portal tracts and central
veins are involved.
• This pattern is a kind of incomplete
expression of micronodular cirrhosis.
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11. CLINICAL
FEATURES
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12. Clinical features
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13. Alcoholic liver disease
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14. Introduction
It is said that a person who drinks upto
80gms of alcohol over a period one day to
many days will produce mild fatty change
which are reversible.
Intake of 80gms or more causes hepatic
injury
Only 10-15% alcoholics develop cirrhosis.
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15. Etiopathogenesis
Every one who consumes alcohol may not
develop liver damage. Why only some one
gets affected is not clear, how ever certain
risk factors are said to be associated-
1. Genetic susceptibility
2. Malnutrition
3. Impaired digestive function
4. inflammation
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16. Pathological changes
There are 3 distinct form of cirrhosis due to
alcohol consumption:
• Alcohol/ Hepatic steatosis
• Alcohol Hepatitis
• Cirrhosis
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17. Alcoholic
Steatosis
(Fatty Liver)
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18. DEFINITION
• Described as intra cellular accumulation of
triglycerides within parenchyma of hepatic
cells.
• Earlier it was called fatty degeneration and
fatty infiltration, which is now not in use.
• The change represents an absolute
increase in the intracellular lipids seen in
liver, heart, skeletal muscle, kidneys etc..
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19. Etiology
• Alcohol abuse
• Starvation
• Protein malnutrition
• Obesity
• Diabetes mellitus
• Hepatotoxins
• Chronic illness ( tuberculosis)
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20. PATHOGENESIS
Diet Adipose tissue
Free fatty acids
Fatty acids accumulation in liver
Triglycerides
Lipoproteins
Plasma lipoproteins
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21. MORPHOLOGY
• Gross: changes are better appreciated in
several cases- liver becomes enlarged,
greasy yellow and may weigh 3-6 kgs.
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22. Morphology contd…
Microscopic changes:
• Cell appears as minute vacuoles in the
cytoplasm around the nucleus
• As the disease progresses vacuoles
become large and push the nucleus to the
periphery of the cells
• Sometimes hepatocytes rupture and the
lipid vacuoles form fatty cysts.
• Rarely lymphocytes, macrophages and
few multinucleated giant cells collect to
form lipogranulomas
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24. Alcoholic
Hepatitis
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25. Alcoholic hepatitis
Gross appearance is same as that of
alcoholic steatosis but it will be added with
fibrosis.
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26. MICROSCOPIC APPEARANCE
a. Ballooning degeneration: scattered
degenerating hepatocytes will show
cytoplasm eosinophilic inclusion bodies
which are due to accumulation of
microorganells like cytoskeleton,
cytokeratin called as Mallory bodies.
b. Inflammation: the areas of necrosis is
along the Mallory bodies. If large areas
are involved entire lobe may show
widespread necrosis.
c. Fibrosis: fibrosis comes into focus, which
is seen around sinusoids, veins and splits
the parenchyma, giving it chicken wire
like blood vessels and appearance.
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27. Balloon degenaration
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28. Alcoholic
Cirrhosis
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29. Alcoholic cirrhosis
This is the final and irreversible form of
disorder which occurs very slowly and is
the most common (60-70%) cause of
cirrhosis of liver.
Synonims: hobnail/ cirrhosis, nutritional
cirrhosis, diffuse cirrhosis, Laennec’s
cirhhosis, portal cirrhosis
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30. Morphology
Gross:
• Begins as a micro nodular type with
nodule less than 3mm in size.
• The liver is firm, enlarged, more than 2kgs
in weight.
• Appears yellow & greasy.
• Later the size shrinks to almost about a kg
due to fibrosis, which appears as macro
nodules
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31. Microscopic changes
Like any other form of cirrhosis, the 3 basic
features are-
• Lobular architecture: disruption of
normal architecture, central veins are hard
to find
• Fibrous bands: the fibrous septae are
initially thin, delicate and later becomes
into bands and as time goes by becomes
dense.
• Hepatic parenchyma: nodules show fatty
changes in hepatocytes, as fibrosis
extends fatty changes decreases.
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32. CLINICAL FEATURES
• Discomfort in right upper quadrant due to
mild hepatomegaly
• Anorexia
• Malaise
• Weight loss
• Loss of appetite
• Jaundice
• Ascites
• Peripheral edema
• Distended
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33. Laboratory investigations
• Enzyme assay- SGOT, SGPT,SGGT
• Serum alkaline phosphatase
• Serum bilirubin
• Serum protein
• Prothrombin time
• Haemogram.
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34. Prognosis
• Patients without jaundice, Ascites or
heatemesis and are abstainers from
alcohol have 90% five year survival.
• Cause of death in alcoholic cirrhosis could
be due to –
 Hepatic coma
 Massive gastrointestinal bleeding
 Infections
 Hepatocellular carcinoma
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35. A healthy live depends on
healthy diet, regular exercise
& healthy life style
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