Cirrhosis is scarring of the liver caused by long-term liver damage and injury. It is characterized by the replacement of liver tissue with fibrous scar tissue and regenerative nodules, leading to loss of liver function. Common causes include alcoholism, hepatitis B/C infection, and non-alcoholic fatty liver disease. Symptoms may include abdominal pain, jaundice, easy bruising, fluid retention, and hepatic encephalopathy. Treatment focuses on managing complications, treating the underlying cause if possible, and liver transplantation for end-stage disease. Homeopathic remedies like Nux Vomica, Phosphorus, and Bryonia can help manage symptoms in some cases.

1. LIVER CIRRHOSIS
SUBMITED BY:-
SUBMITTED TO:- Dr. Suruchi

2. CIRRHOSIS
• It represent the Irreversible end-stage of several diffuse diseases
causing hepatocellular injury.
It is Characterized by:-
• It involves the entire liver.
• Normal lobular architecture of hepatic parenchyma is disorganized.
• Formation of nodules separated from one another by irregular bands of
fibrosis.
• It occurs following hepatocellular necrosis of varying etiology so that there
are alternate areas of necrosis and regenerative nodules.

6. PATHOPHYSIOLOGY OF LIVER
CIRRHOSIS
• Continued destruction of hepatocytes.
• Collapse of normal lobular hepatic parenchyma.
• Proliferation of fat storing Ito cells which are transformed into myofibroblasts and
fibrocytes.
• Increased synthesis of type I and III collagen in the space of Disse.
• Fibrosis in the liver lobules portal-central, portal, or both.

7. CLASSIFICATION OF LIVER CIRRHOSIS
MOR PH OLOGIC
1. Micronodular (nodules less
than 3mm).
2. Macronodular (nodules
more than 3mm).
3. Mixed.
ETIOLOGIC
1. Alcoholic cirrhosis (the most common, 60-
70%).
2. Post-necrotic cirrhosis (10%).
3. Biliary cirrhosis (5-10%).
4. Pigment cirrhosis in haemochromatosis (5%).
5. Cirrhosis in alpha-1-antirypsin deficiency.
6. Cirrhosis in Wilson's diseases.
7. Cardiac cirrhosis.
8. Indian childhood cirrhosis (ICC).
9. Cirrhosis in autoimmune hepatitis.
10.Cirrhosis in non-alcoholic forms of cirrhosis
(metabolic, infectious, GI, infiltrative) diseases.
11.Cryptogenic cirrhosis.

8. ALCOHOLIC LIVER DISEASE AND
CIRRHOSIS
• Alcoholic liver disease is the term
used to described the spectrum of
liver injury associated with acute
and chronic alcoholism.
• Acetaldehyde is toxic and
may cause membrane damage
and cell necrosis.

9. 3-STAGE OF LIVER CIRRHOSIS
1. Alcoholic steatosis (fatty liver).
2. Alcoholic hepatitis
(steatohepatitis).
3. Alcoholic cirrhosis
(steatofibrosis).

10. ALCOHOLIC
STEATOSIS (FATTY
LIVER)
1. Initial micro vesicular
droplets of fat in the
hepatocyte cytoplasm.
2. Followed by macro
vesicular large droplets
of fat displacing the
nucleus to the periphery.
3. Fat cysts may develop
due to the coalescence
and rupture of fat-
containing hepatocytes.

11. ALCOHOLIC HEPATITIS
• Alcoholic hepatitis acutely, usually
following a bout of heavy drinking.
• Ballooning degeneration and necrosis.
• Inflammatory response: Polymorphs
and scattered.

12. ALCOHOLIC CIRRHOSIS
• Alcohol cirrhosis is the most common
form of lesion, constituting 60-70% of
all cases of cirrhosis.
• Normal lobular architecture is effect
is replaced with nodule formation.
• Fibrous septa.
• Inflammation and bile
duct proliferation.

13. WILSON'S DISEASE
• Copper accumulates in the liver, kidneys, brain, and eyes Autosomal recessive disease of copper metabolism. Young
patients: Symptoms of liver disease, Older patients: neuropsychic symptoms.
KAISER-FLEISCHER RING
• Deposition of copper in cornea.
• HEPATIC:
1. Most common organ.
2. Fatty change.
3. Acute and chronic hepatitis.
4. Cirrhosis.
• CNS:
1. Basal ganglia is involved primarily. There is dystonia, dysarthria, tremor and chorea.
• OCULAR INVOLVEMENT:
1. Kayser-Fleischer ring (brown/green deposit in Descemet's membrane of cornea)

15. • Wilson disease.
• Mutation in ATP7B gene present on chromosome 13.
• So copper accumulation in liver (primarily) and there is decrease
in circulating ceruloplasmin.
• The accumulated copper causes toxic liver injury.
• Spillage of non-ceruloplasmin-bond copper from the liver into the circulation.
• Deposited in extrahepatic tissue such as the brain, eyes.

16. DIAGNOSIS
1. Liver biopsy with quantitative copper assay
• The gold standard for diagnosis is liver biopsy with quantitative copper assay
connected of copper in a liver biopsy sample> 200m/g dry weight.
• Serum ceruloplasmin level low.
• Urine copper execration increased
• KF rings.
• DNA Haplotype analysis.

17. CLINICAL MANIFESTATIONS OF LIVER
CIRRHOSIS
• Pedal oedema and anasarca
(decrease albumin
decrease oncotic pressure
increase interstitial fluid
oedema)
• Jaundice
• Increase infections
• Indigestion
• Anorexia/Nausea/Vomiting
• Some patient are asymptomatic and diagnosis is made incidentally at
ultrasound or at surgery.

19. • Steatorrhea (Indigested fat present in stool).
• Bleeding tendencies (Due to deficiency of vitamin
K synthesis of clothing factors in liver).
• Detoxification Impairment.
• Hepatic encephalopathy (Due to increase
ammonia crossed BBB and develops CNS
symptoms).
• Thrombocytopenia.
• Anemia.
• Hepatosplenomegaly.
• Parotid enlargement.
• Circulatory changes.
Spider telangiectasia, palmar erythema, cyanosis.
• Endocrine changes.
Loss of libido, hair loss
Men: Gynecomastia, testicular atrophy, impotence.
Women: breast atrophy, irregular menses,
amenorrhea.
• Hemorrhagic tendency.
Bruises, purpura, epistaxis
• Portal hypertension.
Splenomegaly, collateral vessel, variceal bleeding

23. DIAGNOSIS
• Liver function test: increase alkaline phosphate, ALT,AST.
• Blood test: decrease total protein, decrease albumin, increase serum bilirubin and globulin,
increase ammonia.
• Prothrombin time is prolonged (normal:10-14sec).
• Liver cell biopsy to identify liver cell changes.
• Ascites fluid test.
• Liver ultrasound.
• CT Scan: enlarged or atrophied, characteristics.
• Stool for occult blood.
• ERCP.

24. INVESTIGATIONS FOR THE ETIOLOGY
• Viral markers
• Serum autoantibodies.
• Iron indices and ferritin.
• Copper, ceruloplasmin.
• Alpha1 antitrypsin.
(Serum copper and alpha 1 antitrypsin should always be measured in
young cirrhotic)

25. MANAGEMENT OF LIVER CIRRHOSIS
CONSERVATIVE MANAGEMENT
• Treat underlying cause: if cirrhosis is form heavy alcohol use, the treatment
is to completely stop drinking alcohol.
• If cirrhosis is caused by hepatitis C, then treatment of hepatitis C.
• Avoidance of hepatotoxic substances.
• Dietary modification: table salt, salted butter, margarine, ordinary can froze
foods should be avoided.
• The diet should be be adequate calories and protein (75-100gm/day) unless
hepatic encephalopathy is present, in which case protein is limited.
• Restrict fluid.

26. • Lactulose: to reduce serum ammonia level.
• Low-protein diet: 1.0 and 1.5 g/kg or up to 0.5 g/kg.
• Intravenous administration of glucose to minimize protein breakdown.
• Administration of vitamins to correct deficiencies.
• Correction of electrolyte imbalances (potassium with proctor).
• Neurologic status is assessed frequently.

27. SURGICAL MANAGEMENT
• Liver transplantation.
• Removing the liver and replacing it with
a healthy donor organ is another way to
treat liver cancer or liver cirrhosis.
• About 80-90% of people who undergo
liver transplantation, survive.
• Esophageal varices.

28. HOMEOPATHIC MANAGEMENT OF LIVER
CIRRHOSIS
NUX VOMICA
• In liver affections occurring in those who have indulged to excess in alcoholic liquors, highly
seasoned food, quinine or in those who have abused themselves with purgatives, Nux is the first
remedy to be thought of.
• Bruised soreness of abdominal walls.
• Liver engorged, with stitches and soreness.
• Colic, with upward pressure, causing short breath and desire for stool.
• Constipation, with frequent ineffectual urging incomplete and unsatisfactory; feeling as if part
remained unexpelled.
• Alternate constipation and diarrhea-after abuse of purgatives.

29. PHOSPHORUS
• Phosphorus is the remedy for fatty degeneration of the liver, with well-
marked Soreness and jaundice.
• The stools are grayish white.
• Jaundice accompanying pneumonia may also call for phosphorus.
• Suddenness of symptoms, sudden prostration, faints, sweats, shooting
pains, etc.
• Fatty degenerations, cirrhosis, caries, are pathological states often calling for
phosphorus

30. BRYONIA
• When there are stitching pains in the right hypochondriac region, Bryonia is the first remedy to be
thought of.
• Under Bryonia is the liver is swollen, congested and inflamed.
• The pains in the hypochondriac region are worse from any lying on the right side, which lessens
the motion of the parts when breathing.
• Nausea and faintness when rising up.
• Abnormal hunger loss of taste.
• Thirst for large quantity.
• Vomiting of bile and water immediately after eating, as of a stone.
• There is a bitter in the mouth and the stools hard, dry, as if burnt; seem too large. Stools brown,
thick and bloody.
• Bryonia pre-eminently a gastro-hepatic remedy, and has pain in right shoulder, giddiness, skin and
eyes slightly yellow.

31. ARSENIC ALBUM
• For liver cirrhosis with fatigue and weight loss. Natural medicine Arsenic Album is
of great help for patients of liver cirrhosis who experienced fatigue as the main
symptom. The patients feels totally exhausted from doing a little labor. He or she
goes on losing weight due to debilitating effects of cirrhosis of liver. Arsenic
Album is also the remedy for patients who experienced nausea and vomiting of
blood.
Along with vomiting, burning in abdomen is a characteristic feature pointing
towards the use of Arsenic album. Vomiting follows drinking and eating. The liver
region feels painful. Ascites, or accumulation of fluid in abdomen, can also be
dealt with by remedy Arsenic Album, though the general symptoms of fatigue and
burning in abdomen should match too. A general relief from taking warm drinks may
be narrated by patients in addition to the above symptoms. If the mental picture is to
be considered, the symptoms that assume top position are anxiety, restlessness

32. THANK YOU
MADE BY DIVYA
DORA
STAY HEALTHY