A brief presentation on Liver cirrhosis by Mahmood Khaleel Pirani master student in Soran University. 24 April 2018

1. MAHMOOD KHALEEL MAHMOOD
P O S T G R A D U A T E S T U D E N T – S O R A N U N I V E R S I T Y
B I O L O G Y D E P T . - B I O C H E M I S T R Y
2 4 A P R I L 2 0 1 8 T U E S D A Y
Liver Cirrhosis

2. Liver
 The liver is a large, meaty organ that sits on the right
side of the belly. Weighing about 1.35 Kilograms, the
liver is reddish-brown in color and feels rubbery to
the touch. Normally you can't feel the liver, because
it's protected by the rib cage.

3. Liver Functions
Metabolism – Carbohydrate, Fat & Protein
Secretory – Bile, Bile acids, Salts & Pigments
Excretory – Bilirubin, Drugs, Toxins
Synthesis – Albumin, Coagulation factors
Storage – Vitamins, Carbohydrates etc.
Detoxification – Toxins, Ammonia, etc.

4. Liver Cirrhosis
 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.
 A chronic progressive disease of the liver
characterized by diffused damage to cell with fibrosis
and nodular regeneration.

7. Classification
Two major forms of cirrhosis are recognized based on the size of
the regenerative nodules formed, with a cut off point at 3 mm.
1. Micronodular form shows uniform small nodules generally
less than 3 mm. It is associated with:
 Alcoholic Hepatitis
 Haemachromatosis
 Drugs
 Chronic biliary disease
2. Macronodular cirrhosis, the nodules are generally larger than
3 mm.
 This is the form predominantly found in chronic viral hepatitis
 Autoimmune
 It is also found with all other causes of micronodular cirrhosis if the illness is of
sufficiently long duration.
3. Mixed nodularity with variably sized nodules

8. Macronodular Cirrhosis

9. Micronodular Cirrhosis

10. Types of Cirrhosis
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.

11. Etiology
 Cell necrosis occurs
 Destroyed liver cells are replaced by scar tissue
 Normal architecture becomes nodular

12. Physiology of Cirrhosis
 When a hepatocyte injured they secret paracrine factor
and activate the stellate cells and these cells loose
vitamin A and proliferate, and secret TGF-B (transform
growth factor-beta) and this cause produce collagen. It
will be the main ingredient in extracellular matrix,
fibrosis and scar tissue. And this formation of collagen
compress the sinusoid and central vein
 Stellate cells = store vitamin A and quiescent

13. Illustration of fibrosis

14. What are the main causes of cirrhosis?
The condition of cirrhosis may be caused by a wide
range of diseases and disorders. Signs of cirrhosis
progress gradually, developing over time, ultimately
resulting in liver failure if not adequately treated.

15. The most common causes of cirrhosis include
 Long-term hepatitis infections (chronic)
 Chronic alcoholism
 Non-alcoholic fatty liver (or steatohepatitis)
 Primary biliary cholangitis (formerly known as primary
biliary cirrhosis)
 Toxic substances and infections
 Inherited (genetic) disorders
 Cardiac cirrhosis

16. Other causes of cirrhosis include
 Liver disease
 Primary sclerosing cholangitis (hardening and
scarring of the bile ducts)
 Schistosomiasis (infection caused by freshwater
parasitic worms, also known as bilharzia)
 Cryptogenic cirrhosis (due to an unidentified cause
and normally requiring a liver transplant)

17. Signs and Symptoms
 Some of the following signs and symptoms may
occur in the presence of cirrhosis or as a result of the
complications of cirrhosis.
 Many are nonspecific and may occur in other
diseases and do not necessarily point to cirrhosis.
 Likewise, the absence of any does not rule out the
possibility of cirrhosis.

18. Common Symptoms
 Fatigue • Bleeding easily
 Bruising easily • Itchy skin
 Yellow discoloration in the skin and eyes (jaundice)
 Fluid accumulation in your abdomen (ascites)
 Loss of appetite • Nausea
 Swelling in your legs • Weight loss
 Confusion, drowsiness
 Spiderlike blood vessels on your skin
 Redness in the palms of the hands
 Testicular atrophy in men
 Breast enlargement in men

19. The general diagnostic procedures
1. Detailed medical history (Symptoms)
2. Physical examination
3. Laboratory tests
Liver function (blood tests):
Kidney function (blood tests):
Other blood tests:
Imaging tests:
 MRE (magnetic resonance elastography)
 MRI (magnetic resonance imaging)
 CT scan (computerised tomography)
 Or … Ultrasound
Liver biopsy:
Laparoscope:

20. Treatment
Traditionally, liver damage from cirrhosis cannot be
reversed, but treatment could stop or delay further
progression and reduce complications. A healthy diet
is encouraged, as cirrhosis may be an energy-
consuming process. Antibiotics will be prescribed for
infections, and various medications can help with
itching.

21. Continue
No treatment will cure cirrhosis or repair scarring in
the liver that has already occurred. But treatment can
sometimes prevent or delay further liver damage.
Treatment involves lifestyle changes, medicines, and
regular doctor visits. In some cases, you may need
surgery for treatment of complications from cirrhosis.
Lifestyle changes
Your doctor will recommend some lifestyle changes to
help prevent further liver damage.

22. Thank you for attention!
Contact information!
mahmoud_pirani@yahoo.com
+964 (0) 7504128959
Any questions?