This document summarizes hepatic cirrhosis. It discusses the causes of cirrhosis such as alcoholism, hepatitis B and C, and non-alcoholic steatohepatitis. Signs and symptoms are described for compensated and decompensated cirrhosis. Complications include ascites, esophageal varices, and hepatic encephalopathy. Diagnosis involves physical exam, imaging like ultrasound and CT scan, and liver biopsy. Treatment focuses on addressing the underlying cause, pre-transplant care, liver transplantation for end-stage disease, and managing complications. Cirrhosis represents the end stage of chronic liver disease and has a variety of causes that can ultimately lead to liver failure if

1. Islamic Republic of Afghanistan
Ministry of Higher Education
Ghalib university of Higher Education
Medical faculty
Supervised by: Dr. Salahi
Presenters: Mohammad Azizi

2. Hepatic cirrhosis

3. Titles
Introduction Causes
Sign &
symptoms
Complications Diagnosis
Stages
Conclusion and
referencesTreatment

4. Introduction
inportance definition nodule
one of 10
deadly agents
in the world
fibrosis
Cirrhosis
Regenarative
nodules
Micro==3mm
Macro== 1cm

5. Normal liver and liver fibrosis

6. Causes
Alcoholism 20%
Non-alcoholic steatohepatitis
Chronic hepatitis C 30%
Chronic hepatitis B 27%
More common
Causes
More rare
Primary sclerosing cholangitis
Autoimmune hepatitis
Hereditary hemochromatosis
Wilson's disease
Alpha 1-antitrypsin deficiency
Cardiac cirrhosis Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins

7. • Alcohole dehydrogenase alcohol oxidation NAD NADH
• Endotoxin release TNF & cytokines active ito cells
Alcoholism
10-20% people who
has alcoholic cirrhosis
,it can also lead to
hepatocellular
carcinoma
People who has viral
hepatitis specially hepatitis
c and also drinking alcohol
can increase liver diseases
Note Note

8. associated with :
obesity
diabetes
protein malnutrition
coronary artery disease
steroid medications
Non-alcoholic steatohepatitis
This disorder is similar in its
signs to alcoholic liver
disease, but the patient does
not have an alcohol history.
Note

9. Hepatitis
c
B
Infection with the hepatitis C virus causes inflammation of the
liver and a variable grade of damage to the organ. Over several
decades, this inflammation and damage can lead to cirrhosis.
The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis. Hepatitis D is dependent on the
presence of hepatitis B and accelerates cirrhosis in co-infection

10. Primary biliary
cholangitis
in this prominent alkaline phosphatase elevation as
well as elevations in cholesterol and bilirubin and
usually positive anti-mitochondrial antibodies.
also known as primary biliary cirrhosisNote
Primary sclerosing
cholangitis( PSC)
is a progressive cholestatic disorder presenting with
pruritus, steatorrhea, fat-soluble vitamin deficiencies,
and metabolic bone disease.

11. Autoimmune
hepatitis
This disease is caused by an attack of the liver by
lymphocytes, causing inflammation and eventually
scarring and cirrhosis.
Hereditary
hemochromatosis
Usually presents with a family history of cirrhosis, skin
hyperpigmentation, diabetes mellitus, pseudogout, or
cardiomyopathy, all due to signs of iron overload
Alpha 1-antitrypsin
deficiency
Autosomal recessive disorder of decreased levels of
the enzyme alpha 1—antitrypsin.
Cardiac cirrhosis. Due to chronic right sided heart
failure, which leads to liver congestion.

12. Stages

13. 1- Liver dysfunction
1-Spider angiomas
2- Palmar erythema
3-Nail changes
Muehrcke's nails
Terry’s nails
clubbing finger
4-genicomatia
5-hypogonadism
6- jaundice……
2- Portal hypertension(HVPG)
Sign and symptoms:
Decompensated cirrhosis
(complications)
Compensated cirrhosis
(early symptoms )

14. Ascites & SBP Esophageal varices
Portal
hypertension

15. Hepatopulmonary syndrome:

16. Hepatic encephalopathy:

18. Hepatorenal syndrome:

19. Diagnosis
Physical
examination
Imaging
Liver biopsy
Lab findings
ultrasound
CT scan
MRI
ALT&AST
ALP
Albumin level

20. Ultrasound MRI CT-scan

21. Treatment
Etiological
Pre-
transplant
ation care
transplantation
Prophylactic

22. Conclusion :
• Cirrhosis is the End stage of any liver chronic disease
• Alcoholic fatty liver disease and NAFLD like viral hepatitis can lead to liver
cirrhosis
• In Compensated cirrhosis some nonspecific symptoms like RUQ pain,
vomiting, fatigue and so on .
• In Decompensated cirrhosis the complications of cirrhosis begin like HE ,
HRS, HPS….
• liver biopsy is the main method for diagnosis of liver cirrhosis and some
another methods like serologic test, imaging , and so on can use for
conformation
• Liver transplantation is only way for patient who has the end stage of liver
cirrhosis and there are variety methods for treating of its complications.

23. References :
• Harrisons principle of internal medicine 19th edition
• Current medical diagnosis and treatment 2018-57th edition
• Robbins pathology
• Cecil internal medicine
• www.googleimage.com

24. Thank you for your kind attention