Liver pathology:

CIRRHOSIS
Ivana Mari
Mentor: A. mega
Horvat

Consequence of
chronic liver disease
characterized by
replacement of liver
tissue by fibrosis, scar
tissue and
regenerative nodules
leading to progressive
loss of liver function

Aetiology

Alcohol
Chronic hepatitis B
Chronic hepatitis C
Other:
Haemochromatosis
Non-alcoholic fatty liver disease
Primary biliary cirrhosis
Sclerosing cholangitis
Autoimmune hepatitis
Cystic fibrosis...

Pathology
MICRONODULAR
CIRRHOSIS
Uniform, small
nodules up to 3 mm in
diameter
Often caused by
alcohol damage

Pathology
MACRONODULAR CIRRHOSIS
Large nodules
Often seen following hepatitis B infection

 Cirrhosis

with complicatons of
encephalopathy, ascites or variceal
haemorrhage DECOMPENSATED
CIRRHOSIS

Cirrhosis without any of these

complications COMPENSATED
CIRRHOSIS

Signs and symptoms

Jaundice
Fatigue
Weakness
Loss of appetite
Itching
Easy bruising

Investigations
Liver biochemistry (usually slight elevation

of serum alkaline phosphatase and

aminotransferase)
Liver function - serum albumin and
prothrombin
Serum electrolytes
Serum alpha-fetoprotein
Endoscopy

Investigations
Ultrasound
CT

Management
Irreversible disease, frequently progresses
Correcting the underlying cause

(abstinence from alcohol)

Screening for hepatocellular carcinoma
Liver transplantation
5-year survival rate approximately 50%

Complications
PORTAL HYPERTENSION

Symptoms:
Gastrointestinal bleeding from
oesophageal or (less commonly) gastric
varices
Ascites
Hepatic encephalopathy

VARICEAL HAEMORRHAGE

30% of patients with varices bleed from them

often massive bleeding; 50% mortality
Therapy: endoscopic therapy:
sclerotherapy
variceal band ligation
pharmacological treatment
balloon tamponade
TIPS
surgery

ASCITES

Presence of fluid in
the peritoneal cavity
Therapy: diuretics
paracentesis

PORTOSYSTEMIC ENCEPHALOPATHY
Toxic substances (ammonia) bypass the
liver via collaterals and gain access to the
brain
Symptoms: lethargy
mild confusion
anorexia
reversal of sleep pattern
disorientation
coma

HEPATORENAL SYNDROME
Development of acute renal failure in

patients with advanced liver disease

Splanchnic vasodilatation - fall in systemic
vascular resistance, vasoconstriction of
renal circulation, reduced renal perfusion
Oliguria, rising serum creatinine, low urine
sodium

 http://www.youtube.com

/watch?v=pmBBT4veCRc

References:
www.wikipedia.com
Kumar&Clark: Clinical medicine