CIRRHOSIS

End stage chronic liver ds

Diffuse process characterized by FIBROSIS ND ABNORMALLY
REGENERATING NODULES
3 MAIN MORPHOLOGICAL FEATURES: 1. Fibrosis
2) regenerating nodules
3) loss of architecture of entire liver
MORPHOLOGICAL CLASSIFICATION OF CIRRHOSIS
MICRONODULAR MACRONODULAR MIXED
Regular small Irregular large Both features
<3mm >3mm
Involve every Liver surface
lobule of whole grossly distorted
liver
m/C Cause m/c cause VIRAL
ALCOHOLIC CIRRHOSIS HEPATITIS
INC risk of CA liver

PATHOGENESIS
CHRONIC INJURY TO LIVER
↓
 INFLAMMATION &NECROSIS OF LIVER CELLS
↓
EVENTUALLY FIBROSIS
FIBROSIS occurs d/t activation of stellate cells of space of disse
by cytokines,reactive O2 intermediates
TGF-β is potent fibogenic mediator

ALCOHOLIC CIRRHOSIS
Safe limits in males : 200g/week
In females : 140g/week
SIGNS: a)- Ascites
b) circulatory changes: Spider naevi (d/t arteriolar changes by
hyperestrogenism)
: palmar erythema
c) endocrine changes: males – Gynacomastia,testicular atrophy
females: irregular menses,atrophy of breast
d) h’agic tedenices: d\t dec production of coagulation factors –
bruises, purpura, epistaxis
e) portal htn: varices bleeding,splenomegaly
f) flapping tremors nd fetor hepaticus
g) others: pigmentation
: cyanosis nd white nails{terry nails}
DUPUYTREN’S CONTRACTURE (Sign of alcholoism): fibrosis of
palmar aponeurosis d/t microvessel ischemia
: m\c involved- flexion of fingers(ring nd little finger)
D/d: DM; RA; Manual labour
Q) WHY HYPERESTROGENISM: occurs d/t ↓ clearance of
precursor ANDROSTENEDIONE by liver

Nail changes: terry nails

: MUEHRCKE’S NAIL- tranverse white lines that
disappear on pressure nd don’t move wth growth of nails

COMPLICATIONS: 3MAJOR – PORTAL HTN

HEPATIC ENCEPHLOPATHY
RENAL FAILURE
CHILD PUGH SCORE/CHILD TURCOTTE PUGH SCORE
Used to grade severity of ds nd prognosticate pt wth
established cirrhosis
Other mthd is MODEL FOR END STAGE LIVER DS which bilirubin;
creatinine nd INR for prothrombin time
INV: hepatic elastography is non invasive test for detecting
hepatic fibrosis