Liver cirrhosis

Definition
Hepatocytes necrosis
Increase echogenicity
Causes: CITTTAN
 Biliary obstruction
 Cystic fibrosis,&1-ATD,
 Infection: hepatitis&cholangitis
 Toxins: afla toxin, drugs & others
 Autoimmune chronic active hepatitis
 Metabolic: Wilson disease, hemochromatosis
 Chronic hepatic congestion e.g. cardiac cirrhosis

Normal liver  Fatty liver  Liver fibrosis  Liver cirrhosis

Clinical picture:
A- Compensated:
B- Decompensated:
 Jaundice
 Spider nevi
 Gynecomastia
 Finger clubbing
 Muscle wasting
 Palmar erythema
 Ascites& G.edema
 Bleeding tendency
 Portal hypertension
 Hepato-renal syndrome
 Hepatic encephalopathy
 Hepato-pulmonary syndrome
Investigations:
 CBC
 LFT
  PT
 Albumin
 Gamma globulin
 Search for the cause
 Abd. U/S
 Liver biopsy

Head of P.W. Dr. Noura Noreddeen

Complications:
 Weight loss
 Nutrient loss
 Hormonal disturbances
 Hepatocellular carcinoma
 Portal HTN& its complications
Treatment:
Supportive& specific
A-compensated:
 Low fat diet
 Low salt diet
 Low protein diet
 CHO& vitamin support
 Treat the cause as Wilson
 Eliminate toxins e.g. Quat
B- Decompensated:
 Treatment of complications
 Supportive liver transplantation
 Surgical correction for biliary anomalies
 Immuno-suppresant for autoimmune hepatitis
 Jaundice:
 Ursodeoxycholic acid
 Muscle wasting:
 Nutritional support
 Ascites& G.edema
 Albumin infusion& spironolactone
 Bleeding tendency:
 Vitamin K IV& FFP
 Hepatic encephalopathy:
 Lactulose, neomycin, Mannitol& KCl in IVF
 Hepato-renal syndrome:
 Spironolactone
 Treatment of complications:
Hematemesis from esophageal varices:
 Ligation or sclerotherapy
Prognosis:
 Usually poor
 Death in 1 year in:
 Rising bilirubin
 Refractory ascites
 Refractory bleeding

Head of P.W. Dr. Noura Noreddeen