explain the cirrhosis

1. Fgh‫يلبيل‬
ODAI RJOUB (STUDENT) - HEBRON UNIVERSITY-
BIOLOGY DEPARTMENT-

2. Cirrhosis: is a serious chronic disease , is
widespread disruption of normal liver structure by fibrosis
and the formation of regenerative nodules that is caused by
any of various chronic progressive conditions affecting the
liver (such as long-term alcohol abuse or hepatitis).
Cirrhosis is derived from Greek word
kirros=orange or tawny and osis=condition

3. -WHO definition
:a diffuse process characterized by liver necrosis
and fibrosis and conversion of normal liver
architecture into structurally abnormal nodules
that lack normal lobular organization.

5. Causes:
A wide range of diseases and conditions
can damage the liver and lead to cirrhosis.
The most common causes are:
 Alcohol abuse
 Hepatitis( A,B,C)
 Use of drugs
 Hepatic congestion from severe right sided heart failure
 Constrictive pericarditis
 Valvar diseases
 Wilsons diseases
 Infiltrative diseases( amyloidosis, glycogen storage
 diseases,haemochromatosis)

8. Pathology of cirrhosis:
nodularity(regenerating nodules).
fibrosis(deposition of dense fibrous septa)- fragmentation of
sample.
abnormal liver architecture
hepatocyte
Abnormalities : pleomorphism ,dysplasia , hyperplasia
Gross pathology : irregular surface ,yellowish
Color , small ,firm
Nodules
surrounde
d
by fibrous
tissue
Normal Cirrhosis

9. Four types of cirrhosis:
1. Alcoholic (Laennec’s) Cirrhosis
– Associated with alcohol abuse
– Preceded by a theoretically reversible fatty infiltration
of the liver cells
–Widespread scar formation
2. Postnecrotic Cirrhosis
– Complication of toxic or viral hepatitis
– Accounts for 20% of the cases of cirrhosis
– Broad bands of scar tissue form within the liver

10. 3.Biliary Cirrhosis
– Associated with chronic biliary obstruction and
infection
– Accounts for 15% of all cases of cirrhosis
4. Cardiac Cirrhosis
– Results from longstanding severe right-sided heart
failure

11. CLINICAL FEATURES (symptoms):
• Hepatomegaly (although liver may also be small)
 Jaundice
• Ascites
• Circulatory changes
– Spider telangiectasia, palmar erythema, cyanosis
• Endocrine changes
– Loss of libido, hair loss
– Men: gynecomastia, testicular atrophy, impotence
– Women: breast atrophy, irregular menses, amenorrhea

12. • Hemorrhagic tendency
Bruises, purpura, epistaxis, menorrhagia
• Portal hypertension
Splenomegaly, collateral vessels, variceal bleeding, fetor hepaticas
• Hepatic (portosystemic) encephalopathy
• Other features
Pigmentation, digital clubbing

13. Complications:
 Portal hypertension
 Ascites
 Hepatic encephalopathy
 Spontaneous bacterial peritonitis
 Renal failure
 Infection
 Hepatocellular carcinoma

14. Diagnosis of cirrhosis:
1. clinical
2. laboratory
3. radiologic
4. liver biopsy
5. Endoscopy

15. 1.clinical:
Any patient with chronic liver disease
Chronic abnormal aminotransferases and/or alkaline
phosphatase
 Physical exam findings:
Stigmata of chronic liver disease (muscle
wasting, vascular spiders, palmar erythema)
Palpable left lobe of the liver
Small liver span
Splenomegaly
Signs of decompensation
(jaundice,ascites,asterixis)

16. 2.laboratory:
· Liver insufficiency
· Low albumin (< 3.8 g/dL)
· Prolonged prothrombin time (INR > 1.3)
· High bilirubin (> 1.5 mg/dL)
· Portal hypertension
· Low platelet count (< 175 x1000/ml)
· AST / ALT ratio > 1

17. 3.Radiologic:
ultrasound, CT, or MRI scans.
Observed:
· Small nodular liver
· Intra-abdominal collaterals
· Ascites
· Splenomegaly
· Colloid shift to spleen and/or bone marrow
Yes No
Yes No
Liver

18. 4.liver biopsy:
a small sample of liver cells are extracted and examined under a
microscope. The biopsy can confirm cirrhosis and its cause.
5. Endoscopy:
a long, thin tube with a light and video camera at the end goes
down the patient's food pipe (esophagus) and into their stomach.
The doctor looks out for swollen blood vessels (varices), a
hallmark sign of cirrhosis.

19. Treatment of liver cirrhosis:
Treatment for cirrhosis varies based on what caused it and how far the
disorder has progressed. Some treatments your doctor might prescribe
include:
 beta blockers or nitrates (for portal hypertension)
 quitting drinking (if the cirrhosis is caused by alcohol)
 banding procedures (used to control bleeding from esophageal
varices)
 intravenous antibiotics (to treat peritonitis that can occur with
ascites)
 hemodialysis (to purify the blood of those in kidney failure)
 lactulose and a low protein diet (to treat encephalopathy)
 Liver transplantation is an option of last resort, when other
treatments fail.
 All patients must stop drinking alcohol. Medications, even over-the-
counter ones, should not be taken without consulting your doctor.

20. General management:
 Good nutrition
 Avoid protein excess
 Low salt diet
 Alcohol abstinence
 Avoid NSAID and sedatives & opiates
 Cholestyramine for pruritus

21. Specific treatment :(liver transplantation)
Indications for liver transplantation
 cholesteric forms of cirrhosis
 PBC
 Alcoholic cirrhosis
 cirrhosis due to hepatitis C
 Alpha1Antitrypsin deficiency
 Haemochromatosis

22. Signs of liver in suffiency pointing to
the need for liver transplant:
Sustained or increased jaundice
TB >100 Umol/l
 Ascites
Hepatic encephalopathy not responding to medical
therapy
 hypoalbuminemia <30g/l
 Fatigue and lethargy affecting the quality of life
 Intractable itching
 Recurrent variceal bleeding

23. Statistics:
• > 50% of liver disease in the US is directly
related to alcohol consumption
• Of the estimated 15 million alcoholics in the
USA 10-20% have or will develop cirrhosis
• Growing number of cases related to chronic
hepatitis C
• 4th leading cause of death in people between
35 and 54 years of age
 Direct correlation between alcohol consumption in any
geographic area and the death rate from cirrhosis in that
area