CIRRHOSIS
Pathophysiology
&
Complications
What is Cirrhosis?
Cirrhosis
Definition:
Hepatic necrosis and degeneration combined with
hepatic regeneration and fibrosis leading to
Nodular formation
Normal liver functions
Carbohydrate Metabolism
Hypo- or hyperglycemia
Fatty Acids Metabolism
Lipid Transport
Hyper- or hypolipidemia
Proteins Metabolism
Serum Albumin
Vitamin K–Dependent Blood Coagulation Proteins
Bilirubin Metabolism
Bile Production
Fat-Soluble Vitamins
Detoxification
Drugs and hormones
Providing continual source of energy for entire body
Regulation of storage and modulate availability of systemic nutrients
Subject to hormonal modulation by endocrine organs
(Pancreas, adrenal gland, and thyroid, neuronal regulation)
1. Atrterial
System
3. Venous
System
2. Capillary
System
5. Venous
System
4. Second
Visceral
Capillary
System
3. Venous
System
2. First
Visceral
Capillary
System
3. Visceral
Venous
System
2. Capillary
System
1. Atrterial
System
Normal Liver Histology
CV
2-3 mmHg
6 mmHg
PV
None = 0
Portal Fibrosis = 1
Bridging Fibrosis = 3
Cirrhosis = 4
What is patophysiology
of Cirrhosis?
Cirrhosis
Causes
(Etiology of chronic necrosis)
+
Host
(Liver reaction)
Lead to
Cirrhosis & complications
What is clinical
manifestation of
Cirrhosis?
Cirrhosis
Clinical manifestations:
- No symptoms (routine examination) 40%
- Impaired hepatocellular function (Liver failure)
- Portal hypertension
- Clinical manifestation of underlying disease
Qu i c k T i m e ™ a n d a
T I F F (Un c o m p re s s e d ) d e c o m p re s s o r
a re n e e d e d t o s e e t h i s p i c tu re .
What is natural history
of Cirrhosis?
How do you make
diagnosis of cirrhosis?
Cirrhosis
Clinical work up:
1. Nature
(Causes, Diseases)
2. Severity (Fibrosis, Complications)
Cirrhosis
Diagnostic approach:
1. Liver function tests (PT, Pr., Alb, Bili, PLT)
2. Liver damage tests (AST>ALT, Alk.Ph)
3. Liver ultrasound (nodularity, decrease in size, portal vein
enlargment, prominent left lobe)
4. Etiological diagnostic tests
5. Liver biopsy
6. Surveillance tests (AFP, sonography, endoscopy, pracentesis,
creatinine)
What is general clinical
management of cirrhosis?
Cirrhosis
Clinical management:
1. Etiological treatment
2. Prophylactic treatment
3. Pre-transplantation care
4. Liver transplantation