Level of competence 2

Fardah Akil
Centre of Gastroentero-Hepatology Department of Internal Medicine
Medical Faculty, Hasanuddin University
Makassar

Lecture of Gastroentero-Hepatology System 2010

Definition :
Fibrosis & nodular
regeneration resulting
from hepatocellular injury

Epidemiology :
Cirrhosis & CLD accounted
for > 25.000 death &
375.000 hospitalization
 Alcohol
Virus Hepatitis : chronic infection of HBV,HCV, HDV
Autoimmune hepatitis (female, IgG, +ANA, +ASMA)
Metabolic disease : NASH/NAFLD
Cogenital :
hemocromatosis, wilsons disease, -1antitrypsin deficiency, cogenital hepatic fibrosis
Biliary tract disease :
PBC/PSC, secondary biliary cirrhosis (calculus, neoplasm,post-op stricture, biliary
atresia)
Vascular disease :
Budd-Chiari syndrome, R-side heart failure, constrictive pericarditis
Cryptogenic :
may reflect terminal progression of NAFLD or some may be non/missed diagnosed AIH
A late stage of progressive
hepatic fibrosis
characterized by
distortion of hepatic
architecture & formation
of regenerative nodules
Form of
chronic
hepatitis Inflammatory
infiltration of
hepatic portal

Necrosis of
hepatocytes
(parenchyme or
portal areas)
 Subclinical or present at
progressive liver dysfunction
(jaundice, coagulopathy,
encephalopathy) and/or
portal hypertension (ascites,
varices)
Liver : enlarged, palpable,
firm, nodular >> shrunken &
nodular
 SIGN OF LIVER FAILURE :
Jaundice, spider angiomata (marker of chronicity), palmar
erytema, duputyrens contracture, white nail lines
(muehrckes line) & proximal nail beds (terrys nail), parotid
& lacrimal glands, gynecomasti, asterixis, enchephalopathy,
fetor hepaticus
SIGN OF PORTAL HIPERTENSION
Splenomegaly, ascites, dilated superficial abdominal vein
(caput medusae), epigastric cruveilhier-Baumgarten
venous hum
 bilirubin, PT, albumin,
aminotransferases, alkaline
phosphatase
Na
Anemia (bone
marrowsupression,
hypersplenism, iron and/or
folate deficiencies),
neutropenia (hypersplenism),
thrombocytopenia
(hypersplenism,
thrombopoietin production)
 Liver biopsy (percutaneus/transjugular)
Abdominal U/S doppler
Hepatic serologies (HBsAg, AntiHCV)
Autoimmune hepatitis study (IgG, ANA, ASMA)
Fe and Cu studies
1-AT phenotype
AMA (PBC), p-ANCA (PSC)
Echocardiogram (right sided heart failure)
AFP
 Portal hypertension Hepatopulmonary
: ascites, varices, syndrome
hepatohydrotorax Liver failure
Coagulopathy Infection
Hepatic Hepatocellular
encephalopathy carcinoma
Hepatorenal
syndrome
 Correlates with Child-Pugh class
1 2 3
ascites none Easy control poor
encephalopathy none Grade I/II Grade III/IV

Bilirubin <2 2-3 >3

Albumin > 3.5 2.8-3.5 <2.8
PT <4 4-6 >6

A B C
Total point 5-6 7-9 10-15
1-y survival 100% 81% 45%
2-y survival 85% 57% 35%