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 KDependent 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
3. Venous System
System

2. Capillary
System
 5. Venous
System

4. Second
Visceral
Capillary
System 2. First 1. Atrterial
3. Venous Visceral
System
Capillary
System 3. Visceral System
Venous
System

2. Capillary
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
 QuickTime and a
TIFF (U ncompressed) decompressor
are needed to see this picture.
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