c irrhosis. a lcoholic l iver i njury : alcoholic liver disease - patterns fatty change, acute...
TRANSCRIPT
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CIRRHOSIS
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ALCOHOLIC LIVER INJURY:
Alcoholic Liver disease - Patterns Fatty change, Acute hepatitis Chronic hepatitis Cirrhosis, Chronic Liver failure
All reversible except cirrhosis stage.
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PATHOPHYSIOLOGY
Irreversible chronic injury of the hepatic parenchyma
Extensive fibrosis - distortion of the hepatic architecture
Formation of regenerative nodules
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ETIOLOGY OF CIRRHOSIS
Alcoholic liver disease Viral hepatitis Biliary disease Primary hemochromatosis Wilson’s, 1AT def
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CLINICAL FEATURES
Spider neavi Palmar erythema Nail changes Gynecomastia Testicular atrophy
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CLINICAL MANIFESTATIONS
Muehrcke's nails
Terry’s nails
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CLINICAL MANIFESTATIONS
Fetor hepaticus Jaundice Parotid gland
enlargement Flapping tremors
Hepatomegaly Splenomegaly Caput medusa
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LABORATORY STUDIES AST/ALT ALP, gamma GT PT/INR S albumin USS scan Liver biopsy
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MORPHOLOGIC CLASSIFICATION
Micronodular cirrhosis Nodules less than 3 mm in diameter Believed to be caused by alcohol
Macronodular cirrhosis
Nodules larger than 3 mmBelieved to be secondary to chronic viral
hepatitis
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MICRONODULAR CIRRHOSIS
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MACRONODULAR CIRRHOSIS
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COMPLICATIONS
Ascites Spontaneous Bacterial Peritonitis Hepatorenal syndrome Variceal hemorrhage Hepatopulmonary syndrome Hepatic Encephalopathy Hepatocellular carcinoma
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ASCITES
Accumulation of fluid within the peritoneal cavity
Due to several factors including portal hypertension, low protein levels, fluid retention etc.
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ASCITIS IN CIRRHOSIS
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ASCITES
Dietary sodium restriction Diuretics aspiration
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HEPATORENAL SYNDROME
acute renal failure coupled with advanced hepatic disease
characterized by:Oliguriaprogressive rise in the plasma creatinine
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VARICEAL HEMORRHAGE
Due to portal hypertension Can be lethal if not treated early
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HEPATIC ENCEPHALOPATHY
neuropsychiatric abnormalities seen in patients with liver dysfunction sleep pattern variation Altered conciousness
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HEPATOCELLULAR CARCINOMA
Patients with cirrhosis have a markedly increased risk of developing hepatocellular carcinoma
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LIVER TRANSPLANTATION
Liver transplantation is the definitive treatment for patients with decompensated cirrhosis
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GYNAECOMASTIA IN CIRRHOSIS
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