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    Cirrhosis 1

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    abhishekhalake191

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    Cirrhosis 1

    Uploaded by

    abhishekhalake191
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    0 views26 pages

    Cirrhosis 1

    Uploaded by

    abhishekhalake191

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    CIRRHOSIS OF LIVER

    CIRRHOSIS :

    • ELEVENTH LEADING CAUSE OF DEATH WORLDWIDE.


    • IT REPRESENTS THE IRREVERSIBLE END STAGE OF SEVERAL DIFFUSE
    DISEASES CAUSING HEPATOCELLULAR INJURY.
    IT IS A COMBINATION OF
    1. THE NORMAL LOBULAR ARCHITECTURE OF HEPATIC PARENCHYMA
    IS DISORGANISED.
    2. FORMATION OF NODULES.
    3. BRIDGING FIBRA SEPTA.
    DUE TO CIRRHOSIS OF LIVER,LIVER WILL NOT FUNCTION NORMALLY.
    • DECREASED SYNTHESIS

    1. PROTEIN:
    A:G WILL GO DOWN THIS WILL CAUSE EDEMA.
    2. CLOTTING FACTORS:
    THESE FACTORS WILL ALSO GO DOWN AND IT WILL CAUSE BLEEDING.
    PLATELET COUNT INCREASED.
    • DECREASED METABOLISM:

    1. ESTROGEN:
    PALMAR ERYTHEMA,SPIDER ANGIOMA,GONADAL ATROPHY.
    2. AMMONIA:
    SE CROSSES BLOOD BRAIN BARRIER RESULTS IN. HEPATIC
    ENCEPHALOPATHY
    PORTAL HYPERTENSION
    CIRRHOSIS

    INCREASE IN RESISTANCE TO PORTAL


    CIRCULATION

    PORTAL HYPERTENSION
    LEADS TO:
    1. ASCITES
    2. CAPUT MEDUSAE
    3. CONGESTIVE SPLENOMEGALY
    CLASSIFICATION :
    1. MICRONODULAR CIRRHOSIS:
    NODULE SIZE > 3MM.
    CAUSES :
    PRIMARY BILIARY
    CIRRHOSIS.
    INDIAN CHILDHOOD
    CIRRHOSIS.
    ALCOHOL LIVER DISEASE .
    HEMOCHROMATOSIS.
    2.MACRONODULAR CIRRHOSIS:
    NODULE SIZE <3MM
    CAUSES:
    ALCOHOL LIVER DIESEASE
    WILSON DISEASE
    VIRAL HEPATITIS.
    CAUSES OF CIRRHOSIS:
    • ALCOHOL LIVER DISEASE.
    • AUTO IMMUNE HEPATITIS.
    • CRYPTOGENIC CIRRHOSIS (NALD).
    • BILIARY DISEASE.
    • ENZYME DEFICIENCY ALPHA 1 ANTITRYPSIN DEFICIENCY.
    • HEPATITIS.
    • HEMOCHROMATOSIS.
    • WILSON DISEASE.
    • DRUG INDUCED.
    LCOHOLIC LIVER DISEASE :

    HEALTHY LIVER

    STEATOSIS/FATTY LIVER

    STEATOHEPATITIS

    LAENNEC CIRRHOSIS
    STEATOSIS (FATTY LIVER)

    1. MICROVESICULAR 2.MACROVESICULAR STEATOSIS:


    STEATOSIS: SEEN IN
    SEEN IN OBESITY
    FATTY LIVER OF DIABETES MELLITUS
    PREGNANCY.
    TOTAL PARENTERAL
    HEPATITIS -D NUTRITION
    STARVATION.
    HEPATITIS - C
    NON ALCOHOLIC LIVER DISEASE
    STAGES:
    CAUSES: HEALTHY LIVER
    OBESITY
    INCREASE IN
    TRIGLYCERIDES. NON ALCOHOLIC STEATOSIS

    DIABETES MELLITUS.
    HYPERTENSION.
    NON ALCOHOLIC STEATOHEPATITIS

    CIRRHOSIS OF LIVER
    CIRRHOSIS IN ALPHA-1 ANTITRYPSIN
    DEFICIENCY
    • THIS ENZYME IS PRESENT ON CHROMOSOME 14.
    • IT IS AN AUTOSOMAL RECESSIVE DISORDER.
    • AAT IS A GLYCOPROTEIN NORMALLY SYNTHESISED IN THE
    ROUGH ENDOPLASMIC RETICULUM OF THE HEPATOCYTES AND IS
    THE MOST POTENT PROTEASE INHIBITOR (PI).
    • GENOTYPE PI MM=NORMAL PI ZZ= DISEASE PI MZ=CARRIER
    • PI ZZ WILL CAUSE LIVER OR LUNG DISEASE.
    CIRRHOSIS IN HEMOCHROMATOSIS
    ALSO CALLED AS BRONZE DIABETES
    • GENETIC CAUSE: HFE GENE (CHR 6)
    • ACQUIRED CAUSE:IN BLOOD TRANSFUSION.
    IN THALASSEMIA
    • BANTU SIDEROSIS:
    AFRICAN IRON OVERLOAD IN INDIVIDUALS OF AFRICAN
    DESCENT WHO HAVE A GENE, FERROPORTIN, THAT PREDISPOSES
    THEM FOR IRON OVERLOAD (EARLIER CALLED BANTU SIDEROSIS
    AFFECTING SOUTH AFRICAN BANTU TRIBALS WHO CONSUME
    LARGE QUANTITIES OF HOME-BREW PREPARED IN IRON VESSELS.)
    TRIAD
    LIVER

    PANCREAS. SKIN
    PIGMENTATION/BRONZE
    BETA CELL FUNCTION (DECREASE)
    INSULIN (DECREASE)
    DIABETES MELLITUS.
    • IRON CAN ALSO GO INTO THE HEART AND CAN CAUSE
    CARDIOMYOPATHY.
    • IRON CAN ALSO GO INTO THE PITUITARY GLAND,CAUSE
    CIRRHOSIS IN WILSON DISEASE (CU
    OVERLOAD)
    INHERITANCE: AUTOSOMAL RECESSIVE
    GENE : ATP7B
    NORMALLY, COPPER SO ABSORBED THROUGH THE STOMACH AND
    DUODENUM IS TRANSPORTED TO THE LIVER WHERE IT IS
    INCORPORATED INTO ALPHA2-GLOBULIN TO FORM
    CERULOPLASMIN, WHICH IS EXCRETED BY THE LIVER VIA BILE
    NORMALLY. MOST OF THE PLASMA COPPER CIRCULATES AS
    CERULOPLASMIN. ONLY MINUTE AMOUNT OF COPPER IS
    EXCRETED IN THE URINE NORMALLY
    • IN PATHOLOGICAL CONDITION DUE TO MUTATION OF ATP7B
    GENE,COPPER ACCUMULATES IN LIVER RATHER THAN EXCRETION.
    • AS THE CAPACITY OF HEPATOCYTES TO STORE COPPER IS EXCEEDED AND
    COPPER IS RELEASED INTO CIRCULATION WHICH THEN GETS DEPOSITED
    IN EXTRAHEPATIC TISSUES SUCH AS THE BRAIN, EYES AND OTHERS
    TRIAD
    LIVER

    EYE BRAIN(BILATERAL DEGENERATION


    OF BASAL GANGLIA)
    KAYSER-FLEISCHER RING
    BILIARY CIRRHOSIS
    BILIARY CIRRHOSIS IS DEFINED AS A CHRONIC DISORDER
    CHARACTERISED BY CLINICAL, BIOCHEMICAL AND
    MORPHOLOGICAL FEATURES OF LONG CONTINUED CHOLESTASIS
    OF INTRAHEPATIC OR EXTRAHEPATIC ORIGIN.
    1.PRIMARY BILIARY CHOLANGITIS:
    CHRONIC PROGRESSIVE AUTO IMMUNE CONDITION LEADING TO
    DESTRUCTION OF SMALL INTRAHEPATIC BILE DUCT.
    THIS WILL CAUSE CHOLESTASIS.
    THIS IS DUE TO ANTI MITOCHONDRIAL ANTIBODY.
    SIGNS AND SYMPTOMS:
    1. PRURITUS
    2. DARK URINE
    3. JAUNDICE

    4. SKIN PIGMENTATION.
    2.PRIMARY SCLEROSING CHOLANGITIS:
    CHRONIC PROGRESSIVE CONDITION CHARACTERIZED BY
    INFLAMMATION AND SCARRING OF INTRAHEPATIC AND
    EXTRAHEPATIC BILE DUCT.
    CAUSES:
    1. IMMUNE MEDIATED
    2. GENETIC PREDISPOSITION
    3. BACTERIAL INFECTIONS.
    SIGNS AND SYMPTOMS:
    FATIGUE, PRURITUS, JAUNDICE,FEVER.
    DIAGNOSIS

    1. ULTRASOUND
    2. LIVER FUNCTION TEST. (AST/SGOT=4-17 IU/L,ALT/SGPT=3-15
    IU/L)
    3. LIVER ELASTOGRAPHY.
    4. LIVER BIOPSY.
    5. CT SCAN.
    6. UPPER G.I ENDOSCOPY.
    THANK YOU

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