Cirrhosis is an the irreversibile alteration of hepatic tissue structure, characterised by:
- Hepatocyte necrosis and apoptosis
- Diffuse liver fibrosis, mandatory for diagnosis
- Compensator nodular regeneration
- Vascularization disturbances (portal hypertension)
It is a diffuse process involving the entire liver, characterized by fibrosis and conversion of normal architecture into structurally abnormal regeneration nodules of liver cells.
Chronic Hepatitis B Virus
Hepatitis C Virus
Non alcoholic steatohepatitis ( NASH)
Chronic biliary obstruction
Chronic liver congestion (constrictive cardiac failure, constrictive pericarditis)
Metabolic causes (hemochromatosis, Wilson disease)
Toxic/drugs (methotrexate, amiodarone)
Primary and secondary biliary cirrhosis
Four important processes are involved:
Liver cell death with loss of architecture: The pathogenesis of liver cell damage varies depending on the etiologic agent.
Fibrosis: It is mainly due to the activation of hepatic stellate cells, which are transformed into highly fibrogenic cells called myofibroblasts.
Regenerating nodules: Damage and fibrosis of liver cells stimulate surviving hepatocytes to regenerate and proliferate to form regenerating nodules.
Vascular reorganization: Parenchymal damage and fibrosis disrupt the vascular architecture of the liver.
Signs and symptoms
SKIN: Jaundice, ecchymosis (thrombocytopenia or clotting factor deficiency), increased pigmentation (hemochromatosis). xanthomas (primary biliary cirrhosis);
EYES: Kayser-Fleischer rings. (corneal copper deposition seen in Wilson’s disease; scleral jaundice;
ABDOMEN: painful or painless hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable;
- Laboratory tests:
AST, moderately elevated ALT. AST > ALT. Very high GGT in chronic alcoholic liver disease. Bilirubin increases as cirrhosis worsens. Albumin decreases as synthetic function decreases. Prothrombin time increases as synthetic function decreases.
Ascites and edema
Splenomegaly (can leads to anemia, leukopenia, trombocytopenia and eventually bleeding)
Porto-systemic shunting of blood (Caput medusae, hemorrhois, esophageal varices)
Antiviral medication for Hepatitis
Corticosteroids for autoimmune hepatitis
Diuretics, antibiotics, laxatives. enemas, thiamine, steroids