Liver Cirrhosis

 It is characterized by diffuse hepatic fibrosis and nodule formation.

 Causes of cirrhosis:
1. Alcohol
2. Chronic hepatitis(B and C)
3. NAFLD
4. Immune; primary sclerosing cholangitis, autoimmune liver disease
5. Biliary; primary biliary cholangitis, secondary biliary cirrhosis, cystic fibrosis.
6. Genetic; haemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency
7. Cryptogenic(unknown-15%)
8. Chronic venous outflow obstruction
9. Any chronic liver disease
Pathophysiology

 Following liver injury, stellate cells in space of disse are activated by cytokines produced
by kuppfer cells and hepatocytes. This transforms stellate cells into a myofibroblast like
cell, capable of producing collagen, pro-inflammatory cytokines and other mediators that
promote hepatocyte damage and tissue fibrosis. It evolves over year as progressive fibrosis
and widespread hepatocyte loss lead to distortion of normal liver architecture that disrupts
the hepatic vasculature, causing portosystemic shunts. These changes affect whole liver but
in biliary cirrhosis, they can be patchy.
 It can be classified histologically into:
1. Micronodular: charaterised by small nodules about 1mm in diameter and typically seen in
alcoholic cirrhosis.
2. Macronodular: characterized by larger nodules of various sizes. Areas of previous collapse
of liver architecture are evidenced by large fibrous scars.
Clinical features

 Hepatomegaly( although liver may also be small)

 Jaundice
 Ascites
 Circulatory changes; telangiectasia, palmar erythema, cyanosis
 Endocrine changes; loss of libido, hair loss,
 Men- gynaecomastia, testicular atrophy, impotence
 Women- breast atrophy, irregular menses, amenorrhoea
 Haemorhagic tendency; bruises, purpura, epistaxis
 Portal HTN; splenomegaly, collateral vessels, variceal bleeding
 Hepatic encephalopathy
 Other features; pigmentation, digital clubbing, dupuytren’s contracture.
Management

 Includes treatment of underlying cause, maintainence of nutrition and treatment of

complications.
 Chronic liver failure- liver transplantation
 NOTE: features of chronic liver failure:
 Worsening synthetic liver function; prolonged prothrombin time, low albumin
 Jaundice
 Portal HTN
 Variceal bleeding
 Hepatic encephalopathy
 Ascites; spontaneous bacterial, peritonitis, hepatorenal failure
Prognosis

 Overall prognosis is poor.