LIVER CIRRHOSIS

Introduction
• Cirrhosis of the liver is a diffuse disease having the following 4
features
1. It involves the entire liver
2. The normal lobular architecture of hepatic parenchyma is
disorganised
3. There is formation of nodules separated from one another
by irregular bands of fibrosis
4. Hepatocellular necrosis of varying etiology
• Cirrhosis of the liver can occur because of many factors but the
chief worldwide contributors are alcohol abuse and viral
hepatitis
 Etiology
• Predisposing factors include

i. Drinking patterns
ii. Malnutrition
iii. Infections
iv. Genetic Factors: altered rates of elimination of ethanol due
to genetic polymorphism of enzymes.
 PATHOGENESIS
Cell undergoes death due to any of etiological causes
(Necrosis ). Healing the necrotic place by fibrosis

Deficiency of blood supply to some areas

Hypoxic necrosis due to decreased blood supply

Healing of necrotic area

Some area retain the blood supply by anastomosis

Tries to replace the lost cell by regeneration

Regenerated nodule

Compress

Decreased blood supply

Continuous formation of Fibrosis and regenerated

nodules

Obstruction in biliary flow

Portal hypertension
 Fibrogenesis
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Lymphokines and monokines The ased f coll the
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Fibrosis p

Proliferation of fat storing cells

Transformation of these cells into myofibroblasts and fibrocytes

MORPHOLOGICAL CLASSIFICATION
Micronodular

Macronodular

Mixed
ETIOLOGICAL CLASSIFICATION
• Alcoholic cirrhosis
• Post -necrotic cirrhosis hepatitis, drugs.
• Biliary cirrhosis due to biliary obstruction
• Malnutrition Indian childhood cirrhosis
• Genetic disorder Wilson's disease,
hemochromatosis, alpha-1 antitrypsin deficiency
• Cardiac cirrhosis
 Post-necrotic cirrhosis
• It is characterized by large and irregular nodules with broad
bands of connective tissue and occurring most commonly
after previous viral hepatitis.
• Etiology:

a. Viral hepatitis: Hepatitis B and C are known to cause post

necrotic cirrhosis
b. Drugs and chemical hepatotoxins: phosphorus, carbon
tetrachloride, paracetamol
c. Others: certain infections e.g. parasitic infections
d. Idiopathic:
 Biliary cirrhosis
• It is defined as a chronic disorder characterized by clinical,
biochemical and morphological features of long continued
cholestasis of intrahepatic or extrahepatic origin
• It is of two types

i. Primary biliary cirrhosis: in which the destructive process of

unknown etiology affects intrahepatic bile ducts
ii. Secondary biliary cirrhosis: resulting from prolonged
mechanical obstruction of the extrahepatic biliary passages
• Etiology:
• Primary biliary cirrhosis:
• Auto immune
• Familial incidence
• Secondary biliary cirrhosis.
• Extrahepatic cholestasis, cancer of biliary tree
and head of pancreas.
 Clinical features

• Dark urine
• Pale stools
• Jaundice
• Skin pigmentation
Pigment cirrhosis in haemochromatosis

• It is an iron-storage disorder in which there is excessive

accumulation of iron in parenchymal cells with eventual tissue
damage and functional insufficiency of organs such as liver,
pancreas, heart and pituitary gland
 Genetic abnormalities

Intestinal
mucosal level Post absorption
causing excretion level
excessive iron leading to excessive
absorption accumulation of
iron

Tissue injury due to

lipid peroxidation of
cell organelles due to
excess iron
 Cirrhosis in wilson’s disease
• It is an autosomal recessive inherited disease of copper
metabolism, characterized by toxic accumulation of copper in
many tissues like the liver, brain and eye
• Hence this accumulation leads to cirrhosis of liver