Cirrhosis of the liver is end-stage liver disease.
what causes cirrhosis of the liver?
1. Alcohol liver disease (ALD)
2.NASH ( Non-alcoholic steatohepatitis
3. Metabolic liver disease: Hemochromatosis, Wilson's disease and alpha-antitrypsin deficiency.
4. Viral hepatitis
5. Autoimmune hepatitis
6. Drugs and chemicals
7. Bile duct disorders
Cirrhosis is characterized by? | cirrhosis of the liver symptoms:
• Disruption of liver architecture
• Regenerative parenchymal nodules
• Bridging fibrous septae
> TYPES OF CIRRHOSIS BASED ON
Regenerative nodules:
1. Micronodular Cirrhosis: in this condition Nodules is less than 3 mm.
Causes:
- Early Alcoholic liver disease (ALD)
- Hemochromatosis
- Primary Biliary
- Cirrhosis
- American childhood
2. Macromolecular Cirrhosis: In this condition Nodules is more than 3 mm.
Causes:
- Late ALD
- Alpha antitrypsin deficiency
- Wilson's disease
- drugs and toxins
- Viral Hepatitis
CIRRHOSIS PATHOGENESIS:
The main observed thing is capillarization of the sinusoid.
In a Normal liver type 1 and type 3 collagen are present in the periportal and centrilobular area. Type 4 collagen is present in the space of Disse.
In Cirrhosis Type 3 collagen comes to space of disse. this cause loss of fenestrations of the sinusoid and finally it causes capillarization of the sinusoid.
CLINICAL PRESENTATION OF CIRRHOSIS OF LIVER:
Cirrhosis of liver disease effect portal hypertension and cause liver cell failure.
A) effect of portal hypertension
- esophageal varices > Hematemesis
- gastropathy
- splenomegaly
- dilated abdominal veins ( caput medusae )
- Ascites
- Total varices ( Hemorrhoids )
B) effect of liver cell failure
- coma
- factor heretics ( Breath smells )
- spider nevi
- gynaecomastia
- jaundice
- ascites
- loss of sexual hair
- testicular atrophy
- bleeding tendency
- ankle oedema
ALCOHOLIC LIVER DISEASE
Every person who drinks alcohol doesn't develop Alcohol liver disease.
Only 15% develop ALD.
Intake of 70-80 ml of daily Alcohol leads to Alcoholic liver disease.
PATHOLOGY :
Gross: Liver become soft, yellow, greasy
Microscopic: steatosis, Hepatitis and Cirrhosis
steatosis :
• fatty changes in liver
• it is a reversible stage
•begin at centrilobular area
•types
A) Microvascular steatosis ( central nucleus ) which seen in early ALD, Reye's syndrome, acute fatty liver of pregnancy and chronic viral Hepatitis.
B) Macrovesicular steatosis (the nucleus is pushed towards periphery ) which is in Late ALD, obesity, chronic Hepatitis C, NASH
BASIC OF HEPATITIS :
- It is inflammation of the liver parenchyma.
- There are hepatocytes swelling causing ballooning degeneration.
- Neutrophilic infiltrate
- Mallory hyaline bodies seen
BASIC OF REYE'S SYNDROME :
- It's a rare disorder. most of seen in children.
- children who were treated with Aspirin for viral disease is more prone to Reye's syndrome.
- symptoms seen in Reye's syndrome is vomiting, hypoglycemia, features of hepatic encephalopathy.
- sever mitochondrial dysfunction seen in pathology.
- after administration of aspirin cause swollen, pleomorphic mitochondria, reduced in numbers.
- H & E stain shows extensive microvascular steatosis.
BASICS OF METABOLIC LIVER DISEASE :
1) Hemochromatosis
- excessive iron overload
- autosomal recessive
- seen in both gender
- a most common cause of Metabolic liver Disease.
- in this condition increased risk of HCC (Hepatocellular carcinoma )
- Wilson's Disease
- It is an Autosomal recessive Disease.
- Also known as Hepatocellular degeneration.
- In this condition excessive copper accumulation seen in the liver.
3) Alpha 1 Antitrypsin Deficiency
Note: It is for only knowledge points of view. Comment below for Questions.
Thank you.
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