Liver Cirrhosis its pathogenesis,aetiology,clinical picture,investigation and newest treatment

Def.: Cirrhosis is defined as irreversible hepatic injury,

characterized by fibrosis & regeneration nodules ending in

loss of normal liver architecture.

N.B: fibrosis without regeneration module is not cirrhosis.

Pathogenesis:

i- The main damage in cirrhosis is triggered by scaring

(fibrosis) that occurs from injuries due to alcohol,

viruses,…………..

ii- In response to the scaring, liver cells regenerate in

abnormal pattern & form nodules around i scar.

iii- The scar tissue & regenerated nodules block the flow of

blood and bile through the liver, preventing it from working

as it should.

Aetiology:

1- Alcoholic cirrhosis (laennic's cirrhosis).

2- Post hepatitis cirrhosis, Bilharziasis.

3- Cardiac cirrhosis

4- Biliary cirrhosis

5- Metabolic à Haemochromatosis ↑ fe

à Hepatolenticular dengeration ↑ cu

6- Iatrogenic: Methotrexate, INH, Methyldopa

7- Idiopathic à (cryptogenic) cirrhosis.

8- Others : à Severe malnutrition.

à Syphilis.

à α1 antitrypsin deficiency.
Classification of cirrhosis

- Aetiological classification à acc. To aetiology.

- Morphological classification:

à Micro-nodular à < 3mm, same size.

à Macronodular à > 3 mm, variable size.

à Mixed.

Clinical picture:

à Symptoms:

a- Asymptomatic (latent cirrhosis): à Compensated liver cirrhosis

(No LCF or pH à Many patients with liver cirrhosis are

asymptomatic for years, others may show generalized

weakness, anorexia, malaise & weight loss.

b- Symptomatic (Manifest cirrhosis):

Symptoms of cause

Liver cell failure (LCF)

Portal  hypertension(pH)

i- Symptoms of I cause : e.g.:

· Post hepatitis: symptoms of hepatitis (history)

· Haemochromatosis: Bronzed DM.

· Hepatolenticular degeneration: extrapyramidal manifestations.

ii- Symptoms of liver cell failure: easy fatigue–encephalopathy..

iii- Symptoms of portal hypertension: distension, splenmegally,

varices…

à Signs:

1à signs of i cause.

2à signs of liver cell failure: palmer erythema, flapping

tremor,…

3à signs of portal hypertension: splenomegally.

4 à Liver: firm, sharp border

shrunken liver.

à Complication à hepatoma:

N.B1 : The liver is shrunken in all types of cirrhosis except in

- Cardiac cirrhosis.

- biliary cirrhosis

- early cases of liver cirrhosis

N.B2 : Causes of shrunken liver: Cirrhosis, fibrosis, necrosis.

Investigation:

i- Investigation for i cause.

ii- Investigation for liver cell failure (liver function test).

iii- Investigation for portal hypertension.

iv- Investigation for cirrhosis

à biopsy is the surest D

à ultrasound - CT

v- Investigation for complication (hepatoma)

à Tumur marker (α-feoto ptn.) (carboxy prothrombin)

Treatment:

- Liver damage from cirrhosis can't be reversed, but treatment

can stop or delay further progression and reduce

complications.

i- Treatment of i cause.

ii- Treatment of liver cell failure.

iii- Treatment of portal hypertension.

iv- Drugs to decrease liver fibrosis (Antifibrotic) it's still under

trial

à Colchecine à ↑ collagen destruction.

à penicilamine à ↓ collagen synthesis.

v- Hepatic transplantation is the best hope but many

patient are not suitable.
see the pictures