cirrhosis. * definition: chronic, diffuse, irreversible disorder of the liver characterized by loss...
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CirrhosisCirrhosis
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* Definition:* Definition:Chronic, diffuse, irreversible disorder of the liver
characterized by loss of the normal liver architecture
and replacement by regenerating nodules.
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Normal Liver
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Micronodular cirrhosis
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Macronodular Cirrhosis
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Normal Liver Histology
CV
PT
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Liver Biopsy – Cirrhosis
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Liver Biopsy – Cirrhosis:
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* Etiological classification of Cirrhosis:* Etiological classification of Cirrhosis:
A. Congenital cirrhosis:A. Congenital cirrhosis:
1. Congenital syphilis.
2. Hemochromatosis.
3. Wilson disease.
4. α1 antitrypsin deficiency.
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B. Acquired cirrhosis:B. Acquired cirrhosis:
1. Post-hepatitic (viral).
2. Alcoholic.
3. Biliary cirrhosis.
4. Cirrhosis caused by circulatory disorders e.g.
chronic right sided heart failure.
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* Complications of Cirrhosis: * Complications of Cirrhosis:
1. Liver cell Failure.
2. Portal hypertension.
3. Hepatocellular carcinoma.
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1. Liver cell failure1. Liver cell failure
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1. Jaundice: Hepatocelluar jaundice.
2. Hypo proteinaemia: due to decreased
formation of plasma proteins. Contributes in
generalized edema formation and ascitis.
3. Vitamin deficiency: Vit. A, K, B12, folic acid.
4. Coagulation defect: due deficiency of
fibrinogen, factors V, VII, IX, X.
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5. Anemia: due to repeated hemorrhage,
hypersplenism, B12 and folic acid deficiency.
6. Hypoglycemia: due to defects in
carbohydrate metabolism.
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7. Hormone disturbances:
Increased serum aldosterone leads: to salt & water retention.
Increased estrogen leads to:
• Gynaecomastia.
• Hypogonadism (testicular atrophy and loss of libido in
males).
• Menstrual disturbances in females.
• Palmer erythema (local vasodilation).
• Spider angiomas of skin: Each angioma is a central,
pulsating, dilated arteriole from which small vessels radiate
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GynaecomastiaGynaecomastia
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Palmer erythemaPalmer erythema
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Spider angioma Spider angioma
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8. Ascites: Due to salt & water retention, portal
hypertension and hyporpteinaemia.
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Ascites Ascites
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9. Hepatic encephalopathy:
Neurological disturbances (apathy,
disorientation, asterixis i.e. flapping tremors and
coma) due to toxic amonia which are formed in
intestine and not detoxified in liver so pass
directly to brain.
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10. Foetor hepaticus: a characteristic bad
(musty) odor smelled from the body and mouth of
the patients due to formation of mercaptans by
the action of gastrointestinal bacteria on the
sulfur-containing amino acid methionine.
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2. Portal hypertension2. Portal hypertension
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Effects of Portal hypertension:
1. Varices: esophageal varices, piles.
2. Splenomegaly due to splenic congestion.
3. Ascites which is accumulation of transudate in
the peritoneal cavity.
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