1. Liver Cirrhosis
Lecture 19
Dr Mohammad Manzoor Mashwani BKMC Mardan

2. Yellowish
brown
color
Tawny

3. Introduction
• The term cirrhosis was first used by Rene Laennec
(1781-1826) to describe the abnormal liver color of
individuals with alcoholinduced liver
disease.
• Derived from Greek word Kirrhos means
Yellowish brown color.
Cirrhosis is among the top 10 causes of death in the Western world.

4. Definition
• Cirrhosis is defined as a diffuseprocess
• characterised by fibrosis&
• the conversion of normal liver architecture into structurally abnormal nodules.

6. Common Causes
1. Chronic alcoholism & NASH
2. Chronic hepatitis B& C
3. Biliary disease
4. Hemochromatosis (Iron oveload)
5. Cryptogenic 10%
6. Wilson's disease,
7. Alpha-1 anti-trypsin deficiency.

7. Causes of Liver Cirrhosis
• Obesity
• Autoimmune hepatitis
• Diseases that damage or destroy bile ducts.
• Inherited diseases
• Drugs & toxins

8. Types of Cirrhosis
• 1. Alcoholic Cirrhosis (Laennec)
• 2. Post necrotic Cirrhosis (macronodular)
• 3. Billiary Cirrhosis
• 4. Cardiac Cirrhosis

10. Pathogenesis
1. Hepatocellular death
2. Regeneration
3. Progressive fibrosis
4. Vascular reorganization
Three processes are central to the pathogenesis of cirrhosis:
•death of hepatocytes,
•extracellular matrix deposition, and
•vascular reorganization.

12. Morphology
• Its three main morphologic characteristics are:
• 1.Bridging fibrous septa (delicate fibrous bands/broad scars)
• 2. Parenchymal nodules- micro (<3mm) & macro (>1cm)
• 3. Disruption of the architecture of the entire liver.
4. It occurs following hepatocellular necrosis of varying etiology so that there are alternate
areas of necrosis and regenerative nodules. However, regenerative nodules are not essential
for diagnosis of cirrhosis since biliary cirrhosis and cirrhosis in haemochromatosis have little
regeneration.

13. Clinical manifestations
Early manifestations
• No symptoms
• GI disturbances: anorexia, dyspepsia,
flatulence, weakness, fatigue, nausea,
vomiting, weight loss, abdominal pain,
bloating, diarrhea, constipation
• Abdominal pain, dull and heavy feeling
• Fever, lassitude, weight loss, enlargement of
liver and spleen.

14. Clinical manifestations Cont…
Later manifestations:
Results from liver failure and portal hypertension
• Jaundice
• Peripheral edema
• Ascites
• Others: Skin lesion, hematological disorders,
endocrine disturbances, and peripheral neuropathy
• Advanced stage: small and nodular liver

15. Clinical Manifestations

16. Complications
• The ultimate mechanism of deaths in most
cirrhotic patients is
• (1) progressive liver failure,
• (2) a complication related to portal hypertension, or
• (3) the development of hepatocellular carcinoma.
Ascites
Esophageal variceal bleeding
Hepatic encephalopathy
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Portal hypertensive gastropathy
Infection
Liver failure
Hepatocellular carcinoma

17. Annual Exame 2013
• A biopsy report of a 55 years old lady, admitted to
hospital for complaints of abdominal distension and
palor, reveals loss of normal lobular architecture
with replacement of liver parenchyma by
haphazardly regenerating nodules surrounded by
coarse fibrous septa
• a. Name the disease, the lady is most probably suffering from. 2
• b. Enlist only o5 important causes of this disease 2.5
• c. Enumerate only five complications of this disease 2.5
• d. What is the most important complications of ascites in this disease 1
• e. Name only four poor prognostic signs of this disease 2

18. Answer
a. Liver Cirrhosis
b. Chronic alcoholism & NASH, Chronic hepatitis B& C, Biliary
disease ,Hemochromatosis, Cryptogenic 10% ,
Wilson's disease, , Alpha-1 anti-trypsin deficiency.
c. Ascites, Esophageal variceal bleeding, Hepatic encephalopathy,
Hepatorenal syndrome, Spontaneous bacterial peritonitis, Portal
hypertensive gastropathy, Infection, Hepatic failure, Hepatocellular
carcinoma
d, Pleural effusion, dyspnea, Infections (spontaneous bacterial peritonitis
(SBP)), Hepatorenal syndrome.
e. Serum albumin (Hypoalbuminemia), Serum bilirubin (Hyperbilirubinemia),
INR ( increased International Normalized Ratio), Ascites, Encephalopathy.

20. International normalized ratio (INR)
• The prothrombin time (PT) and its derived measures of
prothrombin ratio (PR) and international normalized
ratio (INR) are measures of the extrinsic pathway of
coagulation. This test is also called "ProTime INR" and
"PT/INR". They are used to determine the clotting
tendency of blood, in the measure of warfarin dosage,
liver damage, and vitamin K status. PT measures factors
I (fibrinogen), II (prothrombin), V, VII, and X. It is used in
conjunction with the activated partial thromboplastin
time (aPTT) which measures the intrinsic pathway.
International normalized ratio: A system established by the World Health Organization (WHO)
and the International Committee on Thrombosis and Hemostasis for reporting the results of
blood coagulation (clotting) tests. Abbreviated INR. Under the INR system, all results are
standardized. For example, a person taking the anticoagulant warfarin (brand name: Coumadin)
would regularly have blood tested to measure the INR. The INR permits patients on
anticoagulants to travel and obtain comparable test results wherever they are.

21. • A known patient of chronic Hepatitis B presents
with ascites, weight loss, and splenomegaly. Biopsy
was performed. External surface is irregular and it is
firm in consistency. It showed loss of normal tissue
architecture and fibrosis.
• TASK
• What is your diagnosis?
• Name different etiological factors leading to this
condition.
• What is the most common cause of fatty liver?
• What are various types of this disease entity?