Cirrhosis

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Learn from the mistakes of others. You can't live
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Normal Liver
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Normal Liver Histology
CV
PT
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Jaundice

• Venkatesh Murthy Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Jaundice

• Yellow discoloration of skin sclera due to
  excess serum bilirubin. gt 40umol/l, (3mg/dl)
• Not necessarily liver disease.
• Conjugated Unconjugated types
• Obstructive Non Obstructive
• Pre-Hepatic, Hepatic Post Hepatic types.

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Bilirubin Metabolism

• Blood
• Conjugated Conjugated
• Urine Urobilinogen
• Stool Stercobilin

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Jaundice
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Jaundice
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Jaundice

• Post Hepatic (Obstructive) Stone, tumor
• Conjugated/Direct Bil, High colored urine,
• Pre Hepatic (Acholuric) - Hemolytic
• Unconjugated/Indirect Bil, pale urine
• Hepatocellular Jaundice - Viral
• Liver damage - unconjugated
• Swelling, canalicular obstruction - Conjugated
• Conjugated Unconjugated types.

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Cirrhosis

• Venkatesh Murthy Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Definition

• Diffuse fibrous scarring of liver.
• End result of many diseases of liver.
• Loss of architecture Liver failure
• Portal Hypertension
• Spleenomegaly
• Porta-systemic shunts.
• Ascitis

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Alcoholic Fatty Liver
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Cirrhosis
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Cirrhosis
Fibrosis Regenerating Nodule
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Etiology of Cirrhosis

• Alcoholic liver disease 60-70
• Viral hepatitis 10
• Biliary disease 5-10
• Primary hemochromatosis 5
• Cryptogenic cirrhosis 10-15
• Wilsons, ?1AT def rare

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Pathogenesis

• Hepatocyte injury necrosis
• Fibrous scarring
• Parenchymal regeneration (non functional)
• Loss of archetecture Vascular disruption
• Portal hypertension
• Liver failure Hepatic coma.

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Pathogenesis of Hepatic Encephalopathy
BRAIN LIVER Toxic N2 metabolites From
Intestines
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Micronodular cirrhosis
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Micronodular cirrhosis
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Macronodular Cirrhosis
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Stone in Bile Duct
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Alcoholic Fatty Liver
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CirrhosisClinical Features
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Jaundice, Abdominal Striae
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Porta-systemic anastomosis Prominent abdominal
veins.
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MRI Cirrhosis
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Complications

• Congestive splenomegaly.
• Bleeding varices.
• Hepatocellular failure.
• Hepatic encephalitis / hepatic coma.
• Hepatocellular carcinoma.

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Hepatocellular Carcinoma
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Conclusions

• Common end result of diffuse liver damage.
  (common causes Viral hepatitis Alcohol)
• Characterised by complete loss of architecture.
• Replaced by fibrosis regenerating parenchymal
  nodules.
• Hepatocellular insufficiency portal
  hypertension.