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Cirrhosis of liver

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Ramya Deepthi P
Ramya Deepthi P

This document provides an overview of cirrhosis of the liver. It begins by defining cirrhosis as the end stage of chronic liver disease, marked by diffuse involvement and disruption of the liver architecture with formation of nodules separated by fibrous bands. The causes of cirrhosis include alcoholic liver disease, viral hepatitis, genetic disorders. Clinically, cirrhosis presents with symptoms such as jaundice, ascites, peripheral edema and complications include hepatic coma, gastrointestinal bleeding and liver cancer. The progression of alcoholic liver disease from fatty liver to alcoholic hepatitis and finally cirrhosis is described along with the pathological changes at each stage.

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CIRRHOSIS OF LIVER By- Ramya Deepthi P Vijay Marie College of Nursing
INTRODUCTION • CIRRHOSIS MARKS THE END OF CHRONIC LIVER DISEASE. IT IS AMONG THE TOP 10 CAUSES OF DEATH IN THE WESTERN WORLD. 2 Ramya Deepthi P
Definition Cirrhosis is defined by the following features- 1. Diffuse involvement of entire liver 2. Disruption of the normal architecture of liver 3. Formation of new nodules which are separated by irregular bands of fibrosis. Nodule with less than 3mm is called Micronodule and if several cms it is called Macronodular cirrhosis. 3Ramya Deepthi P
ETIOLOGY • Alcoholic liver disease • Chronic active cirrhosis • Primary biliary cirrhosis • Haemochromatosis • Wilson’s disease • Cystic fibrosis • Alpha1 antitrypsin deficiency • Galactosemia • Glycogen storage disease • Indian childhood cirrhosis 4Ramya Deepthi P
Pathogenesis Due to etiological factors such as Hepatitis, Fatty liver (Steatosis) Development of scar tissue that replaces normal parenchyma This fibrosis blocks the portal circulation f blood through the organ therefore disturbing normal function. Activation of hepatic stellate cells which increases fibrosis by producing myofibroblasts. Formation of macro and micro nodules sepearetd by fibrous tissue bands (septa) Decreased blood flow Portal hypertension ascites 5 Ramya Deepthi P
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Types of cirrhosis 7 Ramya Deepthi P
Micronodular type of cirrhosis • In this type, nodules are less than 3cms in diameter with diffuse involvement of the liver 8Ramya Deepthi P
Macronodular Cirrhosis • In this type, nodules are larger, usually more than 3mm in diameter upto several centimeters. • Involvement is diffuse, but looks more irregular than Micronodular type 9 Ramya Deepthi P
Mixed type of cirrhosis • In this type, mixture of both 2 types are seen. Only few portal tracts and central veins are involved. • This pattern is a kind of incomplete expression of micronodular cirrhosis. 10 Ramya Deepthi P
CLINICAL FEATURES 11 Ramya Deepthi P
Clinical features 12 Ramya Deepthi P
Alcoholic liver disease 13 Ramya Deepthi P
Introduction It is said that a person who drinks upto 80gms of alcohol over a period one day to many days will produce mild fatty change which are reversible. Intake of 80gms or more causes hepatic injury Only 10-15% alcoholics develop cirrhosis. 14 Ramya Deepthi P
Etiopathogenesis Every one who consumes alcohol may not develop liver damage. Why only some one gets affected is not clear, how ever certain risk factors are said to be associated- 1. Genetic susceptibility 2. Malnutrition 3. Impaired digestive function 4. inflammation 15Ramya Deepthi P
Pathological changes There are 3 distinct form of cirrhosis due to alcohol consumption: • Alcohol/ Hepatic steatosis • Alcohol Hepatitis • Cirrhosis 16 Ramya Deepthi P
Alcoholic Steatosis (Fatty Liver) 17 Ramya Deepthi P
DEFINITION • Described as intra cellular accumulation of triglycerides within parenchyma of hepatic cells. • Earlier it was called fatty degeneration and fatty infiltration, which is now not in use. • The change represents an absolute increase in the intracellular lipids seen in liver, heart, skeletal muscle, kidneys etc.. 18 Ramya Deepthi P
Etiology • Alcohol abuse • Starvation • Protein malnutrition • Obesity • Diabetes mellitus • Hepatotoxins • Chronic illness ( tuberculosis) 19Ramya Deepthi P
PATHOGENESIS Diet Adipose tissue Free fatty acids Fatty acids accumulation in liver Triglycerides Lipoproteins Plasma lipoproteins 20Ramya Deepthi P
MORPHOLOGY • Gross: changes are better appreciated in several cases- liver becomes enlarged, greasy yellow and may weigh 3-6 kgs. 21 Ramya Deepthi P
Morphology contd… Microscopic changes: • Cell appears as minute vacuoles in the cytoplasm around the nucleus • As the disease progresses vacuoles become large and push the nucleus to the periphery of the cells • Sometimes hepatocytes rupture and the lipid vacuoles form fatty cysts. • Rarely lymphocytes, macrophages and few multinucleated giant cells collect to form lipogranulomas 22 Ramya Deepthi P
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Alcoholic Hepatitis 24 Ramya Deepthi P
Alcoholic hepatitis Gross appearance is same as that of alcoholic steatosis but it will be added with fibrosis. 25Ramya Deepthi P
MICROSCOPIC APPEARANCE a. Ballooning degeneration: scattered degenerating hepatocytes will show cytoplasm eosinophilic inclusion bodies which are due to accumulation of microorganells like cytoskeleton, cytokeratin called as Mallory bodies. b. Inflammation: the areas of necrosis is along the Mallory bodies. If large areas are involved entire lobe may show widespread necrosis. c. Fibrosis: fibrosis comes into focus, which is seen around sinusoids, veins and splits the parenchyma, giving it chicken wire like blood vessels and appearance. 26 Ramya Deepthi P
Balloon degenaration 27 Ramya Deepthi P
Alcoholic Cirrhosis 28 Ramya Deepthi P
Alcoholic cirrhosis This is the final and irreversible form of disorder which occurs very slowly and is the most common (60-70%) cause of cirrhosis of liver. Synonims: hobnail/ cirrhosis, nutritional cirrhosis, diffuse cirrhosis, Laennec’s cirhhosis, portal cirrhosis 29 Ramya Deepthi P
Morphology Gross: • Begins as a micro nodular type with nodule less than 3mm in size. • The liver is firm, enlarged, more than 2kgs in weight. • Appears yellow & greasy. • Later the size shrinks to almost about a kg due to fibrosis, which appears as macro nodules 30 Ramya Deepthi P
Microscopic changes Like any other form of cirrhosis, the 3 basic features are- • Lobular architecture: disruption of normal architecture, central veins are hard to find • Fibrous bands: the fibrous septae are initially thin, delicate and later becomes into bands and as time goes by becomes dense. • Hepatic parenchyma: nodules show fatty changes in hepatocytes, as fibrosis extends fatty changes decreases. 31 Ramya Deepthi P
CLINICAL FEATURES • Discomfort in right upper quadrant due to mild hepatomegaly • Anorexia • Malaise • Weight loss • Loss of appetite • Jaundice • Ascites • Peripheral edema • Distended 32 Ramya Deepthi P
Laboratory investigations • Enzyme assay- SGOT, SGPT,SGGT • Serum alkaline phosphatase • Serum bilirubin • Serum protein • Prothrombin time • Haemogram. 33 Ramya Deepthi P
Prognosis • Patients without jaundice, Ascites or heatemesis and are abstainers from alcohol have 90% five year survival. • Cause of death in alcoholic cirrhosis could be due to –  Hepatic coma  Massive gastrointestinal bleeding  Infections  Hepatocellular carcinoma 34Ramya Deepthi P
A healthy live depends on healthy diet, regular exercise & healthy life style 35Ramya Deepthi P

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Cirrhosis of liver

  • 1. CIRRHOSIS OF LIVER By- Ramya Deepthi P Vijay Marie College of Nursing
  • 2. INTRODUCTION • CIRRHOSIS MARKS THE END OF CHRONIC LIVER DISEASE. IT IS AMONG THE TOP 10 CAUSES OF DEATH IN THE WESTERN WORLD. 2 Ramya Deepthi P
  • 3. Definition Cirrhosis is defined by the following features- 1. Diffuse involvement of entire liver 2. Disruption of the normal architecture of liver 3. Formation of new nodules which are separated by irregular bands of fibrosis. Nodule with less than 3mm is called Micronodule and if several cms it is called Macronodular cirrhosis. 3Ramya Deepthi P
  • 4. ETIOLOGY • Alcoholic liver disease • Chronic active cirrhosis • Primary biliary cirrhosis • Haemochromatosis • Wilson’s disease • Cystic fibrosis • Alpha1 antitrypsin deficiency • Galactosemia • Glycogen storage disease • Indian childhood cirrhosis 4Ramya Deepthi P
  • 5. Pathogenesis Due to etiological factors such as Hepatitis, Fatty liver (Steatosis) Development of scar tissue that replaces normal parenchyma This fibrosis blocks the portal circulation f blood through the organ therefore disturbing normal function. Activation of hepatic stellate cells which increases fibrosis by producing myofibroblasts. Formation of macro and micro nodules sepearetd by fibrous tissue bands (septa) Decreased blood flow Portal hypertension ascites 5 Ramya Deepthi P
  • 6. 6
  • 8. Micronodular type of cirrhosis • In this type, nodules are less than 3cms in diameter with diffuse involvement of the liver 8Ramya Deepthi P
  • 9. Macronodular Cirrhosis • In this type, nodules are larger, usually more than 3mm in diameter upto several centimeters. • Involvement is diffuse, but looks more irregular than Micronodular type 9 Ramya Deepthi P
  • 10. Mixed type of cirrhosis • In this type, mixture of both 2 types are seen. Only few portal tracts and central veins are involved. • This pattern is a kind of incomplete expression of micronodular cirrhosis. 10 Ramya Deepthi P
  • 14. Introduction It is said that a person who drinks upto 80gms of alcohol over a period one day to many days will produce mild fatty change which are reversible. Intake of 80gms or more causes hepatic injury Only 10-15% alcoholics develop cirrhosis. 14 Ramya Deepthi P
  • 15. Etiopathogenesis Every one who consumes alcohol may not develop liver damage. Why only some one gets affected is not clear, how ever certain risk factors are said to be associated- 1. Genetic susceptibility 2. Malnutrition 3. Impaired digestive function 4. inflammation 15Ramya Deepthi P
  • 16. Pathological changes There are 3 distinct form of cirrhosis due to alcohol consumption: • Alcohol/ Hepatic steatosis • Alcohol Hepatitis • Cirrhosis 16 Ramya Deepthi P
  • 18. DEFINITION • Described as intra cellular accumulation of triglycerides within parenchyma of hepatic cells. • Earlier it was called fatty degeneration and fatty infiltration, which is now not in use. • The change represents an absolute increase in the intracellular lipids seen in liver, heart, skeletal muscle, kidneys etc.. 18 Ramya Deepthi P
  • 19. Etiology • Alcohol abuse • Starvation • Protein malnutrition • Obesity • Diabetes mellitus • Hepatotoxins • Chronic illness ( tuberculosis) 19Ramya Deepthi P
  • 20. PATHOGENESIS Diet Adipose tissue Free fatty acids Fatty acids accumulation in liver Triglycerides Lipoproteins Plasma lipoproteins 20Ramya Deepthi P
  • 21. MORPHOLOGY • Gross: changes are better appreciated in several cases- liver becomes enlarged, greasy yellow and may weigh 3-6 kgs. 21 Ramya Deepthi P
  • 22. Morphology contd… Microscopic changes: • Cell appears as minute vacuoles in the cytoplasm around the nucleus • As the disease progresses vacuoles become large and push the nucleus to the periphery of the cells • Sometimes hepatocytes rupture and the lipid vacuoles form fatty cysts. • Rarely lymphocytes, macrophages and few multinucleated giant cells collect to form lipogranulomas 22 Ramya Deepthi P
  • 23. 23
  • 25. Alcoholic hepatitis Gross appearance is same as that of alcoholic steatosis but it will be added with fibrosis. 25Ramya Deepthi P
  • 26. MICROSCOPIC APPEARANCE a. Ballooning degeneration: scattered degenerating hepatocytes will show cytoplasm eosinophilic inclusion bodies which are due to accumulation of microorganells like cytoskeleton, cytokeratin called as Mallory bodies. b. Inflammation: the areas of necrosis is along the Mallory bodies. If large areas are involved entire lobe may show widespread necrosis. c. Fibrosis: fibrosis comes into focus, which is seen around sinusoids, veins and splits the parenchyma, giving it chicken wire like blood vessels and appearance. 26 Ramya Deepthi P
  • 29. Alcoholic cirrhosis This is the final and irreversible form of disorder which occurs very slowly and is the most common (60-70%) cause of cirrhosis of liver. Synonims: hobnail/ cirrhosis, nutritional cirrhosis, diffuse cirrhosis, Laennec’s cirhhosis, portal cirrhosis 29 Ramya Deepthi P
  • 30. Morphology Gross: • Begins as a micro nodular type with nodule less than 3mm in size. • The liver is firm, enlarged, more than 2kgs in weight. • Appears yellow & greasy. • Later the size shrinks to almost about a kg due to fibrosis, which appears as macro nodules 30 Ramya Deepthi P
  • 31. Microscopic changes Like any other form of cirrhosis, the 3 basic features are- • Lobular architecture: disruption of normal architecture, central veins are hard to find • Fibrous bands: the fibrous septae are initially thin, delicate and later becomes into bands and as time goes by becomes dense. • Hepatic parenchyma: nodules show fatty changes in hepatocytes, as fibrosis extends fatty changes decreases. 31 Ramya Deepthi P
  • 32. CLINICAL FEATURES • Discomfort in right upper quadrant due to mild hepatomegaly • Anorexia • Malaise • Weight loss • Loss of appetite • Jaundice • Ascites • Peripheral edema • Distended 32 Ramya Deepthi P
  • 33. Laboratory investigations • Enzyme assay- SGOT, SGPT,SGGT • Serum alkaline phosphatase • Serum bilirubin • Serum protein • Prothrombin time • Haemogram. 33 Ramya Deepthi P
  • 34. Prognosis • Patients without jaundice, Ascites or heatemesis and are abstainers from alcohol have 90% five year survival. • Cause of death in alcoholic cirrhosis could be due to –  Hepatic coma  Massive gastrointestinal bleeding  Infections  Hepatocellular carcinoma 34Ramya Deepthi P
  • 35. A healthy live depends on healthy diet, regular exercise & healthy life style 35Ramya Deepthi P