cirrhosis. Dr akhondei. cirrhosis. Cirrhosis is a pathologically defined entity that is associated with a spectrum of characteristic clininical manifestation 1-Irreversible chronic injury of the hepatic parenchyma 2-Extensive fibrosis 3-formation of regenerative nodules.
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1-Irreversible chronic injury of the hepatic parenchyma
3-formation of regenerative nodules
Cirrhosis of the liver is the third leading cause of death in people between the ages of 25 and 65 years, exceeded only by cardiovascular disease and cancer.
The cost of cirrhosis in terms of human suffering, financial burden, and loss of productive life is devastating.
Detection of the peripheral stigmata ofchronic liver disease such as
hepatic encephalopathy or one or more complications or systemic manifestations of hepatocellular carcinoma
In some cases, no cause can be determined and the cirrhosis is
* Refers to primary prophylaxis
Cirrhosis, even if early and stable, predisposes to development of primary hepatocellular carcinoma in as many as 3% of patients per year.
Until recently, little could be done to alter the prognosis of patients with cirrhosis and most died of complications. Today, the outlook has begun to change because of advances in orthotopic liver transplantation and development of therapies to prevent and treat complications.
The paradigm of satellite cell activation provides an important framework to define potential sites of antifibrotic therapy follows
Antiviral therapy for chronic hepatitis C and B,
Corticosteroids (with or without immunosuppressive therapy) for autoimmune hepatitis,
Phlebotomy for hereditary hemochromatosis,
Penicillamine for Wilson's disease.
In some cases, even hepatic fibrosis can be reversed; examples include abstinence from alcohol in alcoholic liver disease and immunosuppressive therapy in autoimmune hepatitis
30 - 50 Years
Progression of Hepatitis B Infection
Portal hypertension is the most common and lethal complication of chronic liver disease
All patients with cirrhosis should be evaluated for the presence of varices because of the beneficial effect of prophylaxis with propranolol or nadolol
Patients with most forms of cirrhosis, particularly due to hepatitis B and C, hereditary hemochromatosis, and alcoholic liver disease, are at high risk (1 to 6 percent per year) for the development of hepatocellular carcinoma
Clear chronic viral infection
Abstinence from alcohol,stop toxic drugs
Remove iron ,copper in overload disease
Reverse biliary obstruction
Revers jejunoileal bypass
Resident Teaching Conference
End result of anything that causes hepatocellular
Pathologic response is uniform
Ischemia & autoimmune factors thought
to play a role, although mechanism is not
Postsinusoidal - overall rare
Calculators on the web
1% increase in mortality with each integer rise in
Additional 2% increase in mortality with each integer
rise in MELD score
Rebleeding rates similar to endoscopic