1. Cirrhosis-
Tawny
Lecture 20

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
alcohol induced liver disease.
• Derived from Greek word Kirrhos means
Yellowish brown color.

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

6. Morphology
• Its three main morphologic characteristics
are:
• 1.Bridging fibrous septa
• 2. Parenchymal nodules- micro & macro
• 3. Disruption of the architecture of the entire
liver.

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

8. • Obesity
• Nonalcoholic fatty liver disease
• Autoimmune hepatitis
• Diseases that damage or destroy bile ducts.
• Inherited diseases
• Drugs, toxins & toxins

9. 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

12. Pathophsiology :
Liver insult due to alcohol ingestion, viral hepatitis,
exposure to toxin
Hepatocyte damage
Liver inflammation - ↑WBCs, nausea, vomiting, pain,
fever, anorexia, fatigue
Alteration in blood and lymph flow

13. Cont..
Liver necrosis →liver fibrosis and scarring → portal
hypertension
- Ascities, edema,
- Spleenomegaly ( thrombocytopenia, leucopenia)
- Varices (esophageal varices, hemorrhoids, anemia)
↓ billirubin metabolism – hyperbilirubinemia,
jaundice

14. Cont..
• ↓ bile in gastrointestinal tract – light colored stool
• ↑ urobilinogen – Dark Urine
• ↓ vit K absorption- bleeding tendency
• ↓ metabolism of protein, carbohydrate, fats→
hypoglycemia,
• ↓ plasma protein- ascites and edema
• ↓androgen and estrogen detoxification(↓
hormone metabolism)- ↑ estrogen and androgens
hormone – Gynecomastia, loss of body hair,
menstrual dysfunction, spider angioma, palmer
erythema, testicular atrophy

15. Cont..
• ↓ Aldesterone metabolism so ↑ levels – sodium
and water retention-- edema
• Biochemical alteration - ↑ AST, ALT levels, ↑
bilirubin, low serum albumin, prolong prothombin
time, elevated alkaline phosphatase.
• Liver failure
• Hepatic encephalopathy
• Hepatic coma
• Death

16. 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.

17. 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

18. Clinical Manifestations

19. 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.

20. Complication
Portal hypertension
• The nodules and scar tissue can compress
hepatic veins within the liver.
• This causes the blood pressure within the liver to
be high, a condition known as portal
hypertension.
• Portal venous pressure is more than 15mmHg or
20 cm of water (normal 5-10mm Hg)

21. Cont…
• Is characterized by ↑venous pressure in the
portal circulation, spleenomegaly, large collateral
vein, ascites, systemic hypertension, and
esophageal varices.
• The common area to form collateral channels are
in the lower esophagus( the anastomosis of the
left gastric vein and azygos vein), the parietal
peritoneum, rectum.
• High pressures within blood vessels of the liver
occur in 60% of people who have cirrhosis.