LIVER CIRRHOSIS

Defined as irreversible chr injury to hep parenchyma wth ext fibrosis n formatn f regenertn nodules wth disruptn f architectur f entire liver.

Clasificatn

1-micronodular-reg nodule less than 3mm

2-macronodular-more than 3mm

3-mixed
pathogenesis
stimulant(cytokines,toxins)-stimulatn f hepatic stelate cels-stelate cels transform into myofibroblast lke cels-dpostn f colagen in space f disse-new vascular chanel form in septa-continuous dpostn f colagen leads to los f fenestratn in sinusoid endothelial cels-exchange f solute bet plasma n hepatocyteis impaird-toxic concn f fibroblast lead to constrictn f sinusoid vascular channels-thruout damage n fibrosis rmaining hepatocyte r stimulatd to form fibrotic nodule.



C/f

sym-
low grade fever,weaknes,fatigue,wt loss,anorexia,naus n vomit,uper abd discomfort,los f libido,menstrual irregularities,sym f portal htn.

Sign
-jaundic,parotid enlargement,diminishd body hair,spider naevai,palmar erythma,duptyrens contracture,clubbing,white nail,flaping tremors,gynacomastia,testicular atrophy,ascites,breast atrophy.

Complictn

portal htn,ascites,sbp,he,renal failur,port vein throbosis,hcc,hemolytic manifestatn.

Inv

cbc,lft-serum prot,albumin level,pt,hep b n c marker,blod ammonia,resp alkalosis,glucose intolerance,hyponatremia,hypokalemia,usg-liver size,macronodule,ascites,colaterls,liver biopsy,ascitic fluid exam.

Rx

rx f underlying cause,removal f causatve drug like alc,high protein diet,2000 to 3000kcal p day,diet rich n branched chain fa,mv,thiamine,penicilin,specific rx f complicatn.