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cirrhosis

cirrhosis

Pathology:

  • a generic term for an end stage of chronic liver disease characterised by destruction of hepatocytes & loss of normal hepatic architecture, with replacement by fibrotic tissue & regenerative nodules

3 broad categories:

Laënnec's:

  • a diffuse process with involvement of the entire lobule
  • most often related to chronic alcohol ingestion:
    • 10-20% of chronic alcoholics develop this type of cirrhosis
    • dependent on:
      • amount & duration of alcohol ingestion
      • heredity
      • underlying nutritional status

post-necrotic:

  • usually non-homogeneous, characterised by regions of fibrosis & hepatocyte loss alternating with normal areas
  • most often a consequence of chronic hepatitis of divergent aetiologies:
    • infectious:
      • viral:
        • 50% of pts with hep C develop cirrhosis - most within 5-10yrs
        • 10% of pts with hep B alone (10% of whom will develop hepatoma):
        • 5% pts with coinfection with hep D
        • 80% pts with superinfection with hep D
      • bacterial
      • fungal
    • drug induced
    • metabolic

biliary:

Clinical findings:

  • chronic fatigue
  • poor appetite
  • many can be asymptomatic (except for biliary cirrhosis) until they develop some dramatic complication:
  • cirrhosis is the main cause of hepatocellular carcinoma
  • pts with biliary cirrhosis generally complain of pruritus or develop obvious jaundice before end stage cirrhosis or complications begin
  • physical findings which may be present:
    • muscle wasting
    • thinning of skin with patchy ecchymosis
    • spider angiomata
    • palmar erythema
    • Dupuytren's contracture
    • gynaecomastia
    • testicular atrophy
    • jaundice - usually absent in mild or early cases
    • liver may not be palpable if it is extensively scarred, but a large regenerative nodule, tumor or fatty infiltration can result in hepatomegaly
    • advanced disease:
  • laboratory findings:
    • ALT is rarely more than minimally elevated
    • bilirubin may be increased but usually not until advanced stages
    • sharp elevation of AP out of proportion to other liver enzymes suggests primary sclerosing cholangitis / primary biliary cirrhosis
    • coagulation studies commonly abnormal
    • hypoalbuminaemia due to impaired hepatic synthesis
    • mild-mod. anaemia & thrombocytopenia are often present in Laënnec's
    • elevated urea or CRN should suggest dehydration or hepatorenal syndrome
cirrhosis.txt · Last modified: 2019/03/15 11:30 by wh