Cirrhosis and Portal Hypertension

Posted by e-Medical PPT Saturday, October 16, 2010
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leading to loss of liver function.
Cirrhosis has many possible causes. In the Western World, chronic alcoholism and hepatitis C are the most common causes.
* Alcoholic liver disease . Alcoholic cirrhosis develops for between 10% and 20% of individuals who drink heavily for a decade or more.AST and ALT are both elevated but less than 300 IU/L with a AST:ALT ratio more than 2.0, a value rarely seen in other liver diseases. Liver biopsy may show hepatocyte necrosis, Mallory bodies, neutrophilic infiltration with perivenular inflammation.
* Chronic hepatitis C.Cirrhosis caused by hepatitis C is the most common reason for liver transplant.
* Chronic hepatitis B. The hepatitis B virus causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is dependent on the presence of hepatitis B, but accelerates cirrhosis in co-infection.
* Non-alcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.
* Primary biliary cirrhosis. May be asymptomatic or complain of fatigue, pruritus, and non-jaundice skin hyperpigmentation with hepatomegaly. There is prominent alkaline phosphatase elevation as well as elevations in cholesterol and bilirubin. Gold standard diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid bile duct lesions.
* Primary sclerosing cholangitis. PSC is a progressive cholestatic disorder presenting with pruritus, steatorrhea, fat soluble vitamin deficiencies, and metabolic bone disease. There is a strong association with inflammatory bowel disease (IBD), especially ulcerative colitis.
* Autoimmune hepatitis. This disease is caused by the immunologic damage to the liver causing inflammation and eventually scarring and cirrhosis. Findings
* Hereditary hemochromatosis. Usually presents with family history of cirrhosis, skin hyperpigmentation, diabetes mellitus, pseudogout, and/or cardiomyopathy, all due to signs of iron overload.
* Wilson's disease. Autosomal recessive disorder characterized by low serum ceruloplasmin and increased hepatic copper content on liver biopsy. May also have Kayser-Fleischer rings in the cornea and altered mental status.
* Alpha 1-antitrypsin deficiency (AAT). Autosomal recessive disorder. Patients may also have COPD, especially if they have a history of tobacco smoking. Serum AAT levels are low. Recombinant AAT is used to prevent lung disease due to AAT deficiency.
Others - Cardiac cirrhosis(in Right heart failure),Galactosemia,Glycogen storage disease type IV,Cystic fibrosis,Hepatotoxic drugs or toxins and Certain parasitic infections (such as schistosomiasis)

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1 Response to Cirrhosis and Portal Hypertension

  1. Dr. Azadi Says:
  2. very nice presentation. i want to know more about Primay Scelrosing cholangitis.

     

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