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Liver Cirrhosis | Def.,Causes,clinical picture , Investigations & treatment

This is a review of Liver Cirrhosis , one of the most serious liver diseases with incidence of 500.000 cases per year in the US alone . We will include images and videos to help in illustration .

Definition of Liver Cirrhosis


Diffuse liver disease characterized by Degeneration , Fibrosis , Regeneration nodules and loss of architecture .

Causes of Liver Cirrhosis :






1. Alcoholic Steato-Hepatitis (ASH) .

2. Viral Hepatitis : HCV , HBV , HDV
3. Non- Alcoholic Steato-hepatitis (NASH) .
4. Auto-Immune Hepatitis .
5. Biliary Cirrhosis .
6. Cardiac Cirrhosis .
7. Haemochromatosis .
8. Wilson's disease .
9. Rare causes : - Alpha 1 anti-trypsin deficiency .
                         - Toxins : methotrexate , isoniazide and methyldopa .
10. Cryptogenic (idiopathic ) cirrhosis .

Clinical Picture of Liver Cirrhosis :



A. Latent Cirrhosis ( Compensated ) :

· Early in the disease , there is no impairment of liver functions .

· The patient is discovered accidentally .

· An enlarged and maybe an enlarged spleen are found during examination or imaging of the patient for a non-related condition . 

B. Manifest Cirrhosis ( Decompensated ) :

Late in the disease there will be :

· Features of Hepatocellular failure .

· Features of Portal hypertension .

· Hepatocellular carcinoma (HCC) may occur .

· Shrunken liver and Splenomegaly .

C. Specific Features
Related to the causes of cirrhosis .
Video illustrating Liver Cirrhosis 
Investigations for liver cirrhosis :

1.      Ultrasonography : will show coarseness & nodularity of liver tissue plus attenuation of hepatic veins . it can also diagnose portal ++ and HCC .


2.      Liver Function tests  : INR , albumin & bilirubin + CBC .
3.      Endoscopy : to diagnose portal ++
4.      Alpha Foetoprotein : for early detection of HCC ( if more than 400 ng% ) .
5.      Liver biopsy : to diagnose  cirrhosis and it's aetiology .
6.      Specific investigations for the cause of cirrhosis .

Child - Pugh classification 
this is a classification for assessment of severity of cirrhosis .
- The patient is classified as Child A , B or C depending on
* Encephalopathy and Ascites .
* Bilirubin , Albumin and Prothrombin .

Treatment of Liver cirrhosis :


it relies on treatment of theCause and treatment of Complications to avoid further injury of liver tissue .

Complications include Portal Hypertension and HCC and details of treatment of those complications will be discussed later on .
Diet in Liver Cirrhosis :
avoid: alcohol and high-fat foods and the rest is as normal ,,, this is the golden rule .
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Tamer Mobarak

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