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 .