Liver cirrhosis : Etiology , Pathology , Clinical manifestations , Diagnosis , Treatment

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Liver cirrhosis -
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Liver Cirrhosis is a chronic, progressive liver disease characterized by irreversible scarring (fibrosis) of the liver tissue, leading to impaired liver function. It results from long-standing injury to the liver due to various causes such as chronic alcohol abuse, viral hepatitis (especially hepatitis B and C), non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis, and other metabolic disorders like hemochromatosis and Wilson’s disease. In cirrhosis, the normal liver architecture is replaced by fibrotic tissue and regenerative nodules, disrupting the organ's ability to perform essential functions, including detoxification, protein synthesis, and regulation of biochemical pathways. 🧬🩺
Pathophysiology: Continuous liver injury triggers inflammation and activation of hepatic stellate cells, leading to collagen deposition and fibrosis. As fibrosis progresses, it disrupts the normal blood flow through the liver, increasing portal venous pressure (portal hypertension) and causing complications such as esophageal varices, splenomegaly, and ascites. Over time, cirrhosis can progress to liver failure, where the liver loses its ability to regenerate and sustain normal function.
Clinical Presentation: Symptoms of cirrhosis may vary based on the stage of the disease. Early stages are often asymptomatic, while advanced stages present with fatigue, jaundice, pruritus (itching), easy bruising, and signs of portal hypertension like ascites (abdominal fluid accumulation), spider angiomata, and caput medusae (dilated abdominal veins). In severe cases, hepatic encephalopathy may occur, characterized by confusion, altered mental status, and asterixis (flapping tremor).
Diagnosis: Diagnosis is made through clinical evaluation, imaging, and laboratory tests. Blood tests may reveal elevated liver enzymes, low albumin, prolonged prothrombin time, and thrombocytopenia. Imaging studies such as ultrasound, CT, or MRI can show nodular liver surface and signs of portal hypertension. A liver biopsy remains the gold standard for confirming cirrhosis and assessing the extent of fibrosis.
Management: Treatment focuses on managing complications, slowing disease progression, and treating the underlying cause. Abstinence from alcohol, antiviral therapy for hepatitis, weight management, and controlling blood sugar levels in NAFLD are crucial. Medications such as diuretics for ascites, beta-blockers for varices, and lactulose for hepatic encephalopathy are used to manage symptoms. In advanced cases, liver transplantation may be the only definitive treatment.
Complications: Cirrhosis can lead to life-threatening complications including variceal bleeding, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatocellular carcinoma (HCC). Regular monitoring and screening for HCC and varices are essential parts of management.
Liver cirrhosis significantly impacts quality of life and increases morbidity and mortality; thus, early detection and management are vital to improving patient outcomes. 🚨🩹
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[@amolkelkar7231]

Nice video

[@doctorbhanuprakash]

Thanks

[@shamakuma1967]

Mercaptans.