Liver cirrhosis
(necrosis+regeneration+fibrosis)
Destruction of hepatic architecture
Etiology ;
1-parenchymal a-alcoholic
b-post-viral B,C.
2- biliary
a-primary biliary cirrhosis
b-secondary to biliary obstruction
1-congenital(biliary atresia)
2- primary sclerosing cholngitis.
3-traumatic stenosis
Etiology of liver cirrhosis (cot.)
3-hepatic veinous out flow obstruction
a-Budd-chiari syndrome
b-sever chronic congenital heart failure
4-metabolic iron, copper over load
5-nutritional
6-Idiopathic
Liver cirrhosis cont.
Liver cirrhosis lead to
1- hepatocellular insufficiency
2 -portal hypertention
Manifestation of hepato-cellular insufficiency
1-s-albumin decrease
2-bleeding tendency
3-jaundice
4-encephalopathy high amonia
5-ascitis
6-testicular atrophy
7-associatted disease
CHILD`s classification
Group A
Group B
Group C
Bilirubin mg/dl
<2.0
2.0-3.0
>3.0
Albumin mg/dl
>3.5
3.0-3.5
<3.0
ascitis
none
Easily controlled
Poorly controlled
Neuological disorder
none
minimal
advanced
nutrition
excellent
good
wasting
Treatment of liver cirrhosis;
Liver birrhosis is irreversible
1- CHO,
2- VIT.,
3- ovoid alcohol
Portal hypertension
Normal pressure 7mmHg
Portal hypertension >20 mmHg
Etiology due to interference to portal blood flow
1-prehepatic a- congenital malformation of.p.v.
b- portal vein thrombosis
c- obstruction of portal vein by tumour
2-hepatic a-liver cirrhosis
b-bilharzial periportal fibrosis
3-post-hepatic a- Budd-chiari syndrome
b-congenital obliteration
c-obstruction of hepatic vein by tumour
THE MOST COMMON CAUSE IS LIVER CIRRHOSIS
INVESTIGATION FOR PORTAL HYPERTENSION
1-LIER FUNCTION TEST
2-DETECTION OF OSPHAGEAL VARICES
a-endoscope
b-Ba. Swallowing
c-doppler study
3-HYPERSPLEENISM
a-pancytopenia
b- bone marrow examination
c-isotop study spleen/liver index of RBC with cr51
4-ETIOLOGY liver biopsy ,immunological study
Portal hypertension(cont.)
It cause
1-port-systemic collateralsesophagea varices
2-splenomegally pancytopenia
3-ascites
Esophageal varices
1-silent
2-active bleeding
3-history of bleeding
Management of active bleeding
A-resuscitation
1-i.v. fluid,blood
2-correction of coagulopathy
vit-k, fresh frozen plasma, platelet
3-prevention of encephalopathy
colonic lavage
oral lactulose.
neomyocin
Esophageal varices(cont,)
B-stopping of bleeding 1-endoscopic sclerotherapy (ethanolamine oleate) 2-endoscopic band ligation 3-drug vasopressin, somatostatin 4-ballon tamponate by Sengestaken tube rebleeding in 60% . Temporary 5-Transjuglar intrahepatic porto-systemic shunt TIPSS 6-emergency surgery –splenectomy porto-azygos disconnection stapling of esophagus
Treatment of patient with history of bleeding
1-B-blocker
2-endoscopic banding,sclerotherapy
3-elective surgery
a-porto-systemic shunt surgery
1-selective spleno-renal shunt
2-non- selective porto-caval shunt
b-pota-azygos disconnection surgery
c- liver transplantation after TIPSS
contraindication
1-age >65
2-heart failure
3-respiratory failure
Ascites in liver disease
Transudate fluid in the peritoneum
Etiology 1-portal hypertension
2-hypoalbunaemia
3-high aldosterone,ADH
exclude other cause of ascites by investigation
Treatment 1-salt restriction
2-Diuretic
3-abdominal paracentesis
4-peritoneovenous shunt
5-TIPSS
6-Liver transplantation
