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. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

Types:
Alcoholic Cirrhosis

- in which the scar tissue characteristically surrounds the portal areas. - the most common type of cirrhosis. Postnecrotic Cirrhosis - in which there are broad bands of scar tissue. - this is a late result of a previous bout of acute viral hepatitis Biliary Cirrhosis - in which scarring occurs in the liver around the bile ducts. - usually results from chronic biliary obstruction and infection.

 Alcohol

Obesity
Drugs and Toxins Genetic Disorders such as cystic fibrosis, Wilson's

disease, alpha-1 antitrypsin and glycogen-storage diseases Blocked Bile Ducts Age Hepatitis

Causes:
Alcoholism Hepatitis B and C Fatty liver disease Blockage of the bile duct Repeated bouts of heart failure with fluid backing up into

the liver. Certain inherited diseases such as: Cystic fibrosis. Glycogen storage diseases Alpha 1 antitrypsin deficiency Diseases caused by abnormal liver function, such as hemochromatosis

Clinical Manifestations:

Signs and symptoms of cirrhosis increases in severity as the disease progresses. The severity of the manifestations helps to categorize the disorder as compensated or decompensated cirrhosis.

Compensated Cirrhosis

- with its less severe, often vague symptoms, may be discovered secondarily at a routine physical examination.
Decompensated Cirrhosis

- the hallmarks result from failure of the liver to synthesize proteins, clotting factors, and other substances and manifestations of portal hypertension.

1. Liver Enlargement - early in the course of cirrhosis, the liver tends to be large and the cells are loaded with fat.
2.

Portal Obstruction and Ascites Ascites -an abnormal accumulation of serous fluid in the abdominal cavity. - late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation.

3. Infection and Peritonitis - bacterial peritonitis - ascites develop in the absence of an intraabdominal source of infection or an abscess.

4. Gastrointestinal Varices - the obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessel into blood vessels with lower pressure. 5. Edema - another late symptom of cirrhosis is edema, which is attributed to chronic liver failure. A reduced plasma albumin concentration predisposes the patient to the formation of edema. 6. Vitamin deficiency and Anemia - because of inadequate formation, use, and storage of certain vitamins, signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency.

7. Mental Deterioration - additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma. 8. Abdominal indigestion or pain 9. Confusion or problems thinking 10. Impotence, loss of interest in sex, and breast development (gynecomastia) in men 11. Nausea and vomiting 12. Nosebleeds or bleeding gums 13. Pale or clay-colored stools 14. Small, red spider-like blood vessels on the skin 15. Swelling or fluid buildup of the legs (edema) and in the abdomen (ascites) 16. Vomiting blood or blood in stools 17. Weakness 18. Weight loss 19. Yellow color in the skin, mucus membranes, or eyes (jaundice) 20. Fever