Overview of Cirrhosis

• Cirrhosis: Progressive, chronic destruction of the liver.
• Characterized by extensive fibrosis (scarring) leading to shrinkage and loss of liver function.
• Often results from chronic liver injury.

Causes of Cirrhosis:

1.  Alcoholic Liver Disease and Stages:

a) Initial stage: Fatty liver (Steatosis)

• • Accumulation of triglycerides within hepatocytes.
  • Liver enlarges (hepatomegaly).
  • Usually reversible with alcohol cessation.

b) Next stage: Alcoholic hepatitis

• • Significant inflammation.
  • Cell death.
  • Usually not reversible.
  • Symptoms: Nausea, anorexia, tender liver.

c) Final stage: End-stage Cirrhosis

• • Extensive fibrosis and muscle atrophy.
  • Loss of function.
  • Portal hypertension develops.

2.  Viral Hepatitis:

• Chronic infections (especially Hepatitis B and C).
• Causes tissue destruction, fibrosis, and cirrhosis.
• Post-necrotic cirrhosis: caused by long-term viral or toxic injury.

3.  Other Causes:

• Biliary cirrhosis: autoimmune diseases affecting bile ducts.
• Gallstones: cause blockages.
• Cystic fibrosis: excess mucus blocks bile flow.
• Toxins: drug toxicity or environmental toxins.
• Genetic diseases affecting nutrient storage.

Pathophysiology and Macroscopic Changes

• Initial stage: Liver enlarges due to inflammation.
• Fibrosis and scarring replace healthy tissue.
• Atrophy occurs, leading to shrinking liver.
• Blood flow becomes obstructed, causing portal hypertension.
• Bile duct scarring causes bile backup (biliary stasis).

Complications

• Portal hypertension leads to:
  • Ascites: Fluid buildup in the abdominal cavity.
  • Varices (enlarged veins).
  • Risk of bleeding and hemorrhage.
• Impaired liver functions:
  • Decreased gluconeogenesis.
  • Reduced protein and bile production.
  • Inability to detoxify blood.

Signs and Symptoms of Cirrhosis

• Fatigue, weakness.
• Jaundice: due to bilirubin buildup.
• Ascites: abdominal swelling.
• Edema and varices.
• Impaired glucose regulation:
  • Decreased gluconeogenesis.
  • Decreased glycogen storage.
• Reduced bile secretion → impaired fat digestion and absorption.
• Bleeding tendencies: due to clotting factor deficiencies.

Summary

• Cirrhosis results from ongoing liver damage, often from alcohol or viral hepatitis.
• Leads to significant fibrosis, vascular changes, and organ failure.
• Early detection and lifestyle modifications are critical to slow progression and prevent complications.