Liver cirrhosis- classification, etiology, pathogenesis, clinical manifestations, and complications.
Cirrhosis is a diffuse, chronic liver disease characterized by fibrosis and the conversion of normal liver architecture into regenerative nodules, leading to loss of liver function and distorted vascular architecture.
Classification
By morphology
By etiology
Etiology
- Alcohol abuse (most common in Western countries).
- Chronic viral hepatitis (HBV, HCV).
- Non-alcoholic fatty liver disease (NAFLD).
- Biliary diseases (primary or secondary).
- Genetic/metabolic: hemochromatosis, Wilson’s disease, alpha-1-antitrypsin deficiency.
- Chronic right heart failure (cardiac cirrhosis).
Pathogenesis
- Chronic liver injury (toxic, viral, metabolic) → hepatocyte death.
- Activation of hepatic stellate (Ito) cells → transformation into myofibroblasts → excessive collagen deposition (fibrosis).
- Formation of fibrous septa and regenerative nodules → disruption of sinusoidal blood flow and bile flow.
- Progressive distortion of architecture → portal hypertension and hepatocyte dysfunction.
Clinical manifestations
General
- Fatigue, weakness.
- Weight loss, muscle wasting.
- Anorexia, nausea.
Signs of liver dysfunction
- Jaundice.
- Coagulopathy → easy bruising, bleeding.
- Hypoalbuminemia → peripheral edema.
Portal hypertension signs
- Splenomegaly → cytopenias.
- Ascites.
- Esophageal and gastric varices → risk of bleeding.
- Caput medusae (dilated periumbilical veins).
- Hemorrhoids.
Hormonal/ metabolic signs
- Gynecomastia, testicular atrophy (due to increased estrogen ).
- Spider angiomas.
- Palmar erythema.
Neurologic
- Hepatic encephalopathy → confusion, asterixis, coma.
Complications
- Portal hypertension complications: variceal bleeding, ascites, spontaneous bacterial peritonitis.
- Hepatorenal syndrome: renal failure due to severe liver dysfunction.
- Hepatopulmonary syndrome: hypoxemia due to intrapulmonary vasodilatation.
- Hepatocellular carcinoma: increased risk in cirrhotic livers.
- Coagulopathy and infections: due to reduced synthetic function and immune dysfunction.