Chronic liver failure pathogenesis and complications Pratyush kumar
Chronic liver failure pathogenesis and complications
Pratyush kumar
Pattern of liver injury
Degeneration
Necrosis and apoptosis
inflammation
Regeneration /fibrosis
Degeneration and intracellular accumulation
Toxic and immunologic insult
Cell swelling
Degeneration
Feathery and balloning
Accumulation of Fe , Cu, triglycerides
Steatosis
Microvascular and macrovesicular
Necrosis and Apoptosis
Ischemic coagulative necrosis
• Mummified cells
• poor staining
• lysed nuclei
Apoptotic cell death
• Shrunken cells,pyknosis
• , intensely eosinophilic
• fragmented nuclei
Lytic necrosis
• Osmotically swell
• rupture
• Centrilobular necrosis
• Periportal and midjonal necrosis are rare
• Bridging necrosis
• Submassive necrosis
• Massive necrosis
INFLAMMATION
Influx of acute and chronic inflammatory cells
Collection of quiescent lymphocytes in portal tract
Kupffer cell engulf the apoptotic cell fragments
Regeneration
• Longer life span
• Mitoses,thickening of hepatocyte cord,disorganization of parenchyma
• DUCTULAR REACTION
• If connective tissue framework is intact almost perfect iver restitution may occur
Fibrosis
• Irreversible hepatic damage
• Sites of collagen deposition
• Nodule formation
• cirrhosis
Portal hypertension and varices
• Portal pressure >12 mm of hg
• Pre,intra and post hepatic cause
• Portosystemic shunting to lower portal pressure
• Development of collateral circulation
• Recurrents bouts of haemorrhage
Complications
• Hepatic encephalopathy
– Disorder of neurotransmission in cns and neuromuscular system
– Increased level of ammonia
– Confusion to coma
– Edema and astrocytic reaction
• Hepatorenal disease
– Renal failure without any intrinsic or functional cause of renal failure
– Sodium retention,
– Decreased renal perfusion
– Decrease GFR
– Ability to concentrate urine retained
• Hepatopulmonary syndrome
– Chronic liver disease +hypoxemia+IPVD
– Ventilation perfusion mismatch
– Limitation of oxygen diffusion
– Increase synthesis of NO
Thank you