Post Hepatitis and Cryptogenic Cirrhosis Cardiac, Cirrhosis, Metabolic, Hereditary, Drug Related Cirrhosis

POST HEPATITIC AND CRYPTOGENIC CIRRHOSIS

• Post hepatitis or post necrotic cirrhosis may follow any chronic liver disease.
• Cryptogenic cirrhosis is cirrhosis of unknown etiol­ogy.

POST HEPATITIC Cirrhosis Etiology

• · Cirrhosis may follow viral hepatitis B or C.
• · It is especially common in high-risk groups ­multiple sexual partners, injection drug users, following blood transfusion.
• · Non alcoholic fatty liver disease.
• · Autoimmune hepatitis.

POST HEPATITIC Cirrhosis Clinical features

• · Signs and symptoms related to portal hyperten­sion and liver damage.

POST HEPATITIC Cirrhosis Treatment

• Management of portal hypertension.
• Treatment of primary disorders like Wilson’s dis­ease, hemachromatosis.

CARDIAC CIRRHOSIS

• Prolonged, severe, right-sided congestive heart fail­ure leads to chronic liver injury and cardiac cirrhosis.
• There may be reversible passive congestion of liver due to acute heart failure leading to chronic hepato­cellular necrosis, fibrosis, regenerative nodules and cirrhosis.

CARDIAC CIRRHOSIS Etiology

• · Right sided ,heart failure as in mitral stenosis.
• · Reduced car€Jiac output.
• · Nutmeg liver is congestive liver with pale (fibrotic) areas.

CARDIAC CIRRHOSIS Clinical features

• · Mild jaundice
• · Liver dysfunction
• · Hepatomegaly – firm, non tender
• • *Ascites
• · Peripheral edema
• · Oesophageal bleeding
• · Encephalopathy.

CARDIAC CIRRHOSIS Lab diagnosis

• · Raised serum bilirubin
• · Raised alkaline phosphatase
• · Increased prothrombin time
• · Increased AST.

CARDIAC CIRRHOSIS Treatment

• Treat underlying cardiac disorder.

METABOLIC / HEREDITARY / DRUG RELATED CIRRHOSIS

• The etiology, clinical features, and treatment depends on the underlying pathology.

NONCIRRHOTIC FIBROSIS OF LIVER Causes:

• · Noncirrhotic portal hypertension (Indian child- hood cirrhosis)
• · Banti’s syndrome
• · Intrahepatic fibrosis
• · Portal and splenic vein sclerosis
• · Portal and splenic vein thrombosis
• · Schistosomiasis (pipe-stem fibrosis)
• · Congenital hepatic fibrosis associated with poly-
• cystic disease of liver and kidney.
• Indian childhood cirrhosis is a common cause of por­tal hypertension in India of unknown etiology.

NONCIRRHOTIC FIBROSIS Clinical features

• · Clinical features are secondary to portal hyper­tension.
• · There is no hepatocellular damage