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