To be familiar with the cause, pathogenesis, histopathology, clinical presentation and course of macronodular cirrhosis. OBJECTIVES 1. Examine these images and note the features present, particularly those that define macronodular cirrhosis. 2. [medicine.tamu.edu]

OBJECTIVE: Patients with hepatocellular carcinoma (HCC) presenting with nonmicronodular or micronodular cirrhosis are usually treated by hepatectomy. [ncbi.nlm.nih.gov]

[…] type (9 cases) in alcoholic cirrhosis. 3) Secondary biliary cirrhosis due to congenital biliary atresia was presented in 5 children. [jpatholtm.org]

It may occasionally present with shortness of breath(due to large R pleural effusion) or with hepatopulmonary syndrome. [brainscape.com]

Regarding complications, one case (2.43%) presented deep venous thrombosis, one case (2.43%) presented heterotopic ossification classified as Brooker18 grade 3, and one case (2.43%) presented transient paresthesia of the pudendal nerve. [scielo.br]

• Weight Loss

  Symptoms may not develop for years and are often nonspecific (eg, anorexia, fatigue, weight loss). Late manifestations include portal hypertension, ascites, and, when decompensation occurs, liver failure. Diagnosis often requires liver biopsy. [msdmanuals.com]

  A loss of 4% to 10% body weight is recommended, with 10% to 40% weight loss completely reversing NASH without cirrhosis. [en.wikipedia.org]

  Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight. Reduce your risk of hepatitis. [mayoclinic.org]

  Affected individuals can experience fatigue, weakness, loss of appetite, weight loss, nausea, swelling (edema), enlarged blood vessels, and yellowing of the skin and whites of the eyes (jaundice).People with cryptogenic cirrhosis may develop high blood [icdlist.com]

  Clinical Consequences Nonspecific Symptoms Fatigue, anorexia, and weight loss are common nonspecific symptoms of cirrhosis. [pathwaymedicine.org]

• Non-Alcoholic Cirrhosis

  2014 ICD-9-CM Diagnosis Code 571.5 Cirrhosis of liver without mention of alcohol 2014 Billable Thru Sept 30/2015 Non-Billable On/After Oct 1/2015 Short description: Cirrhosis of liver NOS. [icd9data.com]

• Easy Bruising

  Cirrhosis can lead to Easy bruising or bleeding, or nosebleeds Swelling of the abdomen or legs Extra sensitivity to medicines High blood pressure in the vein entering the liver Enlarged veins called varices in the esophagus and stomach. [fpnotebook.com]

  Cirrhosis can cause weakness, loss of appetite, easy bruising, yellowing of the skin (jaundice), itching, and fatigue. Diagnosis of cirrhosis can be suggested by history, physical examination and blood tests, and can be confirmed by liver biopsy. [medicinenet.com]

  Anorexia, early satiety, dyspepsia, altered bowel habits, and easy bruising and bleeding also are reported often. [medical-dictionary.thefreedictionary.com]

• Jaundice

  Pruritus is reported when significant jaundice is present. [medical-dictionary.thefreedictionary.com]

  Structural changes in the liver may cause impairment of hepatic function manifested as: jaundice portal hypertension and varices ascites hepatorenal syndrome spontaneous bacterial peritonitis hepatic encephalopathy ultimately hepatic failure This definition [mergersdrugfil.com.ph]

  13.5 Cirrhosis of the liver Pictures Ascites, liver cirrhosis: Ascites, liver cirrhosis, Macro, autopsy (70346) Ascites: Ascites, Macro, autopsy (72476) Eyes, jaundice: Eyes, jaundice, Macro, autopsy (70350) Eyes, jaundice, Macro, autopsy (70351) Kidney [atlases.muni.cz]

• Fetor Hepaticus

  Fetor hepaticus. Palmar erythema. Terry's nails. Kayser-Fleischer rings. Tattoos. IV tract marks. What is the Child-Pugh scoring system for cirrhosis. It is used to predict the prognosis of cirrhotic patients. [brainscape.com]

  hepaticus (musty odor of breath and urine found in cirrhosis with hepatic failure) CHEST: Possible gynecomastia in men ABDOMEN: Tender hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable, nontender gallbladder (neoplastic [encyclopedia.lubopitko-bg.com]

  Others: Fetor hepaticus (sweet musty breath smell due to high levels of dimethyl sulfide and ketones in the blood) [17] and asterixis (flapping tremor when the arms are extended and the hands are dorsiflexed) are both features of hepatic encephalopathy [ncbi.nlm.nih.gov]

  This may be visible as an increase in abdominal girth.[13] Fetor hepaticus is a musty breath odor resulting from increased dimethyl sulfide.[14] Jaundice, or icterus is yellow discoloration of the skin and mucous membranes, (with the white of the eye [en.wikipedia.org]

• Scleral Icterus

  icterus BREATH: Fetor hepaticus (musty odor of breath and urine found in cirrhosis with hepatic failure) CHEST: Possible gynecomastia in men ABDOMEN: Tender hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable, nontender [encyclopedia.lubopitko-bg.com]

• Epistaxis

  Epistaxis. Gynacomastia (in men). Xanthelasma/xanthoma. Dupuytren's contracture. Clubbing. Dilated chest/abdominal wall veins (caput medusae). Scratch marks. Parotid enlargement. Collateral vessels. Variceal bleeding. Encephalopathy. [brainscape.com]

• Sexual Dysfunction

  dysfunction, and can eventually be fatal. [en.wikipedia.org]

• Dark Urine

  Hepatitis B Electron micrograph of hepatitis B virus Specialty Infectious disease, gastroenterology Symptoms None, yellowish skin, tiredness, dark urine, abdominal pain[1] Complications Cirrhosis, liver cancer[2] Usual onset Symptoms may take up to 6 [en.wikipedia.org]

• Amenorrhea

  Women can develop amenorrhea and irregular menstrual bleeding as well as infertility. Nail changes: Clubbing, hypertrophic osteoarthropathy, and the Dupuytren contracture are seen. [ncbi.nlm.nih.gov]

DIAGNOSIS WORKUP Diagnostic workup is aimed at identifying the most likely cause of cirrhosis. [encyclopedia.lubopitko-bg.com]

The workup revealed a possible liver mass, and a CT-guided FNA biopsy was performed. The presence of intact reticulin in the pigmented zones is consistent with cirrhosis due to hemochromatosis ( Fig. 6A, B ). [nature.com]

• Enlargement of the Spleen

  Splenomegaly Increased pressure in the portal vein is conducted to the splenic vein resulting in congestive enlargement of the spleen. Over time this can cause symptoms of hypersplenism such as thrombocytopenia. [pathwaymedicine.org]

  The scar tissue and regenerative nodules compress portal tracts and cause portal hypertension with dilatation of varicose veins at the lower part of the esophagus, enlargement of the spleen and fluid accumulation in the abdomen (ascites). [eurorad.org]

  The physical exam can show signs such as: pale skin yellow eyes (jaundice) reddened palms hand tremors an enlarged liver or spleen small testicles excess breast tissue (in men) decreased alertness Tests can reveal how damaged the liver has become. [healthline.com]

  Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets. [mayoclinic.org]

  […] of the spleen, enlargement of the veins in the oesophagus (gullet) (which may rupture to cause severe bleeding), and accumulation of fluid in the peritoneal cavity (ascites). [flipper.diff.org]

• Albumin Decreased

  decreased in chronic liver diseases. prothrombin time: increased in acute and chronic liver diseases. [quizlet.com]

• Hyperglobulinemia

  Significance of hyperglobulinemia in severe chronic liver diseases--with special reference to the correlation between serum globulin/IgG level and ICG clearance. Hepatogastroenterology. 2007 Dec;54(80):2301-5. [PubMed: 18265652] 21. [ncbi.nlm.nih.gov]

• Globulins Increased

  Findings include elevations in serum globulins, especially gamma globulins.[13] Hereditary hemochromatosis. [en.wikipedia.org]

• Hepatocellular Carcinoma

  Hepatocellular carcinoma is rare in infancy. This report describes the first documented case of congenital hepatocellular carcinoma associated with macronodular cirrhosis. [ncbi.nlm.nih.gov]

  AASLD Guidelines for the treatment of hepatocellular carcinoma 2016. 71. Bruix J, Sherman M. Management of hepatocellular carcinoma: An update. Hepatology. 2011;53(3):1020–2. 72. [scriptiebank.be]

  carcinoma, liver, gross [CT] Hepatocellular carcinoma with satellite nodules, liver, gross Hepatocellular carcinoma, liver, gross [CT] Hepatocellular carcinoma, liver, microscopic Hepatocellular carcinoma, liver, microscopic Hepatocellular carcinoma [ar.utmb.edu]

  Natural history and prognosis of adenomatous hyperplasia and early hepatocellular carcinoma: multi-institutional analysis of 53 nodules followed up for more than 6 months and 141 patients with single early hepatocellular carcinoma treated by surgical [ajronline.org]

• Liver Biopsy

  Secondary biliary cirrhosis MRCP, ERCP, liver biopsy Primary sclerosing cholangitis MRCP, ERCP, liver biopsy Autoimmune Autoimmune hepatitis ANA, IgG level smooth muscle antibodies, liver-kidney microsomal antibodies, liver biopsy Vascular Cardiac cirrhosis [abdominalkey.com]

  Histology: Liver biopsy (punction): no cirrhosis, increased amount of hemosiderin on the periphery of liver lobules. [atlases.muni.cz]

  METHODS: Forty-two patients with at least one liver biopsy strongly suggestive of ISC were selected for the study covering a period between 1968 and 1987. [ncbi.nlm.nih.gov]

Prednisone treatment tended to accelerate the conversion, but not significantly. [ncbi.nlm.nih.gov]

Review the latest developments in the field and get up-to-date clinical information on hot topics like polyps, capsule endoscopy, and pancreatic treatments. [books.google.de]

Treatment of Malum Coxae Senilis, Old Slipped Upper Capital Femoral Epiphysis, Intrapelvic Protrusion of the Acetabulum, and Coxae Plana by Means of Acetabuloplasty. [deepdyve.com]

Surgical treatment is indicated in cases when conservative treatment brings only temporary relief.9,10 Some authors claim that, since it is a mechanical condition, delaying surgical treatment of the FAI may not be beneficial to the patient. [scielo.br]

Treatment and prognosis depend on the correct assessment of these paramenters. CONTENTS [meddean.luc.edu]

Prognosis: The classic teaching is that cirrhosis is irreversible; however, there is increasing evidence that it regresses.[3][4][5] Special types: Garland cirrhosis (AKA holly leaf cirrhosis) - see primary biliary cirrhosis. [librepathology.org]

It is a landmark of the progression into the decompensated phase of cirrhosis and is associated with a poor prognosis and quality of life; mortality is estimated to be 50% in 2 years. [ncbi.nlm.nih.gov]

Prothrombin time: an elevated PT in patients with liver disease indicates severe liver damage and poor prognosis. 11. Presence of hepatitis B surface antigen implies acute or chronic active hepatitis B. 12. [encyclopedia.lubopitko-bg.com]

Clinical records of the cirrhosis patients were summarized, and morphologic as well as etiologic classifications on liver cirrhosis were attempted. The morphologic and etiologic patterns characteristics in Korean were discussed in details. [jpatholtm.org]

RESULTS: Possible etiological factors for ISC were alcohol abuse, arsenic treatment, and hepatitis B infection. In three cases, a genetic factor could not be excluded. [ncbi.nlm.nih.gov]

Different cirrhotic etiologies tend to result in either micronodular, macronodular, or a mixed picture. Historically, this was used as a classification scheme for cirrhotic etiologies but has been put aside in recent years. [pathwaymedicine.org]

Etiology: Perisinusoidal fibrosis may suggest congestive hepatopathy.[1] In NAFLD portal-to-portal fibrosis (septal/bridging fibrosis) tends to be more common than perivenular fibrosis.[2] The etiology of late stage fibrosis (cirrhosis), may be impossible [librepathology.org]

Etiologic classification: preferred This method of classification is the most useful clinically; by combining clinical, biochemical, histologic, and epidemiologic data, the likely etiologic agent can be ascertained The two most common causes of cirrhosis [mergersdrugfil.com.ph]

Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2] Synonyms and Keywords: Cirrhosis of liver; hepatic fibrosis; hepatic sclerosis Overview Historical Perspective Classification Pathophysiology Causes Differentiating Cirrhosis from other Diseases Epidemiology [wikidoc.org]

Hepatocellular carcinoma in Germany: a retrospective epidemiological study from a low-endemic area. Liver 2000 Jul;20(4):312-8. [eurorad.org]

"Hepatitis B virus infection: epidemiology and vaccination". Epidemiologic Reviews. 28: 112–25. doi:10.1093/epirev/mxj009. PMID 16754644. ^ a b c Chen, W; Gluud, C (19 October 2005). "Vaccines for preventing hepatitis B in health-care workers". [en.wikipedia.org]

Epidemiology The worldwide prevalence of cirrhosis is unknown; however, in the United States, it has been estimated to be between 0.15% and 0.27% [2][3]. [ncbi.nlm.nih.gov]

Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2] Synonyms and Keywords: Cirrhosis of liver; hepatic fibrosis; hepatic sclerosis Overview Historical Perspective Classification Pathophysiology Causes Differentiating [wikidoc.org]

[…] sclerosing cholangitis Chronic biliary obstruction Drug induced liver injury Cryptogenic (idiopathic) cirrhosis: accounts for 8 - 9% of liver transplants in the US; "burnt out" NAFLD / NASH is a common cause of cryptogenic cirrhosis (Hepatology 2000;32:689) Pathophysiology [pathologyoutlines.com]

The development of ascites is the final consequence of anatomic and pathophysiologic abnormalities occurring in patients with cirrhosis. [hindawi.com]

It is therefore important to understand the underlying pathophysiology of cirrhosis, as well as be able to concisely convey to clinicians important imaging findings, particularly those that would alter patient management. [jaocr.org]

Pathophysiology Multiple cells play a role in liver cirrhosis including hepatocytes and sinusoidal lining cells such as hepatic stellate cells (HSCs), sinusoidal endothelial cells (SECs) and Kupffer cells (KCs). [ncbi.nlm.nih.gov]

Prevention Eliminating alcohol abuse could prevent 75-80% of all cases of cirrhosis. [medical-dictionary.thefreedictionary.com]

What research is ongoing to prevent and treat cirrohsis of the liver? Progress in the management and prevention of cirrhosis continues. [medicinenet.com]

Prevention[edit] Vaccine[edit] Vaccines for the prevention of hepatitis B have been routinely recommended for babies since 1991 in the United States.[62] The first dose is generally recommended within a day of birth.[63] The hepatitis B vaccine was the [en.wikipedia.org]

| Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies Case Studies Case #1 v t e Digestive system - Digestive disease - Gastroenterology (primarily K20-K93, 530-579 ) Upper GI tract Esophagus Esophagitis ( Candidal [wikidoc.org]