It is the condition of destruction of hepatic cell.

Cirrhosis of liver is a diffuse disease having 4 features following.

1.It involve the entire liver.

2. The normal lobular architecture of hepatic parenchyma is disorganised.

3. Formation of nodules separated from one other by irregular bands of fibrosis.

4. It occur necrosis and regenerative nodules.

In western world, cirrhosis of liver is one of the ten leading cause of death.

Type

Micronodular 

Macronodular

Mixed

Micronodular

Nodules less than 3mm

Chronic alcoholism is commonest cause.

Involvement of every lobule of whole liver.

Uniform, regular connective septa.

Macronodular

Nodules more than 3mm

Chronic hepatitis is commonest cause.

Liver surface is grossly distorted.

Mixed

Shoe the feature of both micronodular and macronodular cirrhosis.

Aetiology

Alcoholic cirrhosis

Post necrotic cirrhosis

Post viral cirrhosis

Biliary cirrhosis

Cardiac cirrhosis

Wilson's cirrhosis

Glucogen storage disease

Intestinal bypass surgery

Galactosemia

Idiopathic cirrhosis

India childhood cirrhosis

Pigment cirrhosis

Drug induced cirrhosis

Clinical features

Low grade fever

Weakness

Fatigue 

Weight loss

Anorexia

Nausea

Vomiting

Upper abdominal discomfort

Abdominal distention 

Menstrual irregularities

Haemorrhagic tendency

Bleeding piles

Haematemesis

Gradual swelling of abdomen and feet.

Diarrhea

Constipation

Sterlity 

Impotense.

Sign

Age more than 30 years 

Hepatic face

Anaemia

Jaundice

Spider angioma

Oedema

Ascites 

Haemorrhage

Cyanosis

Tongue pale and dirty

Bloated abdomen

Umbilicus everted

Abdominal vein prominent 

Apex beat- displaced upward

Murmur- soft systolic murmur

Falling of public and axillary hair due to lack of detoxification of oestrogen.

Liver enlarged

Parotid enlarged

Clubbing

White nail

Complication

1. Portal hypertension
2. Ascites
3. Bleeding piles
4. Anaemia
5. Haemorrhage 
6. Hernia

Management

Bed rest 

Removal the causative agent 

High protein diet 

Vaccination (hepatitis A and B, influenza, pneumococus)

Blood transfusion

Diuretic oral thiazide diuretics

Na should be restricted in the diet upto 400-800mg/day.

Liver transplantation.

Investigation

1.X-ray- hepatomegaly

2. CBC- Anaemia, leucopenia

3. Liver function test

4. Liver biopsy

5. Portal venography- dialated portal vein

6.Ultrasound- splenic enlargement, ascites, small size liver

7. Metabolic abnormalities

8. Hepatitis B and C marker

9. Prothrombin time

10. Urine- urobilinogen

11. Ba oesophagogram- earthworm like filling.