SURGERY CAPSTONE PROJECT REPORT- LIVER CIRRHOSIS

Liver cirrhosis and Liver transplantation surgery

Table of Contents:

PART:1

1.INTRODUCTION [1] : ............................................................................................................................4

2.EPIDEMIOLOGY ....................................................................................................................................4

3. SIGNS AND SYMPTOMS.......................................................................................................................5

4.ETIOLOGY CAUSES OF LIVER CIRRHOSIS ..............................................................................................6

➢ MOST COMMON CAUSES: [32]...................................................................................................6

▪ OTHER COMMON CAUSES ......................................................................................................6

5.DIAGNOSIS ...........................................................................................................................................7

❖ BY CLINICAL FEATURES................................................................................................................7

❖ BY LAB INVESTIGATION...............................................................................................................9

▪ CBC..........................................................................................................................................9

▪ LIVER FUNCTION TEST: IN CIRRHOTIC PATIENT MOSTLY LEVER ENZYME ELEVATED.............9

▪ RENAL FUNCTION TEST: TO IDENTIFY HEPATOREANAL SYNDROME IS PRESENT OR NOT .....9

▪ ADDITIONAL TESTING SHOULD BE DONE ACCORDING TO SUSPECTED CAUSES OF LIVER 

CIRRHOSIS .....................................................................................................................................10

❖ BY IMAGING TEST......................................................................................................................10

▪ FIBROSCAN............................................................................................................................10

▪ ULTRASOUND........................................................................................................................10

▪ CT SCAN.................................................................................................................................10

▪ PET-CT SCAN..........................................................................................................................11

▪ MRI........................................................................................................................................11

▪ OESOPHEGOGASTROSCOPY..................................................................................................11

▪ HEPATIC VENOUS PRESSURE GRADIENT(HVPG)...................................................................11

❖ BY LIVER BIOPSY TEST AND HISTOPATHOLOGY ........................................................................12

➢ PATHOLOGY OF LIVER BIOPSY IN LIVER CIRRHOTIC PATIENTS:............................................12

❖ BY SCORING SYSTEM.................................................................................................................15

6.DIFFERENTIAL DIAGNOSIS OF LIVER CIRRHOSIS ................................................................................16

7.TREATMENT OF LIVER CIRRHOSIS......................................................................................................17

1.Treatment according to underlying causes ...................................................................................17

2.TREATMENT OR MANAGEMENT OF LIFE-THREATENING COMPLICATION OF LIVER CIRRHOSIS ..20

3.PHARMACOLOGICAL REVERSAL TREATMENT OF LIVER CIRRHOSIS ..............................................21

4.LIVER TRANSPLANTATION..............................................................................................................21

• IN FUTURE LIVER TRANSPLANTATION PROCEDURE .............................................................23

8. PROGNOSIS .......................................................................................................................................24

REFERENCE:...........................................................................................................................................26

PART:2...................................................................................................................................................30

CASE REPORT ........................................................................................................................................30

CASE HISTORY: ..................................................................................................................................30

▪ Subjective examination.........................................................................................................30

▪ Objective examination of patient: ........................................................................................31

▪ DIFFERENTIAL DIAGNOSIS.........................................................................................................31

▪ LAB INVESTIGATION:.................................................................................................................32

▪ INSTRUMENTAL EXAMINATION OF PATIENT:...........................................................................32

▪ INTERPRETATION OF INVESTIGATION TESTS AND RULING OUT DIFFERENTIAL DIAGNOSIS....33

▪ FORMAL DIAGNOSIS: ALCOHOLIC LIVER CIRRHOSIS.................................................................33

TREATMENT : ....................................................................................................................................33

▪ CHOICE OF SURGICAL METHOD............................................................................................33

TECHNICAL DETAILS OF SURGERY:....................................................................................................34

❖ACKNOWLEDGMENT: ........................................................................................................................35