1.The Following Conditions That Are Known to Lead to Liver Cirrhosis

1.The following conditions that are known to lead to liver cirrhosis:

A)  HEPATOCELLULAR DISEASES

1.  Laennec's Cirrhosis: results from excessive ingestion of alcohol.

2.  Cryptogenic Cirrhosis: cirrhosis of indeterminate origin (most likely non-alcoholic steato-hepatitis or NASH

3.  Chronic Hepatitis with Cirrhosis:

Autoimmune Hepatitis: a chronic disorder caused by a cell-mediated immune response attacking normal cells of the liver.

Chronic Viral Hepatitis:

Hepatitis B: transmitted via blood or sexual contact, perinatally, or via percutaneous contamination

Hepatitis C: transmitted via blood and possibly sexual contact(<5%).

B)  INBORN ERRORS OF METABOLISM:

Alpha 1 Antitrypsin Deficiency: Alpha 1-antitrypsin is an inhibitor of trypsin, an enzyme secreted in inactive form by the pancreas, which breaks down proteins when it is activated in the duodenum. It is thought to account for 10 to 20% of all chronic liver disease in infancy. In adults, alpha 1 Antitrypsin deficiency often manifests as asymptomatic cirrhosis, but can progress to macronodular cirrhosis and may be complicated by the development of hepatocarcinoma.

Wilson's Disease: Due to a genetic mutation resulting impaired hepatic excretion of copper; copper accumulates in the liver causing hepatitis and cirrhosis.

Hemochromatosis: This is a genetic disorder resulting in altered absorption of iron form the intestine. Excess iron accumulates in the hepatocytes. If this disease goes undiagnosed and untreated, cirrhosis may result.

C)  DRUG INDUCED LIVER DAMAGE

Phenytoin (Dilantin),Acetaminophen (Tylenol),Isoniazid (INH),Felbamate,Ketoconazole.

Carbamazepine (Tegretol),Amanita Phalloides poisoning (wild mushroom ingestion).Certain Herbs (Crotalaria, Senecio, Symphytu, Heliotropium, Senna, Jin Bu Huan, Antracylis, "Chinese Hebal Complex", etc.Others (niacin, nitrofurantoin, valproate, dapsone, azathioprine, ticlodipine, etc).

D)CHOLESTATIC DISEASES

a)  Sclerosing Cholangitis: an inflammatory process involving hardening and thickening of the tissues along the lumina of the intra- and extrahepatic bile ducts.

b)  Primary Biliary Cirrhosis (PBC): a chronic inflammatory process with unknown cause, resulting in fibrosis of the small intrahepatic bile ductules.

c) Secondary Biliary Cirrhosis: occurs due to chronic obstruction of extrahepatic ducts, which could include the common bile duct and its major branches. This may result from several primary causes, some of which could include gallstones, chronic pancreatitis, or primary sclerosing cholangitis.

d)Caroli's Disease: a disorder manifested by recurrent episodes of cholangitis and/or gallstones, resulting from the formation of cystic dilations of major intrahepatic bile ducts. Progression to Secondary Biliary Cirrhosis is common.

E)VASCULAR DISEASE OF THE LIVER such as hepatic vein thrombosis (AKA Budd Chiari Syndrome) which involves the hepatic vein and blocks hepatic venous outflow.

2.) PRIMARY LIVER CANCERS:

Tumors must be small (~<5cm) and not multicentric (can't have >3 foci), and must not extend outside the liver.

3.) VARIANT SYNDROMES

a)  Diuretic resistant ascites

b)  Chronic hepatic encephalopathy

c)  Intractable pruritus

d)  Hepatopulmonary syndrome

e)  Familial amyloid polyneuropathy

f)  Familial hypercholesterolaemia

g)  Polycystic liver disease

h)  Hepatic epithelioidhaemangioendothelioma

i)  Sickle cell hepatopathy

4.ACUTE LIVER FAILURE

Acute liver failure is a multi-system disorder in which severe acute impairment of liver function with encephalopathy occurs within 8 weeks of the onset of symptoms and no recognized underlying chronic liver disease .it can be caused by drugs and toxins such as paracetamol,halothane, viral infections(hepatitis A,B,E, HSV, CMV,EBV),metabolic disorders, autoimmune hepatitis,miscellaneous conditions such as acute fatty liver of pregnancy, peripartum cardiomyopathy or indeterminate causes sometimes.

Causes of AcuteLiver Failure