Smooth cirrhosis

While the formation of nodes is a typical finding on the liver surface (s. figs. 28.13 35.2-35.4), in sectional preparations (s. fig. 35.5) and under the microscope (s. fig. 35.4), it is not an obligate criterion. It is hardly recognizable in many cases, such as in haemochromatotic, biliary and alcoholic cirrhosis. Smooth cirrhosis, showing a smooth liver surface despite complete transformation, is likewise found it is micronodular and poor in fibres, (s. fig. 14.3)... 

The hepatotoxic effects of carbon tetrachloride have been widely studied in animals. Indeed, carbon tetrachloride is used as a model chemical in many laboratory investigations of the basic mechanism of action of hepatotoxic chemicals. Oral exposure to carbon tetrachloride has been observed to result in a wide spectrum of adverse effects on the liver, the most prominent of which are destruction of the smooth and rough endoplasmic reticulum and its associated enzyme activities (Reynolds and Yee 1968), inhibition of protein synthesis (Lutz and Shires 1978), impaired secretion of triglycerides with resultant fat accumulation (Fischer-Nielsen et al. 1991 Recknagel and Ghoshal 1966 Recknagel and Glende 1973 Waterfield et al. 1991), centrilobular necrosis (Blair et al. 1991 Reynolds and Yee 1968 Waterfield et al. 1991 Waterfield et al. 1991 Weber et al. 1992), and eventually fibrosis and cirrhosis (Allis et al. 1990 Bruckner et al. 1986 Fischer-Nielsen et al. 1991 Weber etal. 1992). 

Immunology. Blood tests can detect viruses and antibodies to viruses, for example hepatitis A/B virus, or auto-antibodies from autoimmune disorders of the liver, for example primary biliary cirrhosis (associated with anti-mitochondrial antibodies), autoimmune hepatitis (associated with smooth muscle antibodies) and primary sclerosing cholangitis (associated with antinuclear cytoplasmic antibodies). 

Fig. 4.9 Smooth red tongue with angular cheilosis in liver cirrhosis...

A smooth red tongue is often combined with a peculiar reddish colouring and smoothness of the lips, known as lacquered lips. They are also one of the late signs of cirrhosis, mainly with a necrotic course of the disease. 

Fig. 14.3 Smooth cirrhosis with smooth surface and portal hypertension resulting from chronic vitamin A intoxication (same patient as in fig. 14.2)...

PO/IV. Well absorbed, 80% metabolized in first pass. 90% protein bound. Metabolites are active. Half-life is 5 hrs but may be up to 20 hrs in patients with cirrhosis. Patient on IV blockers or digitalis. A-V node block, sick sinus syndrome, cardiogenic shock, heart failure, hypotension. Beta blockers or digitalis Increases likelihood of bradycardia or A-V blockade. Quinicfine or prazosin Increases hypotension. Digoxin levels are increased. Cimetidine reduces verapamil clearance. Calcium supplements may inhibit actions of verapamil. Depolarization (leading to contraction) of vascular smooth muscle is dependent on calcium entry. Vasodilation is induced by calcium entry blockers because they inhibit calcium influx. 

If the protein fails to fold properly, its shape is incorrect and it cannot perform its intended function. Aberrations in protein folding appear to contribute to human diseases. Among these are Alzheimer s disease, prion diseases, emphysema and cirrhosis, amyelotrophic lateral sclerosis (Lou Gehrig s disease), cystic fibrosis, some tumors, and osteogenesis imperfecta (King et al., 2002). The prion that seems to cause ovine transmissible spongiform encephalopathy, for instance, appears as a pleated sheet rather than a smooth helix. 

Autoantibodies which react with a component, possible acto-myosin of smooth muscle cells. They can be found in the sera of patients with infectious mononucleosis, chronic active hepatitis, primary biliary cirrhosis and certain malignant conditions. 

---