Liver weight 1.2-1.5 kg, classically divided into left & right lobes by falciform ligament and further into eight segments according to subdivision of the Hepatic and Portal veins. Liver is organ with high regenerative capacity and under the great load of circulation, various functions for the survival of the host, including detoxification, breakdown of red blood cells and substances, synthesis of proteins and hormones and storage glycogen as well as holding as reservoir of blood. Any damage that weakens the functioning of the liver is called Liver disease including liver cancer, liver fibrosis results from the perpetuation of normal wound healing respons resulting in an abnormal continuation of fibrogenesis of connective tissues, production and deposition. Histologically cirrhosis is characterised by vascularised fibrosis septa that link portal tract with each other and with central veins leading to hepatocyte islands that are surrounded by fibrotic septa which aredevoid of a central vein. The major clinical manifestations of cirrhosis are impaired hepatocyte function and increased intrahepatic resistance and development of portal hypertension and hepatocellular carcinoma. Severity ranges from Hepatomegaly to fibro fatty changes to nodularity. Alcohol was the most common etiologic factor of Liver Cirrhosis followed by Non alcoholic steato-hepatitis in obese and Diabetic followed by Hepatitis-C, Hepatitis B infection. The general circulatory abnormality in cirrhosis, splanchnic vasodilation, vasoconstriction, hypoperfusion of the kidney, and water and salt retention are intimately linked to hepatic vascular, alteration, resulting in portal hypertension.

 The current study aims to analyse severity of disease in the liver cirrhosis deaths

This was a prospective study done from 1st January 2023- 31^st December 2023. A total of 100 deaths with presence of cirrhosis of liver detected during autopsy conducted in mortuary, Department of FMT, PMCH was analysed. Complete demographic, clinical details were obtained from accompanying relatives of the diseased, information sourced from police IO, inquest paper and medical records of the treatment furnished at the time of autopsy which was analysed further.

During autopsy, external and internal observation in the examination was concerned to detect stigma of chronic liver disease like clubbing of fingers and toes, central and peripheral cyanosis, presence of jaundice, ascites, collateral veins in abdomen edema, hepatosplenomegaly, shrunken liver, palmar erythema. The naked eye changes observed in the liver in autopsy ranging from fibro fatty changes. Jaundice with or without ascites, granular puckered fibro fatty liver to micro or macronodular liver.  Higher incidence of liver cirrhosis was found in age group 31-50 years, 74 percent of them were males, 30 percent were diabetic, alcohol was the etiological factor in 65 percent cases, NASH was etiological factor in 19%, hepatitis B and C was etiological factor in 12 % of the cases.

Summary and Conclusion:-

Liver disese has high morbidity and mortality. The presence of which are underestimated as the person in early phase of liver cirrhosis are asymptomatic and most of them with liver cirrhosis with related complication are diagnosed late.  Alcohol, the most common etiological factor affecting the most people of middle age group followed by non alcoholic steatohepatitis and concomitant hepatitis B and C infections. Awareness, educating the public, abstinence from alcohol and faulty dietary habits, regular medical evaluation and treatment and advertisement by government and NGOs are the need of hour as liver cirrhosis is then 14th most common cause of death.

There were 100 cases of liver cirrhosis out of 2563 total autopsy cases conducted during the study period.  The incidence rate is 3.90% with a male-female ratio of 2.85:1.  Other authors also observed the male preponderance (1,2,3). Higher incidence of liver cirrhosis was found in the age group 31-50 years which is consistent with the works of other authors(1,3,4).  Diabetes has nothing to do with the incidence of cirrhosis in the present study. This finding is also consistent with other studies (5,6,7). Most important aetiology was Alcohol consumption seen in 65% and our finding is also consistent with the works of other authors (2,5,7,8). Pale yellowish fibrofatty changes with jaundice with ascites and hepatomegaly were the commonest autopsy findings (9,10).

Liver disese has high morbidity and mortality. The presence of which are underestimated as the person in early phase of liver cirrhosis are asymptomatic and most of them with liver cirrhosis with related complication are diagnosed late.

• Alcohol, the most common etiological factor affecting the most people of middle age group followed by non alcoholic steatohepatitis and concomitant hepatitis B and C infections.

 • Awareness, educating the public, abstinence from alcohol and faulty dietary habits, regular medical evaluation and treatment and advertisement by government and NGOs are the need of hour as liver cirrhosis is then 14th most common cause of death.

Conflict of Intrest: Nil.

Source of funding: None.

Ethical Clearance: Not required.

Table 1: Gender wise Distribution

 Table 2:Distribution according to Diabetic status

  Table 3:Etiology wise Distribution

Table 4:Naked eye changes in liver cirrhosis correlating to clinical parameter in severity of assessment

Table 5

1. Dezy Singh, Ramesh C Tiwari^, Arvind Kumar, Ashish R Bhute, Ravi P Meshram, And Bhawana Mittal. The Role of Pathological Examination of the Liver in Medicolegal Autopsy: A Tertiary Care Center Study From North India. Cureus. 2023 Nov; 15(11): e48131.
2. Khare P, Gupta R, Ahuja M, Khare N, Agarwal S, Bansal D. Prevalence of lung lesions at autopsy: a histopathological study. J Clin Diagn Res. 2017;11:0–6.
3. Bal MS, Singh SP, Bodal VK, Oberoi SS, Surinder K. Pathological findings in liver autopsy. J Indian Acad Forensic Med. 2004;26:55–57.
4. Umesh BR, Gayathri BN, Harendra Kumar ML. Spectrum of liver pathology at autopsy. Int J Res Rev. 2015;2:79–86.
5. Berry CL. Liver lesions in an autopsy population. Hum Toxicol. 1987;6:209–214.