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HOS Unit 4 > #14 Liver 2 > Flashcards

#14 Liver 2 Flashcards

1
Q

what is cirrhosis?

A

damage to hepatic parenchymal cells
nodular regeneration
fibrosis
Overall disturbance from normal

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2
Q

which cells make the scar?

A

stellate cells
myofibroblasts
bone marrow derived fibroblasts
maybe hepatocytes and biliary epithelial cells

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3
Q

What does HSP47 immunostaining look for?

A

fibrillar collagen, therefore it is great to look for cirrhosis.

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4
Q

T/F liver injury alters the hepatocyte-sinusoidal interface?

A

true

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5
Q

with liver damage/injury, what usually happens within the sinusoids?

A

1) deposition of a scar

2) loss of fenestrae

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6
Q

what is portal expansion?

A

infammation/scarring in a localized area such as just around the portal triad.

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7
Q

what is bridging fibrosis?

A

fibrosis that connects the individual units areas (portal expansion areas)

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8
Q

when you have fibrosis, what happens to the resistance?

A

your resistance increases

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9
Q

what is the equation for pressure?

A

pressure=resistance X flow

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10
Q

what is the key initiating event in the development of portal hypertension?

A

Increased resistance inside the liver

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11
Q

T/F Portal hypertension is the root of all evil in most patients with cirrhosis?

A

TRUE

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12
Q

What causes the major resistance in cirrhosis?

A

nodule formation
sinusoidal fibrosis
vasoconstriction (reversible)

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13
Q

what is a pericyte?

A

Its the same thing as a hepatic stellate cell that causes contraction in capillaries/sinusoids.

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14
Q

what often happens to portal venous flow during liver fibrosis?

A

Flow can actually increase. This is because the body tries to compensate by vasodilating the splanchnic arteries/veins supplying the hepatic portal vein.

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15
Q

How do collaterals work?

A

THey allow blood under high pressure to be shunted to an area of lesser resistance. There are four main ones we should know:

1) gastro-esophageal
2) umbilical
3) rectal
4) retroperitoneal

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16
Q

what is the most common cause of esophageal varicies?

A

portal hypertension. This is very common with chronic alcoholics because of a failing liver.

17
Q

what is the number one cause of portal hypertension in the USA?

A

Cirrhosis

18
Q

what can cause a prehepatic blockage?

A

portal vein thrombosis (for our purposes)

19
Q

What can often happen with schistosomiasis?

A

pre sinusoidal blockage

20
Q

what often causes blockage of the hepatic sinuses?

A

cirrhosis

21
Q

where would veno-occlusive disease affect the liver?

A

post sinusoidal

22
Q

Give an example of post hepatic portal flow blockage?

A

congestive heart failure

23
Q

How do you calculate HVPG?

A

HVPG= (wedge - free)

24
Q

what is a normal portal vein pressure?

A

6mmHg

25
Q

what is the normal HVPG range?

A

1-5 mmHg

26
Q

what is the wedge pressure like in cirrhosis?

A

portal pressure nearly matches the wedge pressure because there are no other pathways for dissapating the pressure.

27
Q

will the free pressure of cirrhosis patients be high or low?

A

Low, there will be a large difference in pressures.

28
Q

What is considered the threshold for HVPG?

A

12mmHg. Above this pressure you are at very high risk for ascites and variceal rupture

29
Q

What is TIPS?

A

transjugular intrahepatic portosystemic shunt. It alleviates some of the portal venous pressure.

30
Q

with heart failure, how would the free and the wedge pressures compare? What about HVPG

A

They would both be higher and similar. The HVPG often is normal within the 1-5mmHg range.

31
Q

HVPG, wedge, and free pressures are all what in prehepatic and presinusoidal blockages?

A

They are all normal!

32
Q

what happens to HVPG during cirrhosis?

A

HVPG increases.

33
Q

During constrictive pericarditis, what happens to HVPG, Wedge, and free pressures?

A

HVPG is normal
WHVP is high
FHVP is high

34
Q

A hyperdynamic circulation is characteristic of what?

A

cirrhosis

35
Q

What happens to C.O, heart rate, the peripheral resistance with cirrhosis?

A

increased HR
increases CO
decreased systemic vascular resistance

36
Q

what happens when you give a cirrhotic patient a vasoconstrictive drug?

A

they don’t respond to vasconstrictive drugs because they are bombarded with so many vasodilators.

37
Q

T/F cirrhosis is reversible?

A

kind of, only to a certain degree.

HOS Unit 4 (18 decks)

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