337 - Cirrhosis and Its Complications Flashcards
Cirrhosis pathology includes ___ due to activation of ___ cell in the liver which produce ___- leading to changes in the liver’s ___ together with ___ formation, decrease in liver ___ and function, blood flow changes.
Fibrosis Stellate Architecture Collagen Nodules Mass
Liver cirrhosis can be classified into ___ and ___. The latter has a decrease in ___ and we should consider ___
Compensated
Uncompensated
Liver function
Liver transplantation
____ of liver cirrhosis represent the severity of the disease, while staging and grading are defined by ____.
Clinical symptoms
Biopsy
Hepatocellular injury may lead to: (4)
- Jaundice
- Hemostasis dysfunction
- Hypoalbuminemia
- Encephalopathy
In uncompensated liver cirrhosis we will see ___ which in turns leads to __ and ___ bleeding.
Portal HTN
Varices
Varices
What are the 3 enzyme systems metabolizing alcohol?
ADH
MEOS
Peroxisomal catalase
Alcohol consumption may lead to activation of___ that create fibrinogenic cytokines which promote ___ activation and excessive synthesis of __ and ___
Kupffer cells
Stellate
Collagen
ECM
Alcohol injury leads to the formation of connective tissue between the ____ to the main ___ and creates regenerative ___
Portal triad
Vein
Nodules
Alcohol cirrhosis is a process that progresses for ___ and leads to loss of ___ and decrease in ___ size
Years
Hepatocytes
Liver
Ethanol also increases the accumulation of ___ due to an increase in its ___, decrease in fatty acid ___ and damage in ____ secretion.
Triglycerides
Absorption
Oxidation
lipoproteins
General clinical symptoms of alcohol induced liver cirrhosis include: (5)
- Fever
- Anorexia
- RUQ dull pain
- Nausea/vomiting
- Diarrheas
Specific clinical symptoms of alcohol induced liver cirrhosis include: (5)
- Encephalopathy
- Jaundice
- Ascites
- GI bleeding
- Edema
Physical examination of a patient with alcohol induced liver cirrhosis include: (5)
- Parotid enlargement
- Palmar erythema
- Clubbing
- Spider angioma
- Edema/ascites
In men with alcohol induced liver cirrhosis we can see body___ loss, ___ and ___atrophy due to hormonal changes
Hair
Gynecomastia
Testicular
Lab results of alcohol induced liver cirrhosis may present: ANTI2 (5)
- Anemia
- Nutritional deficiency
- Thrombocytopenia
- Increased direct bilirubin
- Increased AST and ALT
Diagnosis of alcohol induced liver cirrhosis can be made with ____. Only __ months after rehabilitation another biopsy should be made to determine the severity of
Biopsy
6
The best treatment for alcohol induced liver cirrhosis is ___. Drugs that can be used include: (3)
Alcohol absenteeism
Absenteeism calcium
Glucocorticoids
N-acetylcysteine
After exposure to ____, ____ of patients will develop chronic hepatitis, of them ___ will continue to ____
HCV
80%
20-30%
Liver cirrhosis
After HBV exposure, ___ of patients will develop chronic hepatitis, of them ___ will continue to ___
5%
20%
Liver cirrhosis
In chronic HBV we will see positive ___ and ___, and possibly hepatocytes with ground glass appearance in imaging tests
HBc-Ag
HBs- Ag
Chronic HBV can be treated with ___, helping preventing the shift from _____ to uncompensated cirrhosis
Anti viral drugs
Compensated
Chronic HCV can be treated with the very expensive ___ protocol (95% cure rate) for a relative short period of ____ weeks
Anti viral
8-12
AIH stands for____. Diagnosis will require autoimmune markers such as: ___ and ___. If the patients are suffering from cirrhosis in tandem with active inflammation and elevated liver enzymes- treat with ___ drugs.
Auto immune Hepatitis
ANA
ASMA
Immunosuppressive
NAFLD stands for____. Most patients have ____
Non-alcoholic fatty liver disease
Steatohepatitis
Cholestatic disease can be ___ or ____. In the latter we can treat with ___ or ___.
Intrahepatic
Extrahepatic
Surgery
Endoscopy
The main etiologies for cholestatic disease are: (4)
- PBC (Primary biliary cholangitis)
- AIC (Auto immune cholangitis)
- PSC (Primary sclerosing cholangitis)
- Idiopathic
The cause leading to PBC is unknown. It is common in ___ over the age of ___. Characterized by ____ and __ together with ____ and ____
Women 50 Portal inflammation Necrosis of small/medium bile tubeless Cholestatic characteristics Elevated bilirubin
What is the recommended treatment for PBV patients with uncompensated liver cirrhosis? What can slow down the progression of the disease?
Liver transplantation
UDCA (ursodeoxycholic acid)
Most PBC patients will present ___ antibodies
AMA (Anti mitochondrial membrane antibodies)