Circulatory Disorders

Question 1

Circulatory disorders of the liver

Answer 1

1. Impaired blood flow into liver
   - hepatic artery obstruction
   - portal vein obstruction
2. Impaired blood flow through liver
   - chronic passive congestion
3. Hepatic venous outflow obstruction
   - Budd-Chiari Syndrome
   - sinusoidal obstruction syndrome (veno-occlusive disease)

Question 2

Causes of portal vein obstruction

Answer 2

1. Extra-hepatic
   - intra-abdominal sepsis
   - pancreatitis
   - post surgical thrombosis
   - trauma
   - inherited/acquired hypercoagulable disorders
2. Intra-hepatic
   - malignancy
   - cirrhosis

Question 3

Effects of portal vein obstruction

Answer 3

• portal hypertension - esophageal varices
• ascites
• abdominal pain

Question 4

Features of chronic passive congestion of the liver

Answer 4

• caused by congestive heart failure
• obstruction to outflow tracts (hepatic vein obstruction)
• nutmeg liver
• central hemorrhagic necrosis
• cardiac sclerosis - centrilobular fibrosis

Question 5

Features of Budd-Chiari syndrome

Answer 5

• hepatic vein obstruction

- hepatomegaly, pain, ascites

Question 6

Causes of Budd-Chiari syndrome (2)

Answer 6

1. Hepatic vein thrombosis - primary myeloproliferative disorders, inherited disorders of coagulation, pregnancy, oral contraceptive use
2. Tumour invasion - HCC, renal cell carcinoma

Question 7

Features of sinusoidal obstruction syndrome

Answer 7

• veno-occlusive disease
• damages sinusoidal endothelium
• resultant cellular debris embolised downstream w occlusion of terminal hepatic vein
• hepatomegaly, ascites, jaundice

Question 8

Causes of sinusoidal obstruction syndrome (3)

Answer 8

1. Bush tea (pyrrolizidine alkaloid)
2. Allogeneic bone marrow transplantation
3. Chemotherapy