Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Liver and Friends > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

what is cirrhosis

A

the result of chronic inflammation and damage to liver cells

also known as end stage liver failure

damaged liver cells are replaced by scar tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is portal hypertension

A

fibrosis affects the structure and blood flow through the liver which causes increased resistance in the vessels leading into the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of portal hypertension

A

prehepatic - portal vein thrombosis

Intrahepatic - schistosomiasis, cirrhosis.

Posthepatic - right sided heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the process of portal hypertension

A
  • hepatocyte injury
  • secretion of paracrine factors activate stellate cells
  • stellate cells proliferate and release TGF-B
  • produces collagen which is fibrotic
  • extra fibrotic mass compresses sinusoids and central vein
  • increases pressure which causes portal hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the result of portal hypertension

A

collateral blood shunting to gastroesophageal veins or towards systemic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Symptoms of portal hypertension

A
  • mostly asymptomatic
  • present when oesophageal varices rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

complications of portal HTN

A

Ascites
bleeding varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does ascites lead to portal htn

A

fluid is more likely to get pushed into tissues and across into peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

most common causes of liver cirrhosis 4

A

alcoholic liver disease
non alcoholic fatty liver disease
hep B +D
hep c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does chronic liver injury result in?

A

inflammation, matrix deposition, necrosis and angiogenesis all of which lead to FIBROSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does liver injury cause

A

necrosis and apoptosis, releasing cell contents and reactive oxygen species (ROS)

This activates hepatic stellate cells and tissue macrophages (Kupffer cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do hepatic stellate cells do?

A

release cytokines that attract neutrophils and macrophages to the liver which results in further inflammation and thus necrosis and eventual fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do Kuppfer cells do? Macrophages

A

phagocytose necrotic and apoptotic cells and secrete pro- inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the pr inflammatory mediators secreted by Kuppfer cells?

A
  • Transforming growth factor-beta (TGF-beta) which leads to the transdifferentiation of stellate cells to myofibroblasts
  • Platelet derived growth factor (PDGF) which stimulates myofibroblast proliferation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does increased myofibroblasts do?

A

leads to progressive collagen matrix deposition resulting in fibrosis and scar accumulation in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Characteristic features of cirrhosis

A

regenerating nodules separated by fibrous septa and loss of lobular architecture within the nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two types of Cirrhosis?

A

Decompensated - the liver is no longer able to perform any of its functions
Compensated - the liver can still form majority of its functions and patient may be asymptomatic

18
Q

Definitive diagnostic test

A

liver biopsy

19
Q

Bloods and LFTs for liver cirrhosis

A

low albumin,
raised prothrombin time
high: AST, ALT, ALP, GGT, bilirubin,
low platelets,
low WCC
raised serum creatinine

20
Q

What do MRIs show for liver cirrhosis

A
  • Increased claudate lobe size,
  • smaller islands of regenerative nodules
  • presence of right posterior hepatic notch
21
Q

Definitive treatment for liver cirrhosis

A

liver transplant

22
Q

conservative management of liver cirrhosis

A

fluids
analgesia
alcohol abstinence
good nutrition

23
Q

define hypoalbuminemia ?

A

reduced plasma oncotic pressure

24
Q

renal water retention treatment ?

A

peripheral arterial vasodilation by NO

25
Q

what is ascites

A

fluid in the peritoneal cavity

26
Q

causes of ascites

A
  • local inflammation = peritonitis
  • low protein = nephrotic syndrome
  • flow stasis = cirrhosis
27
Q

how does cirrhosis cause ascites

A

Peritonitis - more leaky

Raised capillary hydrostatic pressure

Reduced colloid oncotic pressure

Peritoneal lymphatic draining

28
Q

What is SAAG

A

The serum ascites albumin gradient (SAAG), which is based on the difference between the albumin level of serum and of ascitic fluid,

29
Q

What are the values for high and low SAAG

A

High = more than or equal to 1.1
Low= lower than 1.1

30
Q

Causes of high SAAG

A
  • cirrhosis
  • portal htn
  • portal vein thrombosis
31
Q

presentation of ascites

A

SHIFTING DULLNESS, gained weight, abdo distension.

Signs of liver disease.

Respiratory distress (pleural effusion).

32
Q

investigations of ascites

A

diagnostic aspiration
Imaging- x ray
ultrasound scan

33
Q

1st line treatment of ascites

A

salt restriction
diuretics- furosemide/ spironolactone

34
Q

complications of ascites

A

Spontaneous bacterial peritonitis- an infection of ascitic fluid, most common causes are e coli

35
Q

what are bleeding varices

A

GI bleeds on a background of chronic liver disease

36
Q

GS investigation for bleeding varices

A

UPPER GI endoscopy

37
Q

symptoms of bleeding varices

A

melaena
haematemesis

38
Q

treatment for an active bleeding varice

A

Urgent gastroscopy/endoscopy

Fluid resuscitation, remember can be massive

1-Terlipressin (ADH analogue) or Octreotide

2-Balloon tamponade

Gold std - endoscopic therapy: band ligation or

sclerotherapy.

39
Q

DD of varices

A

mallory wesis tear retching, abdo pressure
oesophageal varices - long history of alcohol abuse

40
Q

How to prevent a bleed

A
  • bb ( non selective) + nitrates
  • repeat variceal banding
  • last resort= liver transplant

Liver and Friends (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions