Cirrhosis Flashcards
Cirrhosis
Irreversible scarring and inflammation of fibrotic liver disease
Death rate of cirrhosis
26%
Causes of cirrhosis
structural changes from injury (alc, viral) and fibrosis
Cirrhosis patho
chaotic fibrosis causes obstructive biliary channels and obstructed blood flow leading to jaundice, portal HTN
Fibrosis
connective tissue from infiltrates of leukocytes that release inflammatory mediators and activate fibrotic processes
What stops the liver from regenerating with cirrhosis?
hypoxia, necrosis, atrophy, liver failure
Does cirrhosis develop quickly?
NO - often slow, but alc can be very fast
What can stop progression of cirrhosis?
removal of the toxin (won’t reverse it tho)
Causes of cirrhosis
- hep b & c
- excess alc intake
- idiopathic,
- non-alcoholic fatty liver disease (NASH & NAFLD)
- autoimmune
- hereditary metabolic conditions
alcoholic cirrhosis
- alcohol is converted to acetaldehyde which activates hepatic stellate cells in excess (involved in fibrosis);
- acetaldehyde inhibits export of proteins from the liver, alters vitamin metabolism, induces malnutrition
- Kupffer cells attract neutrophils which cause toxins to accumulate from gut bacteria and cause suppressed cell-immunity
Alcoholic fatty liver leads to…
Alcohol steatohepatitis which leads to alcoholic cirrhosis
Alcohol fatty liver
- mild or asymptomatic
- reversible
- fatty accumulation from inc lipogenesis
Alcoholic steatohepatitis
- inflammatory degeneration of hepatocytes, WBCs infiltrate, stimulates irreversible fibrosis
- anorexia, nausea, edema, jaundice
- inc hepatic fat storage
Alcoholic cirrhosis
- immunological problem
- inflammation, oxidative stress, cell damage, cell necrosis, fibrosis and scarring
Patho of cirrhosis
Liver cells are destroyed - try to regenerate - disorganization - abnormal growth - poor BF and scarring - hypoxia - liver failure
CM of cirrhosis
Insidious
- N/V, anorexia, flatulence, change bowel habits
- fever, wt loss
- palpable liver
Late CM of cirrhosis (often diagnostic)
- jaundice from bili build up
- peripheral edema
- dec albumin
- inc PT
- ascites from portal HTN
- skin lesions like spider angiomas
- anemia from lacking clotting fx
- esophageal and anorectal varices
- encephalopathy from inc ammonia
Endocrine SE of cirrhosis
- chronic amenorrhea
- hypogonadism
- fertility problems
Varices
Distended veins that can cause high mortality and bleeding if they burst
Portal HTN
Resistant portal BF causing varices and ascites
Fx of portal HTN
systemic hypotension, vascular underfilling, stimulation of RAS system (vasoconstriction), plasma volume expansion, inc CO–ascites
Portal HTN CM
asymptomatic until complications - variceal hemorrhage, ascites, peritonitis, cardiomyopathy, hepatorenal syndrome–kidney/liver failure, heart failure
Tx for portal HTN
Prevent/tx complications
- liver transplant
Protein’s role in HTN
Lack pro to keep fluid in the vessels
Hepatic encephalopathy
- 30-45% cirrhosis patients
- LOC is primary driver of dx
- graded by severity
- toxins build up in the brain, especially inc ammonia (neurotoxins)
- not dx by ammonia levels tho
Acute liver failure aka fulminant liver failure
- not r/t cirrhosis or fibrosis
- often Tylenol OD (tx with acetylcysteine)
- 6-8W after viral hepatitis or metabolic liver disease
- 5d-8W after tylenol OD
Fulminant liver failure patho
Edematous hepatocytes and patchy area of necrosis and inflammatory cell infiltrates that disrupt liver tissue
S/s fulminant liver failure
Like late cirrhosis but without cellular changesT
Tx for fulminant liver failure
Liver transplant
- catch early, stop toxins
