Cirrhosis

Question 1

Cirrhosis

Answer 1

Irreversible scarring and inflammation of fibrotic liver disease

Question 2

Death rate of cirrhosis

Answer 2

26%

Question 3

Causes of cirrhosis

Answer 3

structural changes from injury (alc, viral) and fibrosis

Question 4

Cirrhosis patho

Answer 4

chaotic fibrosis causes obstructive biliary channels and obstructed blood flow leading to jaundice, portal HTN

Question 5

Fibrosis

Answer 5

connective tissue from infiltrates of leukocytes that release inflammatory mediators and activate fibrotic processes

Question 6

What stops the liver from regenerating with cirrhosis?

Answer 6

hypoxia, necrosis, atrophy, liver failure

Question 7

Does cirrhosis develop quickly?

Answer 7

NO - often slow, but alc can be very fast

Question 8

What can stop progression of cirrhosis?

Answer 8

removal of the toxin (won’t reverse it tho)

Question 9

Causes of cirrhosis

Answer 9

• hep b & c
• excess alc intake
• idiopathic,
• non-alcoholic fatty liver disease (NASH & NAFLD)
• autoimmune
• hereditary metabolic conditions

Question 10

alcoholic cirrhosis

Answer 10

• 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

Question 11

Alcoholic fatty liver leads to…

Answer 11

Alcohol steatohepatitis which leads to alcoholic cirrhosis

Question 12

Alcohol fatty liver

Answer 12

• mild or asymptomatic
• reversible
• fatty accumulation from inc lipogenesis

Question 13

Alcoholic steatohepatitis

Answer 13

• inflammatory degeneration of hepatocytes, WBCs infiltrate, stimulates irreversible fibrosis
• anorexia, nausea, edema, jaundice
• inc hepatic fat storage

Question 14

Alcoholic cirrhosis

Answer 14

• immunological problem
• inflammation, oxidative stress, cell damage, cell necrosis, fibrosis and scarring

Question 15

Patho of cirrhosis

Answer 15

Liver cells are destroyed - try to regenerate - disorganization - abnormal growth - poor BF and scarring - hypoxia - liver failure

Question 16

CM of cirrhosis

Answer 16

Insidious
- N/V, anorexia, flatulence, change bowel habits
- fever, wt loss
- palpable liver

Question 17

Late CM of cirrhosis (often diagnostic)

Answer 17

• 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

Question 18

Endocrine SE of cirrhosis

Answer 18

• chronic amenorrhea
• hypogonadism
• fertility problems

Question 19

Varices

Answer 19

Distended veins that can cause high mortality and bleeding if they burst

Question 20

Portal HTN

Answer 20

Resistant portal BF causing varices and ascites

Question 21

Fx of portal HTN

Answer 21

systemic hypotension, vascular underfilling, stimulation of RAS system (vasoconstriction), plasma volume expansion, inc CO–ascites

Question 22

Portal HTN CM

Answer 22

asymptomatic until complications - variceal hemorrhage, ascites, peritonitis, cardiomyopathy, hepatorenal syndrome–kidney/liver failure, heart failure

Question 23

Tx for portal HTN

Answer 23

Prevent/tx complications
- liver transplant

Question 24

Protein’s role in HTN

Answer 24

Lack pro to keep fluid in the vessels

Question 25

Hepatic encephalopathy

Answer 25

• 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

Question 26

Acute liver failure aka fulminant liver failure

Answer 26

• 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

Question 27

Fulminant liver failure patho

Answer 27

Edematous hepatocytes and patchy area of necrosis and inflammatory cell infiltrates that disrupt liver tissue

Question 28

S/s fulminant liver failure

Answer 28

Like late cirrhosis but without cellular changesT

Question 29

Tx for fulminant liver failure

Answer 29

Liver transplant
- catch early, stop toxins