Cirrhosis Flashcards
Risk factors for cirrhosis
1-Obesity
2-DM
3-Meds (ASA, Amio, MTX)
4-Hemachromatosis (genetic disorder,causing excess iron to be stored in the liver)
5- wilson’s disease (genetic; copper build up)
Cirrhosis can be caused by…
Alcoholism
Viral hepatitis
MASLD
Types of cirrhosis
1- alcoholic (fatty liver/fibrosis)
2- post hepatitis (b,c,d )
3- biliary=autoimmune ( primary biliary cholangitis–>duct obstruction)
4- cardiac ( prolonged R ❤️ failure–>liver congestion/fibrosis
Stage 1 cirrhosis
Fatty liver(steatosis)- reversible with lifestyle changes
Stage 2 cirrhosis
Inflammation and fibrosis= beginning of permanent damage
Stage 3 cirrhosis
Advanced fibrosis with regenerative nodules= significant impairment
Stage four cirrhosis
End stage liver disease- severe scarring and liver failure
Complications of cirrhosis
Portal HTN
Hepatic encalopathy
Ascites
Esophageal varices
Lab values in cirrhosis
⬆️AST/ALT-indicate liver
damage
⬆️ Alk Phos(ALP)-indicates blocked bile duct
⬆️ GGT(gamma glutamine transferase) -indicate fatty liver
⬆️bilirubin
⬆️PT/INR
⬇️albumin- liver is not able to synthesize it d/t scarring
What is the mechanism of fibrosis in cirrhosis
Chronic inflammation= collagen + extra cellular matrix deposition–> hepatocytes attempt regeneration and form nodules= disrupt liver function and structure
What are the consequences of portal hypertension
Collateral blood flow
Esophageal varicies
Splenomegaly
Which cells are responsible for the extracellular matrix that causes fibrosis
Stellate cells
What is MASLD
(Metabolic dysfunction associated steototic liver disease)
- excess fat accumulation in the liver in the absence of alcohol abuse
What are the possible complications of MASLD and MASH
Cirrhosis
Risk factors of MASLD
Obesity
HTN
Hyperlipidemia
DM2
Sedentary lifestyle
Family hx
Risk factors for MASH
Obesity
ETOH
Sedentary lifestyle
Metabolic syndrome
Unhealthy diet
Pathophysiology of MASLD
Excess fat accumulation–> insulin resistance–> inflammation–> oxidative stress–> leads to MASH and ultimately cirrhosis
Pathophysiology of MASH
Persistent lipid accumulation–> hepatocyte injury by oxidative stress, inflammation, and immune response activation
What is MASH
(Metabolic dysfunction associated steatohepatitis)
- oxidative stress, inflammation, and lipid toxicity overwhelm liver’s protective mechanisms
- cell death and necrosis release Damps–>trigger further inflamm. & fibrosis
What is ballooning degeneration?
Occurs when normal hepatocytes lose their polygonal shape and become swollen/round
What are mallory-denk bodies?
Hallmark of ongoing liver inflammation
-abnormal inclusions in cytoplasm of hepatocytes
