CIRRHOSIS

Question 0

What causes death in cirrhosis patients?

Answer 0

Progressive liver failure
Complications of portal hypertension
HCC

Question 1

What are main causes?

Answer 1

Alcoholic hepatitis
Chronic hepatitis C or B
Non-alcoholic steatohepatitis NASH

Question 2

What is the pathological change in cirrhosis?

Answer 2

Regeneration nodules
Disruption or the architecture
Bridging fibrous septa

Question 3

What is the Pathogenesis of liver cirrhosis? What is the end result?

Answer 3

3 main processes

• death of hepatocytes
• ECM deposition: hepatic stellate cells activate -> collage I and III deposit in space of Disse (space btw sinusoid and hepatocyte), replacing collage IV, creation fibrotic septal bridges
• vascular reorganisation dt parenchymal damage and scarring

Fibrotic nodular liver -> poor blood supply -> impaired filtration and synthetic functions

Question 4

What are the causes of portal HTN?

Answer 4

Pre-hepatic

• obstructive thrombosis
• massive Spleenomegaly

Hepatic

• cirrhosis
• massive fatty change
• sarcoidosis (fibrosis granulomas)

Post-hepatic

• RHF
• hepatic vein outflow obstruction

Question 5

How do you diagnose cirrhosis?

Answer 5

Liver biopsy

Question 6

What percentage of cirrhosis have oesophageal varices?

Answer 6

40%

Question 7

S + S?

Answer 7

Non-specific: anorexia, wt loss, weakness
Lived failure
- synthetic - oedema, ascites, bleeding/coagulopathy
- excretory - hepatic jaundice, hepatic encephalopathy
- metabolic: nutritional deficiency

Portal HTN

• ascites
• varices
• congestive Spleenomegaly

Question 8

How do you stage cirrhosis?

Answer 8

CHILD A (5-6), B (7-9), C (10-15)

5 feats
Looks at ascites, 
encephalopathy, 
bilirubin, 
albumin, 
PTT

Question 9

What is definitive treatment and who gets it? Who can’t get it?

Answer 9

Transplant

Child’s score > 7 -> B or C

Pts with alcoholic hepatitis not immediate dt high surgical mortality, high rates of relapse following transplant

Require 6 months of abstinence and strong social support