cirrhosis

Question 1

cirrhosis

Answer 1

• end stage liver disease
• major cause of death
• fibrosis (liver becomes nodular with collagen deposition)
• degenerative changes
• nodular liver
• primary problems
  
  • dec liver fx and portal HTN

Question 2

et cirrhosis

Answer 2

• alcohol abuse 60-70% (>80g for men and 40g women/day if this persists for over 10yr=v high risk)
• hepatitis
• drugs
• biliary disease (r/t gallstones etc)
• metb disorders or hemochromatosis (iron overload that occurs in liver and elsewhere)
• cryptogenic (idiopathic

Question 3

patho cirrhosis

Answer 3

hepatocytes destroyed->cells regen->fibrinous scar tissue forms
-vessel constriction-> impeded perfusion->portal HTN->fluid shift->ascites
(inc hydrostatic P that pushes out of vessel into abdm cavity)
-duct constriction->bile flow impeded->bile stasis
-dec metb waste clearance
-liver failure

Question 4

mnfts of cirrhosis

Answer 4

vary

common: anorexia, weakness, wt loss
- hepatomegaly, jaundice
- complications
- portal HTN, ascites (excess accum of fluids in body)
- varices, GI bleeds (a varix is dilation of an assoc vein. The P is so high in the eg portal vein that it affects other areas
- spelenomegaly

Question 5

tx of cirrhosis

Answer 5

• maximize regen
  
  • diet (sm meals, lots of calories, low fat high carbs)
  • no alcohol
• complications

Question 6

portal circulation

Answer 6

blood from Gi tract (nutrients and toxins), spleen (blood breakdown products), pancreas (Insulin and glucagon) travel to liver through portal vein before moving into vena cava for return to heart

Question 7

what is portal HTn

Answer 7

• Inc pressure in HPS ( when exceeds >12 mmHg, is portal HTN; N=5-10)
• Portal vein carries most of blood to liver (for processing, not for liver itself); hepatic artery brings in remaining 30% (arterial blood – coming to liver for its own use)
• Hepatic veins take away all blood from the liver, flow into the inferior vena cava

Question 8

et of portal HTN

Answer 8

Etiology
- Etiology can be divided into three categories depending on where problem occurs (obstruction to blood flow) – See page 929
1) Pre-hepatic – blockage in vessel before liver
2) Intra-hepatic – with cirrhosis
3) Post-hepatic – after liver
- Mostly d/t cirrhosis
- Major complication (are many but this most serious) = ruptured varix(varices pl)
o Varix = dilation of assoc vein (vein outside of portal system)
- Eg: esophageal varix

Question 9

complications of portal HTN

Answer 9

-	Other complications
o	Ascites(this is complication of complication of complication of complication….know that there are many complications of serious liver disease, are sequential:  cirrhosis -> portal HTN ->ascites
o	Portosystemic shunts – when build up of pressure within hepatic-portal system, collateral connection form within (or outside?) vessels of this system, distributes some of that blood into the adjoining veins, (ex: splenic vein shunts some blood into esophageal vein…
	This relieves some pressure but ends up passing same problem to other vessel
	This also bypasses liver, so toxic compounds now going to reach brain and tissues
o	Splenomegaly: veins such as splenic vein are engorged, causing inc push pressure, fluid shift into interstitial space of the spleen
	There is no back up! and no increase in spleen workload!
o	See flow chart Fig 38-14: caput medusae – spider-web like appearance, displacement of blood to superficial veins around umbilicus

Question 10

ascites

Answer 10

ASCITES
• Form of third spacing
• Fluid accum in peritoneal cavity
• Is NOT just fluid in this cavity…there is always some fluid.

Question 11

et and patho of ascites

Answer 11

Et and Patho
• If you have cirrhosis & portal HTN, you will have ascites (? Confirm this)
• Right sided HF
o Will this occur with right sided heart failure?
o Left sided HF: Pulmonary congestion + pulmonary edema
o Right sided HF:abdm organ distension +
o With abdmorgani distension because vessels within spleen, liver, etc are engorged…fluid pushed out from these vessels into interstitial space, then into body cavity
• Severe changes in HP & or OP (within vessels of GI tract)
• Water/Na retention(get details on this from foundational concept?), or protein loss

Question 12

mnfts ascites

Answer 12

Manifestations
• Are many but are going to choose 2 here
• Dyspnea p from fluid in abm cavity; for thoracic cavity vol to increase, need to be able to displace diaphragm…is now p countering this push, so can’t adequate inflate lungs
• Abdominal distension (note, this is not bowel distension but rather d/t fluid displacement into cavity)  if small volume, will not be as detectable

Question 13

tx of ascites

Answer 13

Treatment

• Small vol: Diuretic(small if