Cirrhosis Flashcards
What is Cirrhosis?
Cirrhosis is end stage liver disease and a major cause of death. Cirrhosis is degenerativee and involves fibrosis of and changing functional cells with non-functioning. It results in a nodular liver.
What are the two primary problems of Cirrhosis?
Decreased Liver function and Portal Hypertension
What are the seven functions of the Liver?
- Cleanses blood 2. Regulated the supply of body fuel (glucose storage, producing/storing/exporting fat). 3. Manufactures essential proteins. 4. Regulates the balance of hormones (sex/thyroid/cortisone). 5. Regulates body cholesterol. 6. Regulates the supply of essential vitamins and minerals. 7. Produces bile and eliminates toxic substances from the body and aids digestion.
What are the causes of Cirrhosis?
Alcohol abuse (60-70%), Hepatitis, Drugs, Biliary Diseases, Metabolic Disorders, Crytogenic
What is an example of a drug which may cause Cirrhosis?
Metatrexate - a synthetic drug that interfers with cell growth and used to treat leukemia and other cancers.
What are biliary diseases?
Diseases of the gallbladder, ducts and pancreas.
What is an example of a metabolic disorder which may cause Cirrhosis?
Hemochromatosis - overload of Fe- (Iron).
What is cryptogenic?
Obscure or uncertain origin.
What is the pathophysiology of Cirrhosis?
Hepatocytes are destroyed. Due to the regenerative capabilities of the liver, the cells regenerate but fibrous scar tissue forms. Vessel constriction impedes perfusion leading to portal HTN, fluid shifts and ultimately ascities. Duct constriction causes impeded bile flow and bile statis. There is decreased metabolic waste clearance. Ultimately the result is liver failure and patient death.
What are the common manifestations of Cirrhosis?
Anorexia, Weakness, Weight Loss, hepatomegaly, jaundice.
What are two large manifestations which can occur during Cirrhosis?
Hepatomegaly (Enlarged Liver), Jaundice.
What are three complications of Cirrhosis?
Portal HTN and Ascities, Varices and GI bleeds, Splenomegaly
What is varices?
Varices is the dilation of an associated vein. The complication of a varix vein can lead to bleeds or vomitting of blood.
What is splenomegaly?
An enlarged spleen.
How is Cirrhosis treated?
Treatment is meant to maximize regeneration of hepatocytes through diet (small meals, high cal content, no fat), and no alcohol. Treatment of complications will also occur.
Why is a no-fat diet important in Cirrhosis treatment?
Due to bile duct constriction and that bile is produced in the liver, and bile is used in the emulssification of fats, it is important to ensure that fat is not ingested to save the liver’s workload.
What is Portal Hypertension?
Portal HTN is high blood pressure in the hepatic portal system.
What is the pressure in mmHg in the hepatic portal system (normal and high)?
Normal pressure is 5-10 mmHg. Portal HTN is diagnosed when pressure is the hepatic portal system exceeds 12 mmHg.
What vein carries the majority of blood into the liver?
The portal vein. It carries 70% of blood into the liver.
What is the main artery into the liver?
The Hepatic artery carries 30% of the blood to the liver, which meets/delivers the oxygen needs of the liver.
What vein carries blood from the liver?
The Hepatic vein carries 100% of the blood leaving the liver and delivers it to the inferior vena cava.
What is the cause of Portal HTN?
Pre-, post-, or intrahepatic obstructions mostly due to Cirrhosis.
What is a major complication of portal HTN?
Ruptured varix. The patient will die of hypovolemic shock
What are several other complications associated with portal HTN?
Ascites, Portosystemic shunts, Splenomegaly
What is ascities?
Ascities is fluid accumulation in the peritoneal cavity
What is the cause and pathophysiology of ascities?
Ascities can be caused by Cirrhosis and portal HTN, and Right-sided heart failure. Severe changes in hydrostatic pressure or osmotic pressure or water and sodium retention.
What are the manifestations of ascities?
Dyspnea, Abdominal Distention
Why is dyspnea a manifestation of ascities?
Due to the build-up of fluid the diaphragm moves against pressure
What is the treatment for Ascities?
Small volume: Diuretics which decreases hydrostatic pressure in the vasculature so osmotic pressure can push back. Replacement of fluids and electrolytes. Large volume: paracentesis and a volume expander (eg. Albumin)
What is the purpose of a volume expander and Albumin in ascities treatment?
Albumin prevents the rush of fluid from the vasculature post paracentesis.
