Cirrhosis Flashcards
Chronic, inflammatory, irreversible disease of the liver resulting in reduced liver function. Is also a fibrotic condition and characterized by the formation of scar tissue
Cirrhosis
Approximately ________ people per year are hospitlized
400,000
Slightly more common in (men or women)
Men
Word that means “yellow-orange” which is the color that a cirrhotic liver looks like
Kirrhos
25% of cirrhosis cases are due to
Hepatitis C
20% of cirrhosis cases are due to
Alcoholism
Another cause of cirrhosis includes which disease?
Non-alcoholic fatty liver disease (NAFLD)
Liver is supplied from which two vessels?
Hepatic artery (oxygenated blood) and portal vein (deoxygenated blood)
Where do the hepatic artery and portal vein drain into?
Hepatic sinusoid
Sinusoids are lined by ______ and _______ cells
Endothelial and Kupffer cells
Which cells are similar to macrophages and act as a resident immune cell that can stimulate inflammation for the liver?
Kupffer cells
Filtered blood drains into which vessels?
Central veins
Central veins then drain into which vessel?
Hepatic vein
What is the normal pressure of the liver system?
5-10mmHg
What are the cells that synthesize fibrin in the liver and stimulate fibrosis?
Stellate cells
What is the main cause of cirrhosis?
Imbalance between ECM production and degradation, which increases fibrosis
How does the imbalance between ECM production and degradation occur?
- Inflammatory response causes the release of chemical mediators released from hepatocytes and Kupffer cells
- These mediators activate stellate cells to produce excess collagen and fibrin that deposits into extracellular space
- Causes the hepatocytes to regenerate into nodules
- Causes sinusoids to become constricted, which increases portal pressure above 10mmHg, causing portal hypertension
- Collateral vessels form and shunts blood around the liver, which results in poor metabolism of toxins, bilirubin, drugs, hormones, etc.
What is the main chemical mediator release from Kupffer cells?
TGF-beta
No manifestations of cirrhosis until how much of the liver has lost function?
> 80%
Most common, initial symptoms (7)
- Nausea
- Loss of appetite
- Weight loss
- Weakness
- Fatigue
- Hepatomegaly
- Jaundice
Other, not as common symptoms (4)
- Confusion
- Fever
- Edema
- Easily bruise or bleed
100% certain diagnostic measure of cirrhosis
Liver biopsy
What would a CBC test show in individuals with cirrhosis?
Decreased production of all blood cell types
What happens to PT and INR?
Both are increased (takes longer to clot)
How are the liver enzyme levels affected of AST and ALT?
Massive increase of these in blood stream (over 1000x)
What will happen to bilirubin and serum albumin levels?
Increased bilirubin, decreased albumin
A nonspecific marker, alkaline phosphate, will be increased or decreased?
Increased
Complications of portal hypertension (4)
- Esophageal varices - distended veins in lower esophagus
- Ascites - accumulation fluid in peritoneal cavity
- Hepatic encephalopathy - accumulation of ammonia causing neurologic deficits
- Hepatocellular carcinoma; hepatorenal failure
A higher grade of hepatic encephalopathy means condition is (better or worse)
Worse
What is the only cure for cirrhosis?
Liver transplant
Two staging/severity tools used to monitor cirrhosis?
- Child-Turchotte-Pugh (CTP) classification
* More common - Model for End-Stage Liver Disease (MELD)
