Cirrhosis

Question 1

Cirrhosis path

Answer 1

Apoptotic hepatocytes with pyknosis and karyorrhexis

Areas of loss result in collapse of reticulin netowkr and act of hepatic stellate cells that generate a fibrous septum

Inc resistance to portal vein blood flow (portal HTN) and correlates to degree of liver damage

Question 2

CM of jaundice

Answer 2

Inability to process estorgen

Mean arterial pressure falls

Jaundice - both unconjugated and conjugated
Variceal hemorrhage - esophageal portosystemic coll rupture
Ascites
Hepatic enceph - sleepiness, reversal of circadian rhythm and asterixis

Mild to mod AST/ALT elevation with also inc alk phos

Can also get hyponatremia and degress of cytopenias

Question 3

Dx of cirrhosis

Answer 3

Get US - surace nodularity, hepatic steatosis and areas of inc echogenicty…right lobe becomes atrophid and caudate lobe becomes hypertrophid

Liver biopsy is gold std

Question 4

Mg of cirrhoissi

Answer 4

Abstinence from alcohol
Tx of viral hep

Stop any hepatoxic meds and get immunizated

Ascities - sodium restirction and then spirnolactoen and furosemide

Hepatic enceph - dec ammoniogenic substrates, eliminate gut bacterai….lactulose dec luminal pH…rifaximin kills gut bacteria

SBP - acutely managed

Hepatorenal - neprhotioxic and aggressive diuresis should be avoided

Coagulopathy - prophylactic vit K

Variceal hemorrhage - endoscopi and ligation with beta-blokcers