Cirrhosis

Question 1

What is cirrhosis considered a complication of?

Answer 1

Hepatitis

Question 2

what is cirrhosis also known as?

Answer 2

hepatic fibrosis

Question 3

How severe is cirrhosis?

Answer 3

Very severe, it is end stage liver disease

Question 4

Hepatic fibrosis?

Answer 4

Appearance of non-functional fibers that replace hepatocytes

Question 5

What are the primary problems of Cirrhosis?

Answer 5

• decreased liver function (body cannot function without the liver)
• Portal HTN

Question 6

Etiology of Cirrhosis?

Answer 6

• mostly related to alcohol abuse (60-70%)
• Other hepatotoxic drugs
• Hepatitis (hep C)
• Biliary disease
• Metabolic disorders such as hemochromatosis
• Some cryptogenic

Question 7

Hemochromatosis?

Answer 7

Iron overload (normally iron is rested and recycled after heme is broken down so if it is in excess, the liver does not have the ability to excrete large amounts of it. Iron deposits in organs, when it is deposited in the liver it causes cirrhosis)

Question 8

Cryptogenic?

Answer 8

Unknown origin; idiopathic

Question 9

Patho of cirrhosis. What are 4 things affected by cirrhosis and what does it result in?

Answer 9

1. Cells
2. Vessels
3. Ducts
4. Detoxification
   Results in liver failure

Question 10

Pathology of how cirrhosis affects cells.

Answer 10

Hepatocytes (parenchyma) can regenerate, but if damaged in large quantities then fibrous scar tissue forms -> those that do regenerate are surrounded by dysfunctional tissue.

Question 11

Pathology of how cirrhosis affects vessels.

Answer 11

Impeded perfusion due to fibers constricting blood vessels leads to portal HTN. [increased CHP in vessels pushes fluid into the interstitial space of the liver and then into the abdominal cavity -> ascites)

Question 12

Pathology of how cirrhosis affects ducts.

Answer 12

Bile flow impeded d/t duct constriction -> bile stasis -> stones may develop and cause further obstruction of flow

Question 13

List the passageway of bile into the duodenum.

Answer 13

Bile -> bile canaliculi -> bile duct in portal triad -> R/L hepatic duct -> common hepatic duct -> common bile duct -> sphincter of Oddi -> duodenum

Question 14

What occurs if the sphincter of Oddi is closed?

Answer 14

Bile backs up into the cystic duct, fills gall bladder. When there is fat in the duodenum, cholecystokinin (CCK) hormone stimulates the gall bladder to contract and the sphincter of Oddi relaxes to release bile.
- Bile salts in the duodenum are reabsorbed and returned to the liver to stimulate more production. With bile ducts blocked, GI complications and digestion issues arise (b/c fats can’t be emulsified)

Question 15

Manifestations of cirrhosis.

Answer 15

Common: anorexia, weakness (d/t decreased energy production), weight loss
As cirrhosis progresses: jaundice and hepatomegaly

Question 16

What are some complications that can rise from cirrhosis?

Answer 16

• Portal HTN -> ascites (fluid shift)
• Varices (sing. varix)
• Splenomegaly

Question 17

Varices?

Answer 17

When associated veins are distended (along the entire vein)

Question 18

Treatment for Cirrhosis.

Answer 18

Decrease workload of the liver

• maximum regeneration
• no alcohol or hepatotoxic drugs
• increase protein, decrease fat in diet
• sodium restricted diet for portal HTN