Cirrhosis and Liver Disease Part I (exam 3) Flashcards
damage of the liver results in
development of nodules surrounded by fibrous bands –> cirrhosis
complications of cirrhosis
impaired hepatocyte function
portal HTN
hepatocellular carcinoma
acute vatical bleeding
spontaneous bacterial peritonitis
ascites
hepatic encephalopathy
cirrhosis is
irrversible
biggest causes of cirrhosis
alcoholism
hepatitis c
nonalcoholic fatty liver disease
the livers blood supply is mostly
venous
blood enters the liver via
portal triad (portal vein, hepatic artery, bile ducts)
portal vein
80% of livers blood supply
oxygen poor, nutrient rich
blood from GI and spleen
hepatic artery
20% of livers blood supply
oxygen rich, nutrient poor
blood from heart
liver functions
detoxification and clearance
metabolism
storage functions
formation and secretion of bile
metabolism in the liver
carbohydrates, fat and protein metabolism
clearance/detoxification in the liver
detoxification of drugs and poisons via phase I and II
traps bacteria
storage functions of the liver
uptake and storage of vitamins A, D, B12 and folate
bile formation and secretion in the liver
involved in digestion and absorption of fats
major route of excretion of lipid-soluble waste products
what is activated in the liver that leads to fibrotic scar tissue
hepatic stellate cells
fibrosis leads to decreased __________________ which alters portal blood flow
hepatocellular mass and function
portal hypertension
high BP within the portal venous system
portal hypertension is due to ________ which causes blood to ________________
fibrosis
back up in the portal vein
hepatic venous pressure gradient is the pressure gradient between
portal and central venous pressures
Normal HVPG
1-5 mm Hg
portal HTN HVPG
over 5 mm Hg
HVPG for risk for esophageal varices
greater than or equal to 10 mm Hg
HVPG for risk for vatical bleeding and ascites
greater than or equal to 12 mm Hg
varices
fragile blood vessels that may break and bleed
under high HVPG, varices _______________________ which causes bleeding
stretch, swell, twist and break
patients with variceal bleeding may present with
bloody vomiting
black, loose stools
ascites
accumulation of excess fluid within the abdomen
signs and symptoms of ascites
increased abdominal girth and peripheral edema
SOB
malnourished
muscle wasting
weakness and fatigue
hepatic encephalopathy
reversible, metabolically induced disturbance of the brain
hepatic encephalopathy is caused by
accumulation of ammonia which interferes with brain function
patients with hepatic encephalopathy present with
neglect of appearance
forgetfulness
difficulty concentrating
confusion
unresponsiveness
coma
true liver function tests include
hypoalbuminemia
increased prothrombin time and INR
true liver function tests reflects
decreased hepatic synthesis activity
thrombocytopenia causes (in liver tests)
splenomegaly –> platelet destruction
decrease in thrombopoietin production in the liver –> less platelets made
immune destruction of platelets
abnormalities seen in liver disease
hypoalbuminemia
increased prothrombin time and INR
thrombocytopenia
increased aminotransferase levels
increased bilirubin
increased alkaline phosphatase and GGT
which liver function abnormality are markers of hepatocyte injury?
increased aminotransferase levels
aminotransferase leveis may or may not be elevated in
chronic liver disease
increased bilirubin means loss of
liver excretory capacity
what liver test reflects liver injury?
increased alkaline phosphatase and GGT
alkaline phosphatase and GGT is typically elevated in
liver disease with bile flow obstruction
elevated GGT or AST/ALT ratio suggests
alcohol intake
what diagnostic test is the first approach?
why?
ultrasound
no radiation exposure/IV contrast, low cost
ultrasound detects
modularity, irregularity, atrophy, ascites
CT/MRI detects
nodularity, atrophy, hypertrophy, ascites, varices
EGD is the gold standard for
diagnosing varices
Liver biopsy is golden standard for
diagnosing cirrhosis
MELD (model for end stage liver disease)
omits ascites and encephalopathy
includes additional lab markers (SCr, INR)
Child-Pugh components
total bilirubin
albumin
ascites
encephalopathy
prothrombin time prolongation
__________________ for liver impairments are based on Child-Pugh score
drug dose adjustments
