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Year 2 > Cirrhosis and Liver fibrosis > Flashcards

Cirrhosis and Liver fibrosis Flashcards

1
Q

Histologically, how can we see irreversible liver damage

A

Loss of normal hepatic architecture with bridging fibrosis and nodular regeneration

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2
Q

Main causes of irreversible liver damage

A
  1. Chronic alcohol abuse
  2. Non-alcoholic fatty liver disease
  3. Hep B + D
  4. Hep C
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3
Q

What is Wilson’s disease

A

Copper build up in the body - causes liver disease

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4
Q

What diseases can cause liver damage

A
  1. Autoimmune hep
  2. Alpha-antitryspin deficiency
  3. Hereditary haemochromatosis
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5
Q

Risk factors for liver damage

A

Alcohol use

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6
Q

How does liver injury result in irreversible liver damage

A
  1. Chronic injury causes inflammation, matrix deposition, necrosis and angiogenesis -> fibrosis
  2. Liver injury causes necrosis + apoptosis releasing cell contents and ROS
  3. Activates hepatic stellate cells + kupffer cells
  4. Kupffer cells phagocytose necrotic and apoptotic cells + secrete inflammatory mediators
  5. Increased myofibroblasts leads to progressive collagen matrix deposition resulting in fibrosis and scar accumulation in the liver
  6. Severe reduction liver function
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7
Q

Name two inflammatory mediators

A

TGF-beta

PDGF

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8
Q

Role of TGF-beta

A

Transdifferentiation of stellate cells to myofibroblasts

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9
Q

Role of PDGF

A

Stimulates myofibroblast proliferation

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10
Q

What happens to the liver if fibrosis is eliminated

A

Liver can recover

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11
Q

In cirrhosis, can regression occur

A

Yes

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12
Q

What are characteristic features of cirrhosis

A

Regenerating nodules separated by fibrous septa + loss of lobular architecture within nodules

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13
Q

What two types of cirrhosis are there

A

Micro nodular

Macro nodular

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14
Q

What is micro nodular cirrhosis

A

Regenerating nodules are less than 3mm in size

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15
Q

What is micro nodular cirrhosis caused by

A

Alcohol + biliary treat disease

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16
Q

What is macro nodular cirrhosis

A

Nodules are of varying size and normal acini may be seen within the larger nodules

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17
Q

What is macro nodular cirrhosis caused by

A

Chronic viral hepatitis

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18
Q

Clinical presentation of cirrhosis

A
  1. Leuconychia
  2. Clubbing
  3. Palmar erythema
  4. Dupuytren’s contracture
  5. Spider nave
  6. Xanthelasma
  7. Hepatomegaly
  8. Bruising
  9. Ankle swelling + oedema
  10. Abdominal pain due to ascites
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19
Q

What is Xanthelasma

A

Yellow fat deposits under the skin usually around the eyelids

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20
Q

What is leuconychia

A

White discolourations on nails due to hypoalbuminaemia

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21
Q

How is cirrhosis diagnosed

A
  1. Ascites, encephalopathy
  2. HIGH bilirubin
  3. LOW albumin
  4. LONG PTT (1-3 and added up to give score)
  5. Liver biopsy (main way - confirms diagnosis + severity)
  6. Raised AST and ALT
  7. Low Na
  8. Raised serum creatine
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22
Q

What child-pugs classification is gives best prognosis

A

<7

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23
Q

What child-pughs classification is a sign of BAD prognosis

A

> 10

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24
Q

What is the risk at >8

A

Risk of vatical bleeding

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25
Presence of alpha-fetoprotein indicates what
HEPATOCELLULAR CARCINOMA
26
How does an Ultrasound help in cirrhosis diagnosis
1. Shows change in size + shape of the liver - hepatomegaly 2. Shows modularity of liver and distortion of arterial vascular architecture HEPATOCELLULAR CARCINOMA
27
What can a CT show for cirrhosis
1. Hepatosplenomegaly | 2. HEPATOCELLULAR CARCINOMA
28
What can an MRI show for cirrhosis
Detects tumours
29
What can an endoscopy show for cirrhosis
Detection of varies and portal hypertensive gastropathy
30
Complications of cirrhossi
1. Fall in clotting factors 2. Encephalopathy + confusion 3. Hypoalbuminaemia (oedema) 4. Portal hypertension
31
How is cirrhosis treated
1. Good nutrition 2. Alcohol absintence 3. 6 month ultrasound screening for early development of hepatocellular carcinoma 4. Treat underlying cause 5. Hep A and B vaccination 6. reduce salt intake
32
Why should we avoid NSAIDs in treating cirrhosis
Can precipitate gastro-intestinal bleeding or renal impairment
33
What forms the portal veins
Union of superior mesenteric and splenic veins
34
normal pressure of portal veins
5-8mmHg
35
Main pre-hepatic cause of portal hypertension
Portal vein thrombosis
36
Main intra-hepatic cause of portal hypertension
1. CIRRHOSIS 2. Schistosomiasis 3. Sarcoidosis
37
Main post-hepatic cause of portal hypertension
1. RHF 2. Constrictive Pericarditis 3. IVC obstruction
38
How does portal hypertension cocur
Liver injury + fibrogenesis the contraction of myofibroblasts contributes to increased resistance to blood flow
39
How is portal hypertension initially compensated
Splanchnic vasodilatation from portal hypertension causes drop in BP/ increased CO and formation of collaterals between portal and systemic systems
40
Where are collaterals forms
1. Gastro-oesophageal junction 2. Rectum 3. Left renal vein 4. Diaphragm 5. Retroperitoneum
41
What happens to the microvasculature of the gut during portal hypertension
Becomes congested Causes hypertensive gastropathies and colopathies
42
Symptoms of portal hypertension
Often asymptomatic
43
Clinical sign of portal hypertension
Splenomegaly
44
How does chronic liver disease clinically present in conjunction with portal hypertension
1. Haematemesis and Malena from ruptured gastro-oesophageal varice OR portal hypertensive gastropathy 2. Clubbing 3. Palmar erythema 4. Dupuytren's contracture 5. Spider Naevi
45
What will most patients with cirrhosis develop over the next 10 years
Gastro-oesophageal varices
46
How many of those with gastro-oesophageal varies will bleed
1/3
47
When will bleeding occur in gastro-oesophageal varices
Those with large varies or those with red signs at endoscopy and severe liver disease
48
How is bleeding from portal hypertension maanged
1. Resuscitate until haemodynamically stable 2. Blood transfusion if anaemic 3. Correct clotting abnormalities
49
Why is vasopressin given during portal hypertension
Cause vasoconstriction
50
What vasopressin do we give for portal hypertension
IV TERLIPRESSIN (SOMATOSTATIN if contraindicated IHD)
51
What antibiotic is given to people with is given to treat infection and why in portal hypertension
CEPHALOSPORIN
52
Why is cephalosporin given in portal hypertension
Reduce early rebleeding and mortality
53
What is vatical banding
Band is put around avarice using an endoscope (after a few days, banded vary degenerate and falls off)
54
What other surgical methods are there for treating portal hypertension
1. Ballon tamponade to reduce bleeding by placing pressure on avarice if banding fails 2. Transjugular intrahepatic portoclavical shunt
55
When is TIPS done
When bleeding can't be controlled whether acutely or following rebreeding (shunts between systemic and portal system to reduce portal vein pressure)
56
How is portal hypertension prevented
Non-selective B-blocker (PROPRANOLOL) - reduces portal pressure VARICEAL BANDING repeatedly Liver transplant
57
What is Primary Biliary Cirrhosis
Chronic disorder with progressive destruction of small bile ducts = cirrhosis
58
What people does primary biliary cirrhosis effect
Women aged 40-50
59
What gender does primary biliary cirrhosis effect
Females
60
Risk factors for primary biliary cirrhosis
1. Positive family history 2. Many UTIs 3. Smoking 4. Past pregnancy 5. Other autoimmune disease 6. Use of nail polish
61
Pathophysiology of primary biliary cirrhosis
Interlobar bile ducts are DAMAGED by chronic autoimmune inflammation resulting in cholestasis which may lead to fibrosis, cirrhosis and portal hypertension
62
What is cholestasis
Bile can't flow from the liver to the duodenum (caused by a gallstone usually)
63
What is found in all patients' blood with primary biliary cirrhosis
Anti-mitochondrial antibodies
64
Clinical presentation of patients with primary biliary cirrhosis
1. Hepatomegaly 2. Raised serum alkaline phosphate 3. AMA 4. Pruritus (itching) 5. Lethargy and fatigue accompanying itching 6. Eventually jaundice due to hepatomegaly 7. Pigmented xanthelasma
65
What is pigmented xanthelasma
Yellow fat deposits under the skin usually around the eyelids
66
Complications of primary biliary cirrhosis
Cirrhosis Osteoporosis Malabsorption of fat-soluble vitamins due to cholestasis Decreased bilirubin in gut lumen = osteomalacia and coagulopathy
67
What is osetomalacia
Softening of the bone due to a loss of phosphates and calcium
68
Differential diagnosis of Primary biliary cirrhosis
1. Autoimmune cholangitis | Extahepatic biliary obstruction
69
How is extra hepatic biliary obstruction excluded
Ultrasound
70
Blood test for primary biliary cirrhosis
1. Increased alkaline phosphate 2. Raised serum cholesterol 3. AMAs 4. Raised IgM
71
What can an ultrasound show for primary biliary cirrhosis
Diffuse altering in liver architecture + excludes extra hepatic cholestasis
72
How can a liver biopsy help in diagnosis of primary biliary cirrhosis
1. Portal tract infiltrate 2. Granulomas (40% have them) 3. Damage to and loss of small bile ducts + ductur=lar proliferation 4. Portal tract fibrosis and eventually cirrhosis
73
How is primary biliary cirrhosis treated
1. URSODEOXYCHOLIC ACID 2. BISPHOSPHONATES 3. Supplements of vit A,D,E,K
74
Why is URSODEOXYCHOLIX ACID given
Improves bilirubin and aminotransferase
75
Why are bisphosphonates given
Osteoporosis
76
How is pruritus treated
COLESTYRAMINE | NALOXONE and NALTREXONE
77
Problem with COLESTYRAMINE
Unpalatable

Year 2 (155 decks)

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