Cirrhosis & Portal HTN Flashcards
name two common examples of how the liver metabolizes toxins
1) converts ammonia to urea, 2) metabolizes alcohol
Phase 1 of drug metabolism occurs in zone ___ and uses _____ enzymes
zone 3; cytochrome P-450
Phase 2 of drug metabolism results in?
attachment of large molecules to improve water solubility (glucuronidate, methyl groups, acetic acid, sulfa groups)
what is the liver’s role in lipid metabolism?
cholesterol synthesis
what is the purpose of bile?
the emulsify fats (released from gallbladder after meals)
in liver injury, ____ cell activation leads to accum of scar matrix
stellate cell
____ cell activation accompanies liver injury and contributes to ____ activation of stellate cells
kupffer cell; paracrine
liver injury causes loss of hepatocyte ____ and sinusoidal endothelial _____
microvilli; fenestrae
name 4 genetic/hereditary etiologies of cirrhosis
hemachromatosis, wilson’s dz, a1-antitrypsin deficiency, inborn errors of metabolism
decompensated cirrhosis can have a mortality exceeding ___ at one year
50%
jaundice and scleral icterus are a result of?
liver’s inability to process bile
when bile pigments deposit in the skin, patient’s experience _____
pruritis
the liver’s inability to produce albumin results in?
acites and edema
___glycemia may occur in end-stage liver dz
hypoglycemia
clinical sx of portal HTN are seen when the portosystemic pressure gradient exceeds?
10-12mmHg (nl = 5)
portal pressure is directly related to ___ and ___
portal venous inflow & resistance to portal outflow
what influences portal venous inflow?
cardiac output (affects tone of mesenteric arterioles)
collateral blood flow secondary to portal HTN results in? (4 things)
hemorrhoids (rectal vein), caput medusae (umbilical vein), splenomegaly (splenic/left renal vein), varices (left gastric vein)
blood entering the portal venous circulation comes from the ____ arterioles
mesenteric
complications of cirrhosis that indicate decompensated dz (6 major)
variceal hemorrhage, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatocellular carcinoma, hepatic encephalopathy (can also affect pulmonary system)
most devastating complication of cirrhosis and portal HTN
variceal hemorrhage
prevention of esophageal varices
1) screening EGD, 2) rx of portal HTN with non-selective beta-blockers, 3) endoscopic variceal ligation for primary prophylaxis