Cirrhosis + Portal HTN + Liver Failure Flashcards
Cirrh =
What is Cirrhosis?
What kind of changes occur?
Yellow
- Very serious, considered to be end stage of liver disease (will go into liver failure from here)
- Major cause of death
- Fibrosis–> Nodular liver (bumps)
What is fibrosis?
Fibrosis of the liver is excessive accumulation of scar tissue that results from ongoing inflammation and liver cell death that occurs in most types of chronic liver diseases. Nodules, abnormal spherical areas of cells, form as dying liver cells are replaced by regenerating cells.
Et of cirrhosis?
- Alcohol abuse (60-70%)
- Hepatitis
- Drugs
- Biliary disease
- Metb disorders
- Cryptogenic ( idiopathic)
WHat is an example of a metabolic disorder that can result in cirrhosis?
What are the primary problems that occur in cirrhosis?
hemochromatosis = iron overload in body leading to deposition of this iron into tissues including liver
dec liver fx and portal htn
Pathophysiology of Cirr?
- Repetitive assault on hepatocytes –> eventually not able to regenerate; instead will form scar tissue (collagen fibers) to replace these hepatocytes; collagen fibers surround the area of the dead hepatocyte, appear as nodules
- As scar tissue forms, compressed ducts and blood vessels → perfusion impacted
- Vessel constriction → impeded perfusion → portal HTN (pressure inside of vessel increases (inc hydrostatic P) , causing more push pressure → fluid shift → ascites (fluids moves into empty body cavity)
- Duct constriction → bile flow impeded → bile stasis (can result in gallstones)
- Dec in metb waste clearance
- Liver failure
Fx’s of the liver?
- Production of bile salts
- Elimination of bilirubin
- Metabolism of steroid hormones (sex hormones, glucocorticoids, aldosterone)
- Metabolism of drugs
- Carbohydrate metabolism
- Fat metabolism
- Protein metabolism
- Storage of vitamins and minerals
- Filtration of blood and removal of bacteria and pacticular matter from Kupffer cells
What fx does the liver play in carb metabolism?
Stores glycogen and synthesizes glucsoe from amino acids, lactic acid, and glycerol
What fx does the liver play in fat metabolism?
- Formation of lipoproteins
- Conversation of carbs and proteins to fat
- Synthesis, recycling, and elimination of cholesterol
- Formation of ketones from fatty acid
Liver fx in protein metb?
- Deamination of proteins
- Formation of urea from ammonia
- Synthesis of plasma proteins
- Synthesis of clotting factors
Manifestations and complications of cirrhosis?
Manifestations:
• Vary
• Common: anorexia, weakness, wt loss
• Hepatomegaly, jaundice
Complications:
- Portal HTN
- Ascites
- Varices
- GI bleeds
- Splenomegaly
What are varices and were are they seen to form cirrhosis?
varix=singular
= dilation of an associated vein
(associated vein = not a vein within the hepatic portal system itself, but rather extending pressure to other neighbouring veins such as esophopharageal?)
Why does splenomegaly results with cirrhosis?
d/t engorgement of surround vessels (portal htn)
Tx of cirrhosis?
• Maximize regeneration
–> Diet (to dec workload)
–> No alcohol
• Address complications - Need to ensure varix doesn’t rupture, etc (complications will set in as liver failure progresses)
What does the word portal mean?
Pertains to the porta hepatis.
The porta hepatis is a deep fissure in the inferior surface of the liver through which all the neurovascular structures (except hepatic veins) and hepatic ducts enter or leave the liver 1. It contains: right and left hepatic ducts. right and left branches of hepatic artery. portal vein.
2 sources of blood supply to the liver?
1) From hepatic portal vein
2) Arterial supply through the hepatic artery –> supplies nutrients to liver tissue itself
Where does blood in the hepatic portal vein come from?
What does this blood contain?
Hepatic vein carries blood from: intestines, major abdominal organs including pancreas and spleen
This blood carries nutrient and toxic materials absorbed in the intestine, blood cells and their breakdown products from the spleen, and insulin and glucagon from the pancreas
Where does blood exit the liver?
Where does this lead?
hepatic veins
Drain into the inferior vena cava
What occurs in portal htn?
- Inc pressure in hepatic-portal system
What is the parameter for determining when portal htn occurs?
when exceeds >12 mmHg, is portal HTN
N=5-10
Et of portal HTN
3 kinds?
3 kinds of et based on site of obstruction:
1) Pre-hepatic – blockage in vessel before liver
2) Intra-hepatic – with cirrhosis
3) Post-hepatic – after liver
- Mostly d/t cirrhosis