Cirrhosis & Portal Hypertension Flashcards
What is cirrhosis?
nodules of regenerating hepatocytes surrounded by bands of fibrous tissue that is diffuse and irreversible
What are the causes of cirrhosis?
all forms of chronic liver disease including ASH, NASH, chronic hepatitis B and C, autoimmune hepatitis, chronic biliary disease, Wilson’s disease, haemchromatosis, drugs
What is the pathogenesis of cirrhosis?
in chronic inflammation stellate cells are activated to a myofibroblast phenotype so contract and produce collagen
What are the 3 types of complication of cirrhosis?
parenchymal liver failure, endocrine disturbance, portal hypertension
What are the features of parenchymal liver failure?
hepatic encephalopathy, jaundice, coagulopathy, low albumin
What are the features of endocrine disturbance?
gynaecomastia, spider naevi, testicular atrophy
What are the features of portal hypertension?
ascites, splenomegaly, varice at sites of portosystemic anatomoses
What are the clinical signs of chronic liver disease?
jaundice, hepatomegaly, splenomegaly, ascites, caput medusae, spider naevi, palmar erythema, gynaecomastia, testicular atrophy, digital clubbing, dupytrens contracture, metabolic flap
Which types of chronic liver disease are most at risk of hepatocellular carcinoma?
alcohol, chronic viral hepatitis, haemochromatosis
What is portal hypertension?
an absolute increase in blood pressure within the portal vein greater than 8mmHg or increase in pressure gradient between the portal vein and the hepatic vein greater than 5mmHg
What is the commonest cause of portal hypertension?
cirrhosis
What is a cause of pre sinusoidal portal hypertension?
portal vein thrombosis
What is a cause of post sinusoidal portal hypertension?
hepatic vein thrombosis
What are the 4 factors that cause portal hypertension in liver cirrhosis?
increased portal blood flow causing vasoreactive contraction, nodules compressing sinusoids, scar tissue compressing sinusoids, shunting between hepatic artery and portal vein
