Liver

Question 1

Liver failure is defined as:

Answer 1

Loss of 80-90% hepatic functional capacity

Question 2

What is cirrhosis and what is it usually caused by?

Answer 2

Cirrhosis is the scarring/fibrosis of liver.
- usually caused by viral hepatitis, drug induced liver injury, alcohol liver disease, bile duct obstruction

Note!
- not all end-stage liver disease is cirrhotic
- not all cirrhosis = chronic liver failure (regression can happen, aka liver gets better)

Question 3

What is acute pancreatitis?

Answer 3

• reversible pancreatic parenchymal injury associated w inflammation

Question 4

Ascites is..

Answer 4

Accumulation of excess fluid in the peritoneal cavity (500ml = clinically detectable)

Question 5

Cholestasis is..

Answer 5

The systemic retention of bilirubin and other solutes eliminated in bile, caused by impaired bile formation and bile flow

• jaundice: yellow discolouration of skin
• icterus: yellow discolouration of sclera

Question 6

Hepatic encephalopathy is..

Answer 6

Brain dysfunction caused by liver insufficiency and/or porto-systemic shunting manifesting as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations (e.g. confusion) to coma

-

Question 7

Hepatitis is..

Answer 7

Inflammation of the liver

Question 8

Portal hypertension is..

Answer 8

Increased resistance to portal blood flow

Question 9

Cancer in the liver is often ______?

Answer 9

Often secondary. Most common site of metastatic cancers from the colon, lung & breast.

Question 10

Name 2 primary malignancices of the liver.

Answer 10

Hepatocellular carcinoma (HCC) (90%)
Cholangiocarcinoma (CC) (10%)

Question 11

Pathogenesis of portal hypertension:

Answer 11

Due to
1. Increased resistance to portal flow at sinusoids
- vasoconstriction (vascular smooth muscle + fibroblasts)
- disrupted blood flow by scarring / parenchymal nodule formation
- sinusoidal remodeling, arterial-portal anastomosis (intrahepatic shunts)
2. Increased portal venous flow due to hyperdynamic circulation
- arterial vasodilation (splanchnic circulation)
(Reaction to portal hypertension, system tries to expand volume in response to increased pressure, but then it backfires cuz theres even more blood that needs to be drained.. temporary relief but worsens in long term)

Question 12

Effects of portal hypertension:

Answer 12

1. Ascites
2. Portosystemic venous shunts:
   - caput medusae (distention of umbilical veins)
   - anorectal varices/hemorrhoids
   - esophageal varices
3. Splenomegaly
   - enlarged spleen, manifests as decreased platelet count, sometimes decreased RBC count cuz more blood goes through the spleen n is broken down
4. Hepatic encephalopathy
   - Asterixis ‘hepatic flap’
   - check by asking patient to stick out hand in front, but hands will flap down if they have asterixis

Question 13

Consequences of liver failure:

Answer 13

1. Coagulopathy
2. Hepatic encephalopathy
3. Cholestasis
4. Hepatorenal/ hepatopulmonary syndrome
5. Portal hypertension

Question 14

What is coagulopathy?

Answer 14

• impaired hepatic synthetic function
• leads to prolonged clotting time, more bleeding

decreased synthesis of clotting and inhibitor factors, decreased clearance of activated factors, quantitative and qualitative platelet defects

Question 15

Hepatic encephalopathy is..

Answer 15

• impaired hepatic metabolism (ammonia n urea buildup)
• u get altered mental state, varies from confusion to coma
• asterixis ‘hepatic flap’

Question 16

What is hepatorenal and hepatopulmonary syndrome?

Answer 16

• impaired function of kidneys and lungs due to underlying liver failure
• the kidneys n lungs can recover as long as underlying liver failure is solved

Question 17

Portal hypertension seen more in ALF or CLF?

Answer 17

Seen more in chronic liver failure patients.

Question 18

What is acute on chronic liver failure?

Answer 18

• an unrelated acute injury supervenes on a well-compensated late-stage chronic disease
• chronic disease itself has a flare of activity that leads directly to liver failure

Common precipitants of ACLF include patients with chronic liver disease with hepatitis B reactivation or superimposed acute viral hepatitis, such as hepatitis E, alcoholic hepatitis, DILI, bacterial infections, major surgery, or gastrointestinal bleeding.

Question 19

What is regression of cirrhosis?

Answer 19

• when cirrhosis is inhibited or eliminated
  2 processes:
  1. Decrease in fibrosis
  2. Repopulation of fibrogenic region by regenerating hepatocytes