Liver

Question 1

What is the definition of ascites?

Answer 1

Accumulation of fluid within the abdominal cavity

Question 2

What is the cause for ascites

Answer 2

Portal hypertension
Hypoproteinemia

Question 3

What is the mechanism for ascites

Answer 3

depends on different pressures within the capillaries and the impaired balance within these would cause edema (fluid accumulation)
1. Cirrhosis accompanies diffuse fibrosis and loss of regular liver structure
2. stenosis of veins, making it more difficult to flow, so increased pressure (sinusoidal hypertension)
3. Increased blood pressure in portal veins (portal hypertension)

Question 4

Signs of ascites

Answer 4

Distension of lower abdomen
Abdominal discomfort
Lethargy
Decreased appetite

Question 5

Cirrhosis definition

Answer 5

End stage liver accompanied with diffuse fibrosis and loss of regular structure, can cause ascites

Question 6

Mechanism of cirrhosis

Answer 6

Sinusoidal hypertension
• causes increased fluid leakage into Space of Disse with increased lymph formation
• Makes it difficult for lymph to drain, so there’s overflow into peritoneal cavity = ascites
• High protein content in transudate, so fluid leakage due to osmosis = ascites
• Also leads to portal hypertension = increased capillary pressure in abdo area and plasma leakage into peritoneal cavity = ascites
2. Leads to hypoalbuminemia
• decreased albumin synthesis in liver, protein leakage from sinusoids = hypalbuminemia
• Decreasing blood osmotic pressure, plasma leaks into interstitium and abdo cavity = ascites
3. Causes plasma leakage from blood vesssels
- causes noradrenaline release, causing vasoconstriction and increasing blood volume
- RAAS is activated and ADH is excreted all causing edema and ascites
4. Decreased liver blood flow
- portosystemic circulation is unable to metabolise noxious compounds
- peripheral vasodilation occurs causing edema and ascites

Question 7

Complications of cirrhosis

Answer 7

Hepato renal syndrome
Hepatic encephalopathy
Hepatic hydrothorax

Question 8

Define HE

Answer 8

Decline in brain function that occurs as a result of severe liver disease
Liver cannot remove toxins from the blood, ,leading to build up of toxins in blood stream causing brain damage

Question 9

Mechanism of HE

Answer 9

• toxins bypass liver and have toxic action on the brain
• ammonia is a waste product of AA metabolism and urea is formed by AA deamination and urea degradation
• SI digest protein, deaminates AA and produces NH3, bacteria in large intestine degrade urea producing ammonia. Through portal circulation, ammonia enters urea cycle and is bio transformed into urea and kidney excretes. Can also be converted to glutamine in the liver

Question 10

Signs of HE

Answer 10

Depression
Tremor
Stupor/coma

Question 11

Hepatic hydrothorax (pleural effusion) definition

Answer 11

Excessive accumulation of transudate in pleural cavity

Question 12

Mechanism of hepatic hydrothorax

Answer 12

Ascitic fluid effusive so through small diaphragmatic defects

Question 13

Signs of hepatic hydrothorax

Answer 13

Animal can cough
Dyspnoea
Hypoxia
Respiratory failure