Liver Cirrhosis

Question 1

What are the hallmarks of liver cirrhosis

Answer 1

Chronic inflammation causing fibrosis

Assocaited with hepatocyte necrosis

Architectural changes (nodules) - liver pokes out in-between bands of fibrosis

Question 2

What is the end result of the chronic liver injury

Answer 2

Irreversible damage to the liver

Impariment of liver function

Distortion of architecture leading to vascular changes

Question 3

What are the causes of liver cirrhosis

Answer 3

Drugs - alcholic liver disease, iatrogenic, methotrexate

Infection - HBV/HCV

Deposition - fat, iron, copper

Autoimmune - autoimmune hepatitis, PBC, PSC

Other - alpha-1 antitrypsin, glycogen storage disease, Budd-Chiari

Question 4

What are the symptoms of alcholic liver disease

Answer 4

Rapid onset of jaundice

Tender hepatomegaly - RUQ pain

More severe: nausea, oedema, ascties, splenomegaly

Question 5

How does NAFLD cause hepatitis

Answer 5

Non-alcoholic fatty liver disease

There is accumulation of TAGs and other lipids in hepatocytes in the liver leading to fatty liver disease resulting in cirrhosis over a period of years

Question 6

How does hereditary haemochromatosis cause liver cirrhosis

Answer 6

Hereditary haemochromatosis causes abnormal iron metabolism resulting in increased absorption of iron from small intestine -> excess deposition

Excess deposition in liver causes cirrhosis if allowed to occur over many years

Question 7

What is Wilson’s disease and how does it cause liver cirrhosis

Answer 7

Wilson’s disease is an autosomal recessive condition causing abnormal copper metabolism

There is decreased copper secretion from biliary system meaning it accumulates in tissues

Can accumulate in liver -> cause cirrhosis

Patient will have Kayser-Fleischer ring

Question 8

What is PSC

Answer 8

Primary sclerosing cholangitis

It is fibrosis of intra and extrahepatic bile ducts

Can be asymptomatic or present with pruritus, jaundice and cholangitis

It is associated with hepatobiliary malignancy and UC

Question 9

What is PBC

Answer 9

Primary biliary cirrhosis

PBC is destruction of intrahepatic bile ducts

Can be asymptomatic or present with pruritus +/- jaundice

Will have hepatomegaly with advanced disease

Question 10

Name some symptoms of deranged liver function

Answer 10

Jaundice

Oedema/ascites

Bleeding/easy bruising

Confusion

Question 11

Why does cirrhosis cause portal hypertension

Answer 11

Fibrotic liver is not very expandable -> compresses veins entering liver from portal circulation

This causes increased hydrostatic pressure in portal venous system

Can cause ascites

Question 12

What are varices

Answer 12

Varices are places of distension in veins

This distention occurs at the site of anastomoses

They are due to blood shunting from the portal system into venous circulation due to the portal hypertension

Question 13

What are the three sites of varices

Answer 13

Oesophageal varices

Umbilical varices

Anorectal varices

Question 14

Where do oesophageal varices occur and what pathology is associated with them

Answer 14

Oesophageal varices occur at the distal portion of the oesophagus

If varices rupture, they can cause significant haematemesis

Question 15

Where do umbilical varices occur and how does it appear

Answer 15

In umbilical varices, blood is shunted through ligamentum teres causing varices

Caput medusa can be seen - distented veins around the umbilicus

Question 16

Where do anorectal varices occur and what can they cause

Answer 16

Anorectal varices occur between superior, middle and inferior rectal veins

Can cause haemorroids which are typically painless

Question 17

What is hepatorenal syndrome

Answer 17

Development of AKI in the presence of cirrhosis

Portal hypertension causes blood to pool -> brain thinks there is decreased circulating volume -> arterial vasodilation -> RAAS activation -> renal artery vasoconstriction causing reduced blood flow to kidney causing AKI