Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MET3a > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

Anatomy of the Liver

A 
Right and Left Lobes
Supplied by hepatic artery and portal vein
Drained by hepatic vein
8 anatomical segments
Biliary tree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the portal vein formed from?

A

Splenic vein and SMV joining

Portal vein enters liver and divides into R and L branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is blood drained in the liver?

A

Portal vein -> Central vein -> Hepatic vein -> IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the immune liver cells?

A

Kupffer cells

Between blood vessels and sinusoids with other liver cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are stellate cells?

A

Between blood vessels and sinusoids
mesenchymal derived
form collagen when inflammation and scarring
Get damaged in chronic liver failure = portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the functions of the liver?

A

Protein synthesis = albumin, clotting factors
Carbohydrate Metabolism
Lipid metabolism
Bile production
Immunological function = reticuloendothelial system -> hence sepsis
Hormone & drug metabolism/excretion
Detoxification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 2 components of bile?

A

Bile pigment = waste product formed from breakdown of RBCs

Bile salt = key product helping lipid breakdown into smaller products for absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do you get jaundice?

A

When there is a block in the flow of bile, bile pigments refluxes in circulation = jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why do you itching?

A

Reflux of bile salts if blockage of bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mechanism of acute liver failure

A

Hepatocellular dysfunction

Haemodynamic consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of Hepatocellular dysfunction

A

Coagulopathy
Jaundice
Encephalopathy
Increased sepsis risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Haemodynamic symptoms in acute liver failure

A

As a result of inflammation -> leaky vessels:
Cerebral oedema
Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Haemodynamic symptoms in chronic liver failure

A

Due to liver scarring and portal HTN

  • splenomegaly
  • varices
  • ascites
  • hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the usual pressure of the portal system?

A

7-10mmHg

Low pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does portal HTN occur?

A

When liver is scarred in cirrhosis/chronic liver failure the blood from the portal vein struggles to enter this scarred liver. Therefore BP increases inside portal vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens when there is portal HTN?

A

> 12mmHg
Causes a back-pressure
Causes opening of collaterals to allow portal vein to empty into systemic circulation (portal-systemic anastomoses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Portal-systemic anastomoses portal and systemic vessels

A

Portal circulation is left gastric vein and systemic is azygos vein
Portal circulation is superior rectal vein and systemic is middle and inferior rectal veins
P = paraumbilical vein and S = superficial epigastric vein
P = splenic vein and S = renal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Portal-systemic anastomoses sites and condition

A 
Oesophagus = oesophageal varices
Fundus of stomach = fundal varices
Rectal = rectal varices
Paraumbilical = caput medusae
Retroperitoneal = splenorenal shunts
Also around site of a stoma - peristomal bleeds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the mechanism of hepatic encephalopathy?

A

Bypasses the liver via splenorenal shunts

  • normally converts into urea into liver and excreted in urine
  • when cirrhosis bypasses liver goes into systemic circulation to the brain = hepatic encephalopathy
  • goes into astrocytes = swelling and reduced function
  • increases glutamine accumulation
  • confusion to coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the clinical features of portal HTN?

A
  • pancytopenia due to splenomegaly
  • varices = oesophageal, gastric, rectal
  • ascites
  • hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do you get pancytopenia?

A

Backpressure of blood in portal system goes to spleen = splenomegaly
Therefore get splenic sequestration -> pancytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do you get ascites?

A

Portal HTN
Splanchnic vasodilation -> decreased circulatory volume -> RAAS activation -> increased sodium retention and renal vasoconstriction
Also low albumin so lower oncotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the commonest porto-systemic site?

A

Lower Oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Types of symptoms of chronic liver disease

A

Asymptomatic for long phase
Cholestatic
Systemic
Decompensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cholestatic symptoms
- damage to biliary tree microscopically or macroscopically - jaundice - pruritic - pale stools/dark urine
26
Define cholestasis
Decrease in bile flow
27
Why do you get pale stools and dark urine in cholestasis?
Bilirubin not reaching bowel = pale stools | Excess reflux of bilirubin into blood then into kidneys = dark urine
28
Systemic symptoms
Weight loss Muscle loss Fatigue
29
Decompensation symptoms
- liver is not able to keep up - jaundice - fluid retention = swelling feet and abdominal distension - drowsiness/confusion (encephalopathy) - GI bleed (varices( - infection (sepsis) - coagulopathy - hepato renal syndrome (failure)
30
Triggers for decompensation
``` GI bleed Infection Drugs (diuretics & alcohol abuse) Constipation Progression of liver disease HCC Portal Vein Thrombosis (as sluggish flow) ```
31
What to ask about in history of liver patient history?
``` RF = alcohol, IVDU PMH = liver disease, jaundice DH = medications, all SH = sexual, travel, occupation FH Comorbidities = obesity, diabetes ```
32
Signs of asymptomatic compensated liver disease
``` Xanthelasma Parotid enlargement Spider naevi Gynaecomastia Splenomegaly Liver small or large Clubbing Dupytren's contracture Palmar erythema Testucular atrophy Scratch marks in cholestasis Purpura ```
33
General signs of liver disease
Jaundice Fever Loss of body hair
34
Decompensated signs of liver disease
``` Neurological - hepatic flap, drowsy, coma, disorientation Ascites Shifting dullness Dilated veins on abdomen Oedema at ankles ```
35
Spider naevi characteristics
upper chest/back/shoulders | If press center spider will blanch and when let go will fill from center
36
Complications of liver cirrhosis
``` Variceal Bleed Ascites Spontaneous Bacterial Peritonitis Hepatorenal syndrome Jaundice ```
37
How does a variceal Bleed present?
Haematamesis or malaena
38
Tx of variceal bleed?
ABCDE ABs early as increased sepsis risk -> increased portal HTN -> increased bleeding Terlipressin Endoscopic therapy = banding, Glue injection TIPSS
39
What is terlipressin?
Splanchnic vasoconstrictor Reduces blood flow during a bleed Dilates renal veins selectively improving renal perfusion
40
Prophylaxis of varices?
Beta blockers = carvedilol - reduce portal pressure for primary and secondary prevention banding for secondary prevention
41
How to diagnose ascites?
Shifting dullness peripheral oedema - sacral or ankle Liver US + doppler (see portal vein flow) Ascitic tap to rule out spontaneous bacterial peritonitis Cytology to rule out malignancy causing ascites
42
What is the portal vein flow direction?
Normally antegrade = towards liver | When liver is scarred = flow reverse = retrograde = portal HTN and cirrhosis
43
Diagnosis of SBT
Spontaneous bacterial peritonitis WCC Cytology Asitic tap
44
Treatment of ascites
Low sodium diet Diuretics = spironolactone and furosemide (difficult if develop renal failure) Paracentesis (every 2L fluid removes, 200ml of albumin given) TIPSS (if recurrent) Liver Transplantation
45
Spontaneous Bacterial Peritonitis Diagnosis
On ascitic tap: - WCC>250 - neutrophils >80% - gram negative rods + enterococcus
46
Treatment of SBP
IV AB | Human albumin solution
47
Hepatorenal Syndrome types
Type 1 = due to precipitant = SBP, alcoholic hepatitis | Type 2 = progressive
48
Tx of hepatorenal syndrome
Human Albumin Solution and Terlipressin | Liver Transplantation
49
Grades of hepatic encephalopathy
``` 1-4 1 = sleep cycle changes, night insomnia 2-3 = hepatic flap, asterixis 2 = conversation with patient 3 = cannot hold a conversation at all 4 = coma ```
50
Precipitants to hepatic encephalopathy?
``` Constipation Sepsis GI Bleeding Drugs = opoids, benzodiazepines, diuretics Dehydration Portal Vein Thrombosis ```
51
Diagnosis of hepatic encephalopathy
Clinical Hepatic Flap EEF Serum ammonia
52
Tx of hepatic encephalopathy
treat precipitants Lactulose (1st line) Rifaxmin (2nd line) Transplant
53
What is lactulose
Laxative | Changes of flora of bowel so they produce sugar on breakdown instead of proteins diminishing ammonia production in bowel
54
Why is pre-hepatic jaundice acholuric?
Bilirubin is produced by Hb breakdown Bilirubin is attached to albumin as it is unconjugated in circulation so does not pass through the kidneys When there is haemolysis there is increased Hb breakdown = more bilirubin = jaundice This is a pre-hepatic cause of jaundice as the cause is haemolysis Because it is not filtered through the kidneys the urine does not become dark but skin/sclera may be yellow/jaundiced
55
What is hepatic jaundice like?
When bilirubin reaches the liver it becomes conjugated through microsomes in liver Conjugated bilirubin is water soluble so gets refluxed into circulation out -> filtered through kidneys -> dark urine
56
What is post-hepatic jaundice/obstructive jaundice like?
Bilirubin added to bile so gets refluxed into circulation -> through kidneys -> dark urine Also bile salts are now added to the bile -> itching Bile does not reach the bowel = pale stools
57
Hepatic causes of jaundice
``` Viral Cirrhosis Alcohol NAFLD Autoimmune PBC/PSC Wilsons Haemochromatosis ```
58
Post hepatic causes of jaundice
Obstruction Gallstones Microscopic disease of biliary tree due to liver disease
59
Pre hepatic causes of jaundice
Drugs Inherited disorders (increased haemolysis)
60
History of jaundice
``` Urine colour Pale stools itching abdominal pain onset, duration weight loss anorexia fever liver disease causes and RF ```

MET3a (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions