Liver Cirrhosis and Portal Hypertension Flashcards
What is the largest organ in the body?
Liver
What is the double supply of the liver?
Portal vein
Hepatic artery
3 mot frequent liver disease etiologies
- Chronic viral hepatitis (hep B and C)
- Alcoholic fatty liver disease
- Non-alcoholic fatty liver disease
Vaccine/cure for viral hepatitis?
What proportion of adults is currently affected by NAFLD and why are we seeing this increase?
1/3 adults
due to prevalence of obesity
End-stage liver disease prevalence will DOUBLE in Canada
Main difference between primary liver cholangitis and primary sclerotic cholangitis
PBC: Interlobular bile duct destruction
PSC: Intra/extra hepatic bile duct destruction
PBC and PSC: Which is more common in women, and which is more common in men?
Autoimmune hepatitis affects more…
a) women
b) men
a) women
Describe the key histological feature of autoimmune hepatitis
Lymphocyte infiltration of portal triad
Most common genetic disorder in Caucasians
Hereditary hemochromatosis
Female to male ratio of hereditary hemochromatosis genetic mutation carrier
1:10 (female:male)
Lab test results to diagnose hereditary hemachromatosis
Transferrin saturation >45%
Presence of…
What is Wilson’s disease?
Autosomal recessive genetic disorder disruption copper metabolism, causing accumulation of copper in various organs including the liver.
What is alpha-1 antitrypsin deficiency?
Congenital lack of a primary lung antiprotease (alpha-1 antitrypsin) which causes emphysema and liver cirrhosis
Most frequent liver cancer in the world
Hepatocellular carcinoma
Most common cause of deaths by liver cirrhosis?
Viral hepatitis (B and C)
AFLD
NAFLD
What is the global and local impact of liver cirrhosis?
Chronic liver diseases are a major cause of morbidity and martality worldwide (12th leading cause of death in the world)
In Canada, it is the 11th leading cause of death.
Define liver cirrhosis
A diffuse process characterized by liver necrosis and fibrosis. It causes conversion of normal liver architecture into structurally abnormal nodules that lack normal lobular organization.
How does cirrhosis develop
If the liver is affected by a disease that can cause inflammation (hepatitis), chronic inflammation can progress to fibrosis (accumulation of collagen deposits, i.e. scarring of the liver). With time, this scarring can become very severe and is called CIRRHOSIS, which can lead to end-stage liver disease and severe complications that can lead to death.
Define fibrosis, cirrhosis, fibrogenesis
Fibrosis:
Fibrogenesis:
Cirrhosis
What is the key step in pathophysiology of liver fibrogenesis
Disruption of the balance between ECM deposition and removal.
*Normally, ECM metabolism is a dynamic balanced process … (rewatch)
What liver cell is responsible for ECM metabolism in the liver?
Hepatic stellate cells!
What is the function of hepatic stellate cells?
During inflammation, they become activated and start depositing collagen in the space of Disse, causing microscopic changes in the liver.
What is the most rapidly increasing disease in North America? What is its economic impact?
Liver cirrhosis (went from being ranked 14th to 8th for years of life lost in the US).
It dramatically raises healthcare cost…
Describe the diagnostic tools to understand the health of the liver
Gold standard for diagnosing fibrosis and cirrhosis
Biopsy
However this condition is way to common to diagnose everyone, so there are other less invasive tests we can use to diagnose fibrosis/cirrhosis
What biomarkers/blood tests can we use to diagnose fibrosis and cirrhosis
Platelets
ALT
…
What is a great alternative to liver biopsy? Briefly describe how it works
Transient elastography (FibroScan)
Simple fibrosis biomarker
APRI:Platelet ratio of less than 1: Low chance of cirrhosis
APRI:Platelet ratio of more than 2: High chance of cirrhosis
Complications of cirrhosis result from 2 conditions
Portal hypertension
?
Common symptoms of liver cirrhosis (physical exam)
Define portal hypertension
It is an increase in portal venous pressure (>12mmHg).
It increases resistance of portal flow and causes opening of collateral vessels.
Complications of portal hypertension
Varices
Ascites
Caput medusae
Hemorrhoids
What is the consequence of varices in the GI tract?
They increase the diameter of the lumen.
They also become dangerous because they may rupture and cause death.
What is hepatic encefalopathy?
Complication of liver cirrhosis.
When the liver is cirrhotic, it can no longer adequately filter ammonia. Ammonia accumulates in the bloodstream and can cross the blood brain barrier, affecting … cells and cause…?
How do we evaluate the severity of liver cirrhosis
Child-Turcotte-Pugh Scale
Score based on the following clinical and lab criteria:
* Encephalopathy
* Ascites
* Bilirubin
* Albumin
* Prothrombin
Survival in patients based on Child-Pugh cirrhosis classification
Patients with liver cirrhosis should regularly be screened for… (2)
- Hepatocellular carcinoma (ultrasound and alpha-fetoprotein every 6 months)
- Screening for endoscopic signs of portal hypertension (gastroscopy/endoscopy to check for presence of varices)
How do we manage liver cirrhosis
Screening for HCC and varices
Treat the underlying etiology of liver disease (hepatitis, lifestyle interventions)
Is cirrhosis reversible?
Cirrhosis has multiple stages of severity.
If the cause of the disease, liver cirrhosis IS reversible (can regress).
However, DECOMPENSATED…
How do we treat ascites?
Salt restriction
?
How do we treat hepatic encephalopathy?
Provide lactulose to clean intestine and ensure regular bowel movements.
