Portal HTN- GI Flashcards
Cirrhosis cause diffuse bridging fibrosis (via ____ cells) and regenerative _____ which disrupt normal architecture of liver;Increases the risk for _____
stellate
nodules
hepatocellular carcinoma
3 unique clinical findings of Cirrhosis
Juandice
Ascities
Splenomegaly
(JAS, girl, you’ve got cirrhosis)
Varices
Etiologies of Cirrhosis include alcohol, ______, chronic viral hepatitis (HCV), auto immune hepatitis, ______, genetic/metabolic disorders like _____ & _____
non alcoholic steatohepatitis
biliary disease
ARPKD & Alpha 1 antitrypsin deficiency
Cirrhosis is the number 1 cause of
Protal HTN
Etiologies of Portal HTN include cirrhosis, vascular obstruction like ___ & ____, and lastly, _____ infection
portal vein thrombosis
Budd-Chiari syndrome
Schistosomiasis
Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis
Budd-Chiari syndrome
How can you tell its Budd-Chiari syndrome and not cirrhosis yet?
No JVD
May cause nutmeg liver (molted bumpy appearance)
Budd-Chiari syndrome
Budd-Chiari syndrome can be caused associated with (3)
Post-partum
Polycythemia Vera
Anything making you hypercoagulable (OCPs, Nephrotic syndrome, HCC)
Cirrhosis with PAS + globules
Alpha 1 antitrypsin deficiency
Dyspnea
Cirrhosis
Non-smoker
Alpha 1 antitrypsin deficiency
Caused by misfolded protein aggregates in the hepatocyte Rough Endoplasmic Reticulum
Cirrhosis from Alpha 1 antitrypsin mutation
Wilson’s disease (Elf)
Hemachromatosis
can cause
HCC
HCC is associated with what elevated marker
alpha fetoprotein
Tender Hepatomegaly
Polycythemia (increased RBC count)
Ascites
HCC
HCC specific carcinogen
Aflatoxins from Aspergillus
In Portal HTN, Esophageal varices are created when ____ vein cannot feed blood to the Portal vein (due to obstruction usually) and anastamoses with the _____ vein (causing it to dilate inside the esophagus) which then drains to _____ vein which goes to the IVC.
Left Gastric
Distal Esophageal
Azygous
In Portal HTN, Caput Medusae varices are created when ____ vein cannot feed blood to the Portal vein (due to obstruction usually) and anastamoses with the _____ vein (located on the anterior abdominal wall) which drains into the common iliac vein which goes to the IVC.
Paraumbilical
Epigastric
In Portal HTN, Anorectal varices are created when ____ vein (which comes directly from the _____ that cannot feed blood to the Portal vein, due to obstruction usually) and anastamoses with the ___ & ___ vein which drains into the common iliac vein which goes to the IVC.
Superior Rectal
Inferior Rectal and Middle Rectal
Treatment of Portal HTN, with a ____ between the portal vein and ____ vein relieves portal hypertension by shunting blood to the systemic circulation, bypassing the liver, but it can precipitate _____ due toclearance of ammonia from shunting
trans jugular intrahepatic porto systemic shunt (TIPS)
hepatic
hepatic encephalopathy
Non-alcoholic
Obese or Diabetic
Liver cirrhosis (Juandiced/Portal HTN)
ALT>AST
Non-alcoholic Fatty liver
AST>ALT
Mallory bodies (damaged eosinophilic keratin filaments inside cells)
Swollen/Necrotic/Neutrophilic liver
Alcoholic Hepatitis
IRREVERSIBLE
Sclerosis around Central Liver vein
Nodules with fibrous septa
Portal HTN
Alcoholic Cirrhosis
Hepatic steatosis is a fatty change in the liver that is reversible with
ALcohol Cessation
_____ is used to induce natriuresis and resolve ascites without blocking the critical vasoconstrictive effects of angiotensin.
Spironolactone, an aldosterone antagonist
Elevated ___ concentrations increase the likelihood of gallstone formation.
cholesterol
High levels of _____ and ____ increase cholesterol solubility and decrease the risk of gallstones.
bile salts
phosphatidylcholine
Crohn disease & Terminal Ilieum resection/ disease are prone to developing gallstones due to the _____ which promotes _____ of the bile, resulting in gallstone formation.
decreased bile acid reabsorption
cholesterol supersaturation
causes hepatocyte ballooning/swelling degeneration and apoptosis with mononuclear cell infiltration.
Acute hepatitis due to most hepatotropic viruses
_____ assessed via prothrombin time, bilirubin, albumin, cholesterol
____intactness assessed via transaminase (AST/ALT)
____ intactness assessed via alkaline phosphatase (AP), γ-glutamyl transferase
Liver functionality
Liver structural integrity and cellular
biliary tract structural integrity and cellular
Serum ___ levels can be of assistance in determining the extent of liver failure, gastrointestinal bleeding, or metabolic conditions
ammonia
Measurement of ______ can be of assistance in distinguishing hemolytic conditions from hepatic dysfunction or bile duct obstruction.
unconjugated bilirubin (especially in contrast to conjugated bilirubin)
Penicillamine, a first-line treatment for Wilson disease, is a copper chelating agent that increases the ____
urinary excretion of copper
Zinc decreases ______ and can be used in conjunction with penicillamine to treat Wilson disease.
intestinal absorption of copper
Pathogenesis of Wilson disease involves impaired hepatocellular copper transport, which results in decreased ______
biliary excretion of copper
