Sketchy Path: Cirrhosis Flashcards
What is the most common cause of cirrhosis?
Alcohol
The perisinusoidal space is also called what?
Space of Disse
What happens to the perisinusoidal cells in cirrhosis?
Stellate cells activate to become myofibroblast that deposit collagen
What forms the nodules that are characteristically seen in histology of cirrhotic livers?
Regenerative stem cells forms islands of regenerated tissue between the bands of fibrosis
What leads to increases intrasinusoidal pressure?
Compression of the sinusoids from the widespread fibrosis
Increased intrasinusoidal pressure leads to __________.
Portal Hypertension
Why is blood no longer detoxified in a cirrhotic liver?
Thicker ECM which shrinks fenestration that are used to filter and detox blood
What are the symptoms of coagulopathy?
bruising
increase bleeding
bleeding into joints
hemorrhagic stroke
What does PT measure in coagulopathy?
Protein 7 (shorted half life)
What important protein is lost in cirrhosis?
Albumin
What leads to edema in those with cirrhosis?
Loss of albumin decrease the serum oncotic pressure pushing fluid from the serum into the interstitial space
The loss of albumin does what to Ca levels?
Total Ca decreases since can not bind to albumin but the amount of active/ionized Ca is unchanged
(Pseudohypocalcemia)
Cirrhosis can lead to deficiency of Vit ____
D
Decrease 25OH Vit D
What happens to glucose levels in cirrhosis?
Could cause hypoglycemia since the liver can no longer make glucose
Cirrhosis leads to what type of hyperbillirubinemia?
Mixed
What happens to ammonia and BUN concentrations in cirrhosis?
The liver is the site of the urea cycle (ammonia -> urea) therefore as hepatocyte function decreases ammonia builds up and the BUN decreases
What causes hepatic encephalopathy?
Ammonia buildup (phenylalanine and tryptophan act as false neurotransmitters instead of being metabolized into urea)
How does lactulose work?
Acidifies the gut lumen to create NH4+ which is excreted in feces
What causes the increase in estrogen in cirrhosis?
Decrease breakdown of estrogen and androgens
Androgens then are aromatized by fat cells
What are some symptoms of high estrogen?
Palmar erythema
Gynecomastia
Telangiectasia on trunk, face, and arms
impotence
What is a manifestation of portal hypertension?
Varices
Cirrhosis can lead to ascites, what is the pathophys behind this mechanism?
Increased portal pressure squeezes fluid into space of Disse and overwhelms the lymphatic system leading to fluid leak into the peritoneal cavity
What infection is relatively common in cirrhotic patients?
Spontaneous bacterial peritonitis
(SBP)
Ascites with fever, and abdominal pain, mental status change
Why is the RAAS system activated in cirrhotic patients?
Increase fluid in the interstitial space leads to a decrease in CO -> activates the RAAS
Also the liver can not metabolize aldosterone leaving it activated
What causes hypokalemia in cirrhosis?
Increase aldosterone causes sodium to be retained and potassoum to be excreted
Decrease intravascular volume also activates ADH? This causes _________.
Hyponatremia
what is heptorenal syndrome?
Kidney failure in the background of severe cirrhosis without any primary kidney damage
In hepatorenal syndrome what causes the dilation of the splanchnic arteries?
Kuppfer cells are destroyed in cirrhosis this leads to an increase in bacteria in the blood coming from the GI system; these bacteria produce NO and dilate the splanchnic
what causes the decrease in renal blood flow seen in hepatorenal syndrome?
Increase in Renin and Angiotensin II causes vasoconstriction
PRERENAL FAILURE
What is the first sign of hepatorenal syndrome?
Drop in urine output
Increase in BUN/ Creatinine
What is the cause of hepatopulmonary syndrome?
Excess bacteria in the blood leads to increase NO and endothelin which leads to V/Q mismatch
(capillary becomes too dilated to let oxygen diffuse)
What are the symptoms of hepatopulmonary syndrome?
Dyspnea on exertion Clubbing Hypoxemia Platipnea (worse when sitting up)
