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Sketchy Path: GI/Liver > Sketchy Path: Cirrhosis > Flashcards

Sketchy Path: Cirrhosis Flashcards

1
Q

What is the most common cause of cirrhosis?

A

Alcohol

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2
Q

The perisinusoidal space is also called what?

A

Space of Disse

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3
Q

What happens to the perisinusoidal cells in cirrhosis?

A

Stellate cells activate to become myofibroblast that deposit collagen

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4
Q

What forms the nodules that are characteristically seen in histology of cirrhotic livers?

A

Regenerative stem cells forms islands of regenerated tissue between the bands of fibrosis

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5
Q

What leads to increases intrasinusoidal pressure?

A

Compression of the sinusoids from the widespread fibrosis

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6
Q

Increased intrasinusoidal pressure leads to __________.

A

Portal Hypertension

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7
Q

Why is blood no longer detoxified in a cirrhotic liver?

A

Thicker ECM which shrinks fenestration that are used to filter and detox blood

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8
Q

What are the symptoms of coagulopathy?

A

bruising
increase bleeding
bleeding into joints
hemorrhagic stroke

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9
Q

What does PT measure in coagulopathy?

A 
Protein 7
(shorted half life)
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10
Q

What important protein is lost in cirrhosis?

A

Albumin

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11
Q

What leads to edema in those with cirrhosis?

A

Loss of albumin decrease the serum oncotic pressure pushing fluid from the serum into the interstitial space

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12
Q

The loss of albumin does what to Ca levels?

A

Total Ca decreases since can not bind to albumin but the amount of active/ionized Ca is unchanged
(Pseudohypocalcemia)

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13
Q

Cirrhosis can lead to deficiency of Vit ____

A

D

Decrease 25OH Vit D

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14
Q

What happens to glucose levels in cirrhosis?

A

Could cause hypoglycemia since the liver can no longer make glucose

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15
Q

Cirrhosis leads to what type of hyperbillirubinemia?

A

Mixed

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16
Q

What happens to ammonia and BUN concentrations in cirrhosis?

A

The liver is the site of the urea cycle (ammonia -> urea) therefore as hepatocyte function decreases ammonia builds up and the BUN decreases

17
Q

What causes hepatic encephalopathy?

A 
Ammonia buildup
(phenylalanine and tryptophan act as false neurotransmitters instead of being metabolized into urea)
18
Q

How does lactulose work?

A

Acidifies the gut lumen to create NH4+ which is excreted in feces

19
Q

What causes the increase in estrogen in cirrhosis?

A

Decrease breakdown of estrogen and androgens

Androgens then are aromatized by fat cells

20
Q

What are some symptoms of high estrogen?

A

Palmar erythema
Gynecomastia
Telangiectasia on trunk, face, and arms
impotence

21
Q

What is a manifestation of portal hypertension?

A

Varices

22
Q

Cirrhosis can lead to ascites, what is the pathophys behind this mechanism?

A

Increased portal pressure squeezes fluid into space of Disse and overwhelms the lymphatic system leading to fluid leak into the peritoneal cavity

23
Q

What infection is relatively common in cirrhotic patients?

A

Spontaneous bacterial peritonitis
(SBP)
Ascites with fever, and abdominal pain, mental status change

24
Q

Why is the RAAS system activated in cirrhotic patients?

A

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

25
Q

What causes hypokalemia in cirrhosis?

A

Increase aldosterone causes sodium to be retained and potassoum to be excreted

26
Q

Decrease intravascular volume also activates ADH? This causes _________.

A

Hyponatremia

27
Q

what is heptorenal syndrome?

A

Kidney failure in the background of severe cirrhosis without any primary kidney damage

28
Q

In hepatorenal syndrome what causes the dilation of the splanchnic arteries?

A

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

29
Q

what causes the decrease in renal blood flow seen in hepatorenal syndrome?

A

Increase in Renin and Angiotensin II causes vasoconstriction

PRERENAL FAILURE

30
Q

What is the first sign of hepatorenal syndrome?

A

Drop in urine output

Increase in BUN/ Creatinine

31
Q

What is the cause of hepatopulmonary syndrome?

A

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)

32
Q

What are the symptoms of hepatopulmonary syndrome?

A 
Dyspnea on exertion
Clubbing
Hypoxemia
Platipnea 
(worse when sitting up)

Sketchy Path: GI/Liver (19 decks)

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