Syndromes of cirrhosis Flashcards
what does cirrhosis look like?
= fibrous rings separated by degenerative nodules hepatocytes
what makes up the portal vein?
- superior mesenteric
- splenic vein
- gastric
- part from inferior mesenteric
what does portal vein carry outflow from?
- spleen
- oesophagus
- stomach
- pancreas
- small and large intestine
pressure in hepatic vein is usually what?
low
what are 4 collateral pathways?
- Esophageal and gastric venous plexus
- umbilical vein from the left portal vein to the epigastric venous system
- retroperitoneal collateral vessels
- the hemorrhoidal venous plexus
what could happen to anastomoses when there is portal hypertension?
- engorged, dilated or varicosed = rupture
what is portal hypertension?
= portal vein pressure above normal rates of 5-8mmHg
= portal vein-hepatic vein pressure gradient greater than 5mmHg
what does portal hypertension represent?
= an increase in hydrostatic pressure within portal vein or its tributaries
why does portal hypertension occur?
- increased resistance to portal flow
- increased portal venous inflow
how can you classify the causes of portal hypertension?
1) pre-hepatic
= blockage of portal vein before liver due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormality
2) intra-hepatic
= due to distortion of liver architecture either;
- per sinusoidal
- post sinusoidal
what are the commonest cause of cirrhosis?
- alcohol
- hepatits C virus
- NASH (NAFLD)
what are 2 types of clinical cirrhosis?
1) compensated
2) decompensated cirrhosis
describe compensated cirrhosis?
- clinical normal
- incidental finding
- lab test or imaging abnormality
- portal hypertension may be present
describe decompensated cirrshosis?
= liver failure - acute or chronic = infection = insult = SIRS
- end stage liver disease
= insufficiency hepatocytes
= run out of liver
what are clinical signs of compensated cirrhosis?
spider naevi
palmar erythema
clubbing
hepatomegaly
spleenomegaly
gynaecomastia
