W6 Cirrhosis Flashcards
What does cirrhosis look like histologically?
Ring of fibrosis around hepatocytes
What cells in the liver undergo transformation when there is chronic inflammation and where are these cells?
Hepatic stellate cells in the space of Disse
What 4 blood vessels drain into the portal vein?
- gastric vein
- splenic vein
- superior mesenteric vein
- part of inferior mesenteric vein
From what 5 structures does the portal vein carry outflow to the liver?
- spleen
- oesophagus
- stomach
- pancreas
- small + large intestine
From what two blood vessels does blood enter the liver sinusoids and describe the blood from each (oxygenated/deozygenated)?
- Hepatic artery -> oxygenated blood from celiac trunk
- hepatic portal vein -> deoxygenated nutrient rich blood
From what blood vessel does the blood leave the liver and where does it drain to?
Leaves through the hepatic vein and drains into the IVC
What is the approximate blood pressure of the hepatic portal vein?
5-8 mmHg
What are the four sites of anastomosis where the portal venous system joins with the systemic venous system ?
- oesophageal and gastric venous plexus
- retroperitoneal collateral vessels
- umbilical vein from the left portal vein to the epigastric venous system
- hemorrhoidal venous plexus (in rectum)
What does the lack of liver blood flow cause the liver to produce? (in addition to causing portal hypertension)
Causes increased production of vasodilators, enhanced sensitivity to vasodilators and resistance to vasoconstrictors
What does cirrhosis lead to in splanchnic blood vessels?
Splanchnic arteriolar vasodilation
What effect does splanchnic arteriolar vasodilation have on CO, SVR and MAP?
CO increases
SVR decreases
MAP decreases
What does increased CO with decreased SVR and MAP cause activation of?
activation of arterial baroreceptors
What effect does activation of arterial baroreceptors have on HR and CO?
HR increases
CO increases
Increase in HR and CO due to splanchnic arteriolar vasodilation causes activation of which vasoconstrictors?
- Sympathetic Nervous System
- RAAS
- AVP - Arginine vasopressin
- ET -> endothelin
What does activation of SNS, RAAS, AVP and ET lead to in the renal system and retention of?
- renal vasoconstriction
- sodium and water retention
Why is portal hypertension thought to be worse in patients with cirrhosis?
Because there is resistance to outflow and an increase in inflow into portal circulation
What are 2 prehepatic causes of portal hypertension i.e. 2 causes of portal vein blockage?
- portal vein thrombosis
- occlusion secondary to congenital portal venous abnormalities (e.g. premature babies with cannulised umbilical vein)
What can protein S, protein c or MP thrombin 3 deficiencies cause?
pro thrombotic conditions
List 2 presinusoidal intrahepatic causes of portal hypertension?
- Schistosomiasis
- non-cirrhotic portal hypertension
What are Budd-Chiari syndrome and veno-occlussive disease examples of ?
Outflow obstruction problems
List 3 examples of postsinusoidal intrahepatic portal hypertension?
- cirrhosis
- alcoholic hepatitis
- congenital hepatic fibrosis
What is difference between compensated cirrhosis and decompensated cirrhosis?
-Compensated -> appear normal outside
,mildly abnormal findings clinically -Decompensated -> liver failure due to acute/chronic infection/insult/SIRS or end stage liver disease
What 6 clinical signs might you find in patient with compensated cirrhosis?
- spider naevi
- palmar erythema
- clubbing
- gynaecomastia
- hepatomegaly
- spleenomegaly
- OR none
What additional 4 clinical signs are found in patients with decompensated cirrhosis?
- jaundice
- ascites
- encephalopathy
- bruising
