Week 11

Question 1

What is cirrhosis characterized by?

Answer 1

Fibrosis (scar tissue) and coversion of normal liver architecture to abnormal nodules.

Question 2

When does fibrosis occur?

Answer 2

Happens when liver cells attempt to regenerate after liver injuries but the process is disorganized. This results in irregular lobular size and shape and impeded blood flow.

Question 3

What do irregular regeneration, poor cellular nutrition, hypoxia and scar tissue result in?

Answer 3

Decreased functioning of the liver, which ends in cirrhosis.

Question 4

What are the causes of cirrhosis?

Answer 4

Any liver disease, like chronic viral hepatitis, NAFLD, autoimmune hep, excessive alcohol intake.

Question 5

What does alcohol do to the body?

Answer 5

Has a direct hepatotoxic effect, causes cell necrosis and fatty infiltration.

Question 6

Approximately ___% of people with Hep C and ___% of people with Hep B develop cirrhosis.

Answer 6

20 and 25.

Question 7

What are the 2 classifications of cirrhosis?

Answer 7

Compensated and decompensated.

Question 8

What is compensated cirrhosis?

Answer 8

Its when the liver is able to continue to function. Lab tests are normal.

Question 9

What is decompensated cirrhosis?

Answer 9

Its when the liver is unable to continue to function with its damage.

Question 10

What are some early symptoms of decompensated cirrhosis?

Answer 10

Abdo pain, lassitude, fatigue, weight loss, enlargement of liver and spleen.

Question 11

What are some late symptoms of cirrhosis?

Answer 11

Jaundice, peripheral edema, ascites, skin lesions, hematological disorders, endocrine distrubances, peripheral neuropathies.

Question 12

Why does jaundice occur?

Answer 12

Occurs as a result of the liver’s decreased ability to conjugate bilirubin.

Question 13

Why do skin lesions occur?

Answer 13

Happen because of increased circulating estrogen as a result of liver damage.

Question 14

Why do hematological problems happen?

Answer 14

Thrombo-cytopenia, leukopenia, anemia caused by splenomegaly. Overactivity of enlarged spleen results in increased removal of blood cells from the blood.

Question 15

why do coagulation problems occur?

Answer 15

Result from the liver’s inability to produce prothombrin, which is essential for blood clotting.

Question 16

Why do endocrine disturbances occur?

Answer 16

Liver damage stops metabolization of steroid hormones. Can affect reproductive hormones and aldosterone. When aldosterone builds up in the body sodium and water retention occur.

Question 17

Why does peripheral neuropathy occur?

Answer 17

May be caused by dietary deficiency in thiamine, folic acid, and cobalamin.

Question 18

Why are the portal and hepatic veins and sinusoids affected by cirrhosis?

Answer 18

Because of structural changes and the cirrhotic process changes to the portal and hepatic veins occur. These changes result in obstruction to the normal flow of blood through the system.

Question 19

What are the characteristics of portal hypertension?

Answer 19

Increased venous pressure, splenomegaly, large collateral veins, ascites, systematic hypertension, esophageal varices.

Question 20

What are esophageal varices?

Answer 20

Complexes of tortuous veins located at the end of the esophagus. Enlarged and swollen as a result of portal hypertension.

Question 21

Why does peripheral edema occur?

Answer 21

Caused by decreased colloidal oncotic pressure, as a result of impaired liver synthesis of albumin and increased portacaval pressure from portal hypertension.

Question 22

Why does ascites occur?

Answer 22

Accumulation of serous fluid in the peritoneal or abdominal cavity. When the portal pressure elevates, protein shifts from the blood vessels into the larger pores of sinusoids into the lymph space. The lymphatic system is unable to carry protein and water, so it leaks into the peritoneal cavity.

Question 23

Why does hypoalbuminemia occur?

Answer 23

Happens because the liver is unable to synthesize albumin, which results in a decreased colloidal onctic pressure.

Question 24

Why does hyperaldostronism occur?

Answer 24

Liver is unable to metabolize aldosterone, which increases sodium and water retention in the kidneys.

Question 25

What are the clinical manifestations of ascites?

Answer 25

Abdo distention, everted umbilicus, abdo striae, urinary output decreased, signs of dehydration, hypokalemia..

Question 26

What is hepatic encephalopathy?

Answer 26

Neuropsychiatric manifestation of advanced liver disease. Caused by ammonia, abnormal neurotransmission, astrocyte swelling, and inflammatory cytokines.

Question 27

Why does ammonia accumulate in the body?

Answer 27

A major source is bacteral and enzymatic deamination of amino acids in the intestines. the ammonia usually goes to the liver, is converted to urea and then is processed by the kidneys. When the liver is unable to convert ammonia to urea, ammonia levels rise, and cross the blood brain barrier causing encephalopathy.

Question 28

What are some clinical manifestations of hepatic encephalopathy?

Answer 28

Decreased neurological and mental responsiveness, sleep disturbances, lethargy, deep coma, asterixes (flapping tremmor). Hyperventilation, hypothermia, grimancing and grasping reflexes.

Question 29

What is hepato-renal syndrome?

Answer 29

Type of kidney failure with advancing azotemia, oliguria, and intractable ascites. Kidneys have no structural abnormality. Most likely caused by portal hypertension along with liver decompensation. This causes renal vasoconstriction, leading to kidney failure.

Question 30

What are some diagnostic studies used to diagnose cirrhosis?

Answer 30

Enzyme levels like AST, ALT, alkaline phosphatase, and transpeptidase will be elevated because of damaged liver and bile ducts. Decreased total protein, decreased albumin, increased serum bilirubin, increased globulin levels, decreased cholesterol levels.

Question 31

What are some collaberative therapies used to treat cirrhosis?

Answer 31

Avoid alcohol, ASA, sedatives, NSAIDs.
Ascites: diuretics, low sodium diet, paracentesis, TIPS.
Esophageal and Gastric Varices: balloon tamponade, drugs, endoscopic sclerotherapy, TIPS.
Hepatic Encephalopathy: antibiotics, lactulose.

Question 32

What are some complications associated with cirrhosis?

Answer 32

Portal hypertension, peripheral edema, hepatic encephalopathy, hepato-renal syndrome.

Question 33

What is portal hypertension?

Answer 33

Characterized by increased venous pressure in portal circulation.

Question 34

What is esophageal varices?

Answer 34

Complexes of tortuous veins located at the lower end of the esophagus. Bleeding esophageal varices is life threatening.