wk 12- GIT

Question 1

explain the potentially life threatening conditions that cirrhosis can cause even before it has led to complete failure of the liver

Answer 1

1. hepatocellular carcinoma
   malignancy of the hepatosites.
   rare to get primary cancer bc liver cells do not divide (too many functions) but with cirrhosis they can divide and its possible to get multiple primary cancers forming- many patients will die from this before liver completely fails
2. portal hypertension
   scarring and change of normal structure
   arterial circuit is high pressure so still able to get through the system and supply those carinomas that are dividing
   however, the venous circuit because its under low pressure it becomes congested forming varices (dilaed veins)-

Question 2

complications of portal hypertension

Answer 2

venous congestion which causes
-varices: dillated veins (typically oesophageal which are prone to rupturing)
-ascites: fluid collects in spaces within abdomen
-hemorrhoids
-splenomegaly: enlargment of spleen
-caput medusae
-anastomoses between portal and systemic circulation

Question 3

pathogenesis of ascites

Answer 3

portal hypertension
congestion in portal venous system
increased hydrostatic pressure
allows fluid into the tissue (ascites)

Question 4

explain how the effects of liver failure can worsen or exacerbate the conditions caused by cirrhosis

Answer 4

liver failure stops producing plasma proteins, including albumin (main plasma protein)- this reduces osmotic pressure of the plasma
as well as the fact that hydrostatic pressure has increased due to the portal hypertension
this increases oedema and ascites occuring

1. reduced plasma protein production and osmotic pressure causing oedema
2. bleeding tendency- liver fails and stops making clotting factors (can spontaneously hemmhorage/bruise

Question 5

how can cirrhosis cause death

Answer 5

1. hepatocellular carcinoma
2. portal hypertension
3. liver failure

Question 6

list the main causes of cirrhosis

Answer 6

• Chronic:
  – Chronic alcohol consumption
  – NAFLD
  – Autoimmune disease
  – Genetic disease (Haemochromatosis, Wilson’s)
  – Hep B & C
  – Obstruction (gall stones, tumours, stricture)
  – Congestive heart disease
  – Secondary/metastatic Cancer

Question 7

list the major effects that liver failure has on the body (not including oedema and bleeding)

Answer 7

the liver is our major metabolism organ:
metabolism of nutrients is reduced- breaking down functional tissue causing weight loss and wasting away
-metabolism of toxic substances is reduced- poisoning can occur, jaundice
-metabolism of hormones, disruption to endocrine system
-hepatoerenal syndrome
-hepatopulmonary syndrome

Question 8

what is required for the digestion, absorption and metabolism of nutrients?

Answer 8

liver required for metabolism

digestion: fat- need bile and pancreatic lipase

other nutrients- pancreatic enzymes, brush border ezymes in the small intestine

absorpition:
all nutrients- absorbed across the wall of small intestine

Question 9

can you live without stomach?

Answer 9

yes

Question 10

can you live without gallbladder?

Answer 10

yes

Question 11

what are nessecary for digestion, absorption and metabolism

Answer 11

-liver functioning
-bile from liver
-pancreatic enzymes
-small intestine

if any of these are removed, we see malabsorption

Question 12

risk factors for cancer of the tube/accessory organs

Answer 12

smoking
increase in incidence of age
alcohol
chronic inflammation
genetics

Question 13

what are the possible consequences of

Answer 13

1. cancer
2. chronic blood loss/anaemia
3. acute bleed (can kill)
4. perforation (kill)
5. scarring (obstruction)

Question 14

explain pathogenesis of cancers that develop in the tube and accessory organs

Answer 14

1. squamous cell carcinoma (upper osephagus) and adenocarcinoma (lower esophagus) due to chronic gastric reflux. tells us metaplasia occurred before dysplasia
2. adenoma benign tumour in the bowel, genetically unstable and becomes adenocarcinoma