15-18. Cirrhosis, pathogenesis, causes, complications. Effects of liver failure.

Question 1

Define cirrhosis

Answer 1

3-fold definition:
DIFFUSE process with FIBROSIS and NODULE FORMATION

The end stage of chronic liver disease as a result of inflammation and scarring

Question 2

What are some of the causes of cirrhosis?

Answer 2

Alcohol
Viruses - Hep E (face-oral, undercooked pig meat)
Toxins/drugs (paracetamol, antibiotics, anabolic steroids)
Inherited conditions - haemochromatosis
biliary disease

Question 3

List some of the signs and symptoms of cirrhosis

Answer 3

encephalopathy (confusion)
spider angioma
sparse body hair
ascites
muscle wasting
hobnail fibrotic liver
dilated vessels
Jaundice
Red palms
Varices - compensate for scarring
Iron excess - joint discomfort, weight loss, itchy, red

Question 4

What percentage of cirrhotics develop ascites within 10 years of diagnosis?

Answer 4

50%

Question 5

What is ascites a result of?

Answer 5

Portal hypertension
Leads to systemic vasodilation to increase blood flow, with consequent renal vasoconstriction and activation of RAAS –> increased BP and water retention

Question 6

What are the 3 general components of the pathophysiology of cirrhosis?

Answer 6

• Persistence of the injury-causing agent -> progressive liver cell loss
• FIBROUS scarring caused by inflammation and hepatocyte regeneration which leads to hyperplastic NODULES
• the resulting abnormality in liver architecture causes ischaemia and leads to further hepatocyte loss
• eventually becomes irreversible and leads to cirrhosis

Question 7

What are 3 of the complications of cirrhosis?

Answer 7

Portal hypertension
Liver failure
Hepatocellular cancer

Question 8

How does cirrhosis cause portal hypertension? What does this result in?

Answer 8

Cirrhosis increases the resistance to blood flow through the liver, causing an increase in pressure in the portal circulation.

This then causes

• portal-systemic shunts/varices
• ascites
• splenomegaly

Question 9

What risk does oesophageal varices pose in portal hypertension?

Answer 9

Veins may rupture - massive haematemesis (vomiting blood)

This may precipitate liver failure and encephalopathy (confusion)

Question 10

Bearing in mind the functions of the liver, list the possible effects of liver failure.

Answer 10

Coagulation disorders (due to lack of production of coagulation factors)
Altered xenobiotic metabolism e.g. drugs/alcohol
Jaundice
Altered intermediatory metabolism (impaired synthesis of glycogen and urea)
Immune disturbances
Circulatory disturbances (lack of albumin(?))
Endocrine disturbances e.g oestrogen