ana 9 Flashcards
(23 cards)
What is cirrhosis?
Cirrhosis is an end stage of any chronic liver disease characterized by fibrosis and conversion of normal architecture to structurally abnormal regenerating nodules of liver cells.
What are the three main morphological characteristics of cirrhosis?
- Fibrosis
- Regenerating nodules
- Loss of architecture
What does fibrosis in cirrhosis involve?
Fibrous tissue forms delicate bands or broad scars linking portal tracts with one another and with terminal hepatic veins.
Define regenerating nodules in the context of cirrhosis.
Liver cell damage is compensated by regeneration of hepatocytes, forming nodules surrounded by fibrosis, varying in size from very small (<0.3 cm) to large (several centimeters).
What is the significance of ‘loss of architecture’ in cirrhosis?
Hepatocyte injury and consequent fibrosis disrupt the architecture of the entire liver.
How many deaths were attributed to cirrhosis globally in 2017?
Cirrhosis caused more than 1.32 million deaths globally in 2017.
What percentage of total deaths globally in 2017 were due to cirrhosis?
Cirrhosis constituted 2.4% of total deaths globally in 2017.
What were the main risk factors for liver diseases in UNTH, Enugu?
- Alcohol consumption (52.1%)
- Hepatitis B virus infection (49.4%)
- Ingestion of herbs and roots (45.5%)
- Cigarette smoking (30.1%)
List the major aetiological factors for cirrhosis.
- Alcoholic liver disease (60-70%)
- Viral hepatitis (10%)
- Biliary disease (5-10%)
- Primary hemochromatosis (5%)
- Cryptogenic cirrhosis (10-15%)
What characterizes micronodular cirrhosis?
Micronodular cirrhosis is characterized by regular and small nodules measuring less than 3 mm in diameter.
What conditions are associated with micronodular cirrhosis?
- Alcoholic hepatitis
- Hemochromatosis
- Drugs
- Chronic biliary disease
Define macronodular cirrhosis.
Macronodular cirrhosis is characterized by the presence of nodules of variable size, usually larger than 3 mm in diameter.
What forms of liver disease can lead to macronodular cirrhosis?
- Chronic viral hepatitis
- Autoimmune hepatitis
- Other causes of micronodular cirrhosis with sufficient duration
What is the difference between active and inactive forms of cirrhosis?
- Active form: Evidence of continuing liver cell necrosis and inflammatory reaction
- Inactive form: No liver cell necrosis or inflammation
What are the steps in the pathogenesis of cirrhosis?
- Hepatocyte injury leading to necrosis
- Chronic inflammation
- Bridging fibrosis
- Regeneration of remaining hepatocytes
- Loss of vascular arrangement
What are the clinical features of cirrhosis?
- Asymptomatic in about 40%
- Nonspecific manifestations: anorexia, weight loss, weakness
- Symptoms of hepatic failure in advanced disease
What are the common complications of cirrhosis?
- Portal hypertension
- Ascites
- Porto systemic shunts
- Splenomegaly
- Hepatopulmonary syndrome
- Portopulmonary hypertension
Define ascites.
Ascites is the accumulation of excess fluid in the peritoneal cavity, commonly caused by portal hypertension from cirrhosis.
What causes hepatopulmonary syndrome in cirrhosis?
Dilatation of intrapulmonary capillary and precapillary vessels leading to right-to-left shunting of blood and hypoxemia.
What is the most common clinical manifestation of portopulmonary hypertension?
Dyspnea on exertion and clubbing of the fingers.
What are the diagnostic methods for cirrhosis?
- Clinical and laboratory findings
- Liver function test
- Viral hepatitis panel
- Autoimmune markers
- Iron studies
- Imaging
- Liver biopsy
What is the primary management strategy for cirrhosis?
Treat underlying cause, lifestyle changes (like alcohol cessation), medications, and liver transplant for decompensated cases.
What factors influence the prognosis of cirrhosis?
Prognosis depends on cause, severity, and complications, often assessed using Child-Pugh or MELD score.
