Cirrhosis Flashcards
(34 cards)
What is the portal venous system?
● Blood drains into the portal system from stomach, spleen, and intestines (detoxification, nutrient storage in liver)
● Blood then goes to systemic circulation via inferior vena cava (IVC)
● Cirrhosis causes a back-up of blood in the portal system (blood can’t go through liver easily; ↑portal pressure)
What are the major functions of the liver?
Purification, transformation and clearance of:
toxins
drugs
hormones
Regulation of:
glucose cholesterol
Metabolism of:
carbohydrates
fats
amino acids
Synthesis and secretion of: clotting factors transporter proteins cholesterol
bile for digestion glucose
Regenerative organ
Storage of:
glucose
fat-soluble vitamins
folic acid
vitamin B12
iron
copper
What are the hepatic lobules?
helps flow of material
What is Cirrhosis?
impaired liver function caused by formation of tissue (fibrosis) due to damage by liver disease
How does Cirrhosis happen?
Liver damage causes tissue repair and subsequent formation of scar tissue, which over time can replace normal functional tissue leading to impaired liver function
How fast does Cirrhosis occur?
Typically develops slowly over months or years (slow, gradual process)
What is Cirrhosis AKA?
Also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease
Cirrhosis was derived from the Greek word “kirrhos” which describes yellowish color of a diseased liver
stage liver disease
What is Cirrhosis like in the late stage?
● Cirrhosis is a late stage of scarring (fibrosis) of liver caused by liver diseases (eg hepatitis, chronic alcoholism)
● Each time liver is injured, it tries to repair itself and in the process scar tissue forms.
● As cirrhosis progresses, more scar tissue forms, making it difficult for liver to function (decompensated cirrhosis)
● The liver damage done by cirrhosis is generally NOT REVERSIBLE and advanced cirrhosis is life-threatening
● If liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and rarely reversed
What is the pathogenesis of cirrhosis?
balance is lost - therefore more fibrogenesis in scar tissue
- Ascites - heavy & puts pressure of heart & lungs (poor QOL)
- Liver nodules - regenerative nodules
– normal structure is lost & BF is lost
– diff sizes of nodules in the liver
– not normal structure (shape diff) - Fibrosis - blue areas => sign amount of scar tissue formation
What is the major risk factors?
● Excessive alcohol consumption (esp during chronic periods long term)
● Being overweight
- obesity increases risk of conditions that may lead to cirrhosis (eg non-alcoholic fatty liver disease)
- build up of fat in liver increases
● Chronic viral hepatitis
- it is one of the world’s leading causes of liver disease
- NOT everyone with chronic hepatitis develops cirrhosis
What are the common causes of cirrhosis?
A wide range of diseases and conditions can damage the liver and lead to cirrhosis
● chronic viral HEPATITIS (B, C, D)
● chronic ALCOHOL ABUSE
● non-alcoholic FATTY LIVER DISEASE (fat accumulation in liver)
● DRUGS and HERBALS
● METABOLIC LIVER DISEASE
- hemochromatosis (iron build up in body)
- Wilson’s disease (copper accumulated in liver)
- alpha-1 antitrypsin deficiency
What are the signs & symptoms of cirrhosis?
● EARLY stages Asymptomatic
● fatigue, anorexia, weight loss, nausea
● hepatomegaly, splenomegaly
● ascites, edema (legs, ankles), pleural infusion
● easily bleeding or bruising
● pruritus (itchy skin), jaundice, dark urine
● palmar erythema, spider angiomata (spiderlike blood
vessels on skin
● FEMALES: absent or loss of periods
● MALES: reduced libido (loss of sex drive), gynecomastia
(breast enlargement), testicular atrophy
● hepatic encephalopathy (confusion, drowsiness, slurred
speech )
What are some signs/symptoms of cirrhosis?
- spider angiomata
- asterixis
- palmar erythema
What are the signs & symptoms of cirrhosis?
● Cirrhosis *can take a long time to develop
● Cirrhosis often has no signs or symptoms until liver damage is extensive
● *Patients with cirrhosis have higher risk of liver cancer
● *Liver size can be enlarged, normal, or shrunken in people with cirrhosis
● As the disease progresses, liver size typically shrinks due to scar formation
What are the complications of cirrhosis?
- Portal hypertension
- Swelling in legs and abdomen
- Enlargement of spleen (splenomegaly)
- Bleeding. Portal hypertension may cause:
● Blood to be redirected to smaller veins, strained by extra
pressure, smaller veins can burst, cause serious bleeding
● Enlarged veins in esophagus or stomach (esophageal or gastric varices), lead to life-threatening bleeding
● Inability of liver to produce enough clotting factors can contribute to continued bleeding - Jaundice
- Hepatic encephalopathy (buildup of toxins in brain)
- Increased risk of liver cancer
- Infection
- Acute-on-chronic cirrhosis
What are the most imp. complications of cirrhotic liver?
- Portal Hypertension*
- Ascites*
- Variceal bleeding*
- Hepatic encephalopathy (buildup of toxins in brain)*
- Spontaneous bacterial pertonitis (infection - b/c decrease WBC & therefore increase risk of infection)*
What are the Child-Pugh classification system?
● A means of quantifying the myriad effects of cirrhotic process on laboratory and clinical manifestations
● Assess and define the severity of the cirrhosis
● A predictor for patient survival, surgical outcome, and
risk of variceal bleeding
● Drug-dosing adjustments for patients in liver failure
- b/c many drugs are metabolized in liver (see how damaged liver is)
● Mayo End-Stage Liver Disease (MELD) scoring system is now the accepted classification scheme used by the United Network for Organ Sharing (UNOS) in the allocation livers for transplantation
What is the criteria & scoring for the Child-Pugh grading of chronic liver disease?
● By employing the Child-Pugh score, chronic liver diseases are classified into Child–Pugh class A to C
What is the grading of hepatic encephalopathy?
It’s graded as 0, minimal, 1-4
& there are 4 factors:
1. Level of Consciousness
2. Personality/Intellect
3. Neurologic Abnormalities
4. Electroencephalogram Abnormalities (EEG)
How do you diagnose Cirrhosis?
Diagnosis is based on BLOOD TESTS, medical IMAGING, and liver BIOPSY
Explain Lab tests, Imaging, & Biopsy’s?
Lab tests used to 1) ASSESS liver FUNCTION and identify underlying 2) CAUSE of cirrhosis. The major lab findings in cirrhosis are:
● hypoalbuminemia
● ↑prothrombin time, ↑international normalized ratio (INR)
● thrombocytopenia
● ↑alkaline phosphatase (ALP)
● ↑aspartate transaminase (AST), ↑alanine transaminase (ALT), ↑g-glutamyl transpeptidase (GGT)
● Patients are also tested for viral hepatitis
Imaging
● Magnetic resonance elastography (MRE): a non-invasive advanced imaging to detect hardening/stiffening of liver
● Other imaging tests: MRI, CT, ultrasound
Biopsy (take out small piece of liver)
● It may be used to identify severity, extent, and cause of liver damage
- helps to assess severity of disease & how much liver damage
What are the treatment strategies for cirrhosis?
● Cirrhosis is an irreversible disease and does not have any cure
● No specific treatment for cirrhosis is known
● Pharmacotherapies are used to treat:
- underlying causes to reduce liver damage - symptoms and complications of cirrhosis
● Avoiding ALCOHOL is recommended in all cases
● Treatment of hepatitis B and C with antiviral medication
● Liver transplantation: if cirrhosis leads to liver failure
What are the treatment of ascites?
● Initial therapeutic paracentesis should be performed in
patients with tense ascites
● Sodium restriction (2,000 mg/day) and oral diuretics (spironolactone, furosemide)
● Diuretic-sensitive patients should be treated with sodium restriction and diuretics rather than serial paracentesis
What are the refractory ascites treatment?
● SERIAL therapeutic paracenteses may be performed
● Post-paracenteses ALBUMIN infusion (8–10 g/L of fluid removed if >4–5 L are removed during paracenteses)
