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Flashcards in Cirrhosis Deck (23):
1

What is cirrhosis?

When the liver does not function properly due to long term damage

The damage is irreversible and involves scarring and nodules

2

What are the causes of cirrhosis?

Chronic alcohol abuse

Hepatitis B + C

Metabolic disorders such as haemochromatosis, Wilson's disease, alpha1-antitrypsin deficiency

Hepatic vein problems

Non-alcoholic fatty liver disease

Autoimmune conditions

Long term use of some drugs

3

How does alcohol cause cirrhosis?

Alcohol is oxidised to acetaldehyde in the liver

It blocks the normal metabolism of proteins, fats and carbohydrates

This leads to injury of the liver

Which leads to scarring and fibrosis = cirrhosis

4

What is non-alcoholic fatty liver disease (NAFLD)?

Fat builds up in the hepatocytes causing inflammation.
This leads to scar tissue and fibrosis and eventually cirrhosis

It is the same as alcoholic liver disease, except they don't have a history of alcohol

5

What causes NAFLD?

Insulin resistance: diabetes mellitus

Obesity

Genetics

Poor nutrition: drinking lots of soft drinks

Some drugs: amiodarone, methotrexate

6

How do you diagnose NAFLD?

Biospy: to look for fatty deposits and scarring

7

How do you treat NAFLD?

Control risk factors: lose weight, control diabetes

No drug available

Transplant

8

What's the link between NAFLD and cirrhosis?

NAFLD can lead to cirrhosis

9

What is the pathogenesis of cirrhosis?

No matter what the cause is cirrhosis involves:

Development of scar tissue that replaces the normal lung parenchyma

The scar tissue impedes the blood flow through the liver, disturbing its function

10

What is the role of the stellate cells in cirrhosis?

They are activated by the inflammation caused by the damage to liver parenchyma

They increase the production of fibroblasts

And secretes cytokines which lead to proliferation of connective tissue

Also secrete cytokines that prevent proteins from breaking down the fibrotic material

11

What do stellate cells usually do?

They store vitamin A

12

Cirrhosis can present with symptoms that occur as a result of the failure of liver cells.

Describe the symptoms and why they occur?

Spider naevi: occur due to an increase in oestrogen

Palmar erythema: increased oestrogen

Gynecomastia: increase in breast gland size due to increased oestrogen

Hypogonadism:

Ascites: due to low albumin

Jaundice: due to increased bilirubin

13

Why does cirrhosis cause a rise in oestrogen levels?

In liver disease there is an increased production of androstenedione in the adrenal glands

Androstenedione is converted to oestrogen

The liver is less able to clear oestrogen from the blood

So more oestrogen in blood stream

14

Why does cirrhosis cause raised bilirubin?

When healthy, the liver clears bilirubin from the bloodstream.

If the liver is impaired it won't be able to clear it

15

What is bilirubin?

Breakdown product of haem

Haem is released by old rbcs

It is yellow

16

What causes the yellow colour in jaundice?

Bilirubin

Liver failure means it can't be cleared by the liver so it builds up causing yellow skin etc.

17

What is portal hypertension? Why does it occur in cirrhosis?

Raised pressure in the portal venous system

Occurs because cirrhosis causes scarring that impedes blood flow through the liver

This causes resistance in the liver

So blood starts to back-log into the portal system

Raising the pressure of the portal system

18

Cirrhosis can present with symptoms that occur as a result of portal hypertension.

Describe the symptoms and why they occur?

Splenomegaly

Oesophageal varices: vessels of oesophagus enlarge due to raised pressure causing varices

Caput medusa: dilated periumbilical veins, because they are higher pressure than usual due to portal hypertension

19

What occurs in advanced cirrhosis?

Coagulopathy: bruising + bleeding
Problems clotting due to decreased production of coagulation factors

Encephalopathy: neurological problems such as confusion, coma

Hepatocellular carcinoma

20

Why does cirrhosis cause encephalopathy?

Because liver can't remove ammonia and other nitrogenous substances they go to the brain

Here they affect brain function, causing forgetfulness, trouble concentrating, unresponsiveness etc.

21

Investigations of cirrhosis?

Tests for liver dysfunction
- liver function tests
- low platelets
- low albumin

Establish the cause:
- autoantibodies
- antibodies against hep viruses
- other signals

Liver USS:
- show a distended or shrunken liver
- shows splenomegaly

Ascitic tap:
- collect some fluid from ascites to sample

Liver biopsy:
- look for cell damage

22

What are the liver function tests?

AST: Aspartate aminotransferase
- an enzyme that is raised in liver damage

ALT: Alanine aminotransferase
- enzyme, raised indicates liver damage

ALP: Alkaline phosphate
- raised levels indicate bone or liver damage

GGT: Gamma-glutamyl transferase
- Shows whether raised ALP is down to liver or bone disease

Bilirubin

23

Management of cirrhosis?

Prevention of further damage:
- abstain from alcohol
- good nutrition
- avoid liver metabolised drugs
- vaccinate against hep B+C

Treatment specific to cause

Screen for hepatocellular carcinoma

Transplantation