Cirrhosis & Portal Hypertension Flashcards Preview

Jason's GI Block > Cirrhosis & Portal Hypertension > Flashcards

Flashcards in Cirrhosis & Portal Hypertension Deck (22):
1

what's the main difference histologically between acute and chronic alcoholic hepatitis?

acute: hepatocytes are more damaged and have more Mallory bodies and neutrophils

2

NASH looks acute or chronic?

looks more chronic, not crazy severe cellular injury

3

what are the elements of stetohepatitis? 5 things

macrovesicular steatosis
hepatocellular balooning
Mallory bodies
inflamm
pericellular fibrosis

4

a previously well 25 year old male returns from a medical elective in India with acute onset of jaundice and anorexia. On examination he has mild hepatic enlargement and right upper quadrant tenderness. LFTs show SBR 350, ALT 1300. U/S show no bile duct dilatation, liver biopsy most likely to show the following:
A. Coagulative Necrosis
B. evidence of parasitic infection
C. changes consistent with biliary obstruction
D. Lobular disarray and apoptotic bodies?

Lobular disarray and apoptotic bodies

5

a 55 year old barrister is investigated with fatigue and loss of libido. He denies significant alcohol consumption but admits to a period of experimentation ith IVDU while at Uni. LFTs: ALT is 230. HCVAb is positive. Biopsy shows:
A. some degree of periportal fibrosis
B. Panlobular disarray with apoptosis
C. Mallory Bodies
d. Necrosis in acinar zone 1

A. some degree of periportal fibrosis

6

Can you have heart Cirrhosis?

Nope. Only Liver dude.

7

what is the abnormal anatomy of liver cirrhosis?

nodules of regenerating hepatocytes surrounded by bands of fibrous scar tissue

8

features of liver cirrhosis: 2:

diffuse
irreversible

9

only cure for cirrhosis?

liver transplant

10

What kind of fibrosis with chronic Hep cirrhosis?

peri-portal stage 4

11

Adult causes of cirrhosis
7 biggies

Alcohol
Non-alcoholic steatohepatitis
Viral
Autoimmune
Chronic biliary
Metabolic: Wilson's
Drugs

12

Cirrhosis is specific or non-specific?

Non-specific

13

What do Quiescent stellate cells normally do? in cirrhosis?

Normally store vitamins
Cirrhosis: turn 'myofibroblast' due to cytokine activation

14

Pathogenesis of cirrhosis? 3 things:

persistent hepatocyte apoptosis
fibrosis
remodelling

15

why do you get coagulopathy with cirrhosis?

decrease liver production or proteins and splenomegaly leads to thrombocytopenia

16

Does liver carcinoma usually metastasize?

exceptionally rare, can have multiple lesions

17

3 greatest risks for hepatocellular carcinoma?

alcohol
Chronic viral Hep, B,C
Haemochromatosis

18

Portal Vein accounts for how much of hepatic blood flow?

2/3rds

19

how much pressure increase to get portal hypertension? Absolute vs. gradient?

Absolute: 8mm Hg
gradient of >5mm Hg between portal/hepatic veins

20

3 places in liver that can cause portal hypertension?

presinusoidal (thrombosis)
sinusoidal (cirrhosis)
postsinusoidal (thrombosis, back pressure)

21

Pathogenesis of portal hypertension: 4 things

hyperdynamic splanchnic flow
hepatic vein compression from regen nodules
portal veins distorted by scar tissue
shunts due to fibrous septa

22

portal hypertension clinical consequences: 3 things:

splenic enlargement
ascites
varices (oesophagus, rectum(haemorrhoids), umbilicus, caput medusae)