GI Disorders - Cirrhosis

Question 1

What is Cirrhosis?

Answer 1

end stage liver disease

Question 2

What does Cirrhosis refer to in latin?

Answer 2

yellow, in this cases cirrhosis may present with jaundice

Question 3

What is Cirrhosis a major cause of?

Answer 3

Death

Question 4

Etiology of Cirrhosis (6)

Answer 4

1. 60-70% r/t alcohol abuse (hepatotoxic substance)
2. hepatotoxic drugs (liver are prone to exposure of drugs that can be toxic )
3. Viral Hepatitis (Hep C Virus)
4. Biliary Disease (prob with gallbladder but does not account for much for Cirrhosis)
5. Metabolic Disorders eg Wilson Disease
6. some cryptogenic = other forms of cirrhosis is idiopathic

Question 5

How does metabolic disease lead to cirrhosis? What kind? And at what percentage?

Answer 5

Metabolic disease involves the deposition of copper in the liver causing cirrhosis.

This is called hemochromatosis = iron overload b/c the liver is unable to produce bile which is needed to excrete copper and deposits in organs

Up to 5% of Cirrhosis

Question 6

Patho of Cirrhosis: Cells

Answer 6

Hepatocytes injury –> healing–>fibrosis around regenerating cells

Hepatocytes (parenchyma) can regenerate but if damaged in large quantities, fibrous tissue forms surrounding the hepatocytes that regenerates —> causes lumps and bumps

Question 7

Patho of Cirrhosis: Cells

What appearance does the liver give? Why?

What is diffuse fibrosis?

Answer 7

The liver gives nodular appearance d/t nodular and degenerative change (not r/t aging)

Fibrosis is restricted but as hepatocytes are getting targeted in the liver, fibrosis becomes diffused

Question 8

What does it mean by fibrinous tissue is a space occupying lesion? How is this an issue?

Answer 8

Space that provide least resistant are being taken up by fibrinous tissues eg all blood vessels and ducts of liver

This compresses the blood vessels and ducts can poses serious prob.

Question 9

Patho of Cirrhosis: Vessels

Answer 9

vessel constriction –> impaired perfusion –> portal HTN–> fluid shift–> ascites

Fibrosis constricts the blood vessels and impede flow leading to engorgement of vessels and stasis of blood. PORTAL HTN results d/t increase CHP in blood vessels. Increase CHP force fluid out into abdominal cavity resulting in accumulation of fluid –> ASCITES

Question 10

Patho of Cirrhosis: Ducts

Answer 10

duct constriction–> bile stasis

Fibrosis constricts ducts impeding bile flow and causing bile stasis. Stones may develop d/t buildup of bile and cause further obstruction of flow

Question 11

What is the flow of bile?

Answer 11

bile–> bile canaliculi–> bile duct in portal triad–> R/L hepatic duct–> common hepatic duct–> common bile duct–> sphincter of Oddi–> duodenum

Question 12

Patho of Cirrhosis: Detoxification

Answer 12

decrease metabolic waste clearance b/c liver is failing and unable to process metabolites for excretion eg ammonia, urea, and bilirubin

Question 13

What can happen in late stages of Cirrhosis?

Answer 13

hepatic failure

Question 14

Manifestations of Cirrhosis can ___ depending on ___ and ___

Answer 14

vary depending on stage and cause

Question 15

What are the 3 common mnfst of Cirrhosis? Are they specific or non-specific to Cirrhosis?

Answer 15

1. anorexia
2. weight loss
3. weakness
   non-specific

Question 16

What mnfst are specific to Cirrhosis?

Answer 16

1. jaundice: may be absent in cirrhosis
2. hepatomegaly: engorged blood vessels have increased CHP which force fluids into the interstitial space of liver causing the enlargement of liver

Question 17

Treatment of Cirrhosis

Answer 17

1. modify diet
   - liver is involved in the metabolism of proteins, CHO, and fat–> must minimize workload of liver w/ small high calorie/protien dense meals and limited fat
2. no alcohol
   - enhance the damage in liver

Question 18

What is the goal of treatment? (2)

Answer 18

maximize regeneration and avoid further complication

Question 19

Three Complications of Cirrhosis:

Answer 19

1. Portal HTN
   - fluid shift causing increase in pressure in blood vessels
2. Varices
3. Splenomegaly

Question 20

What is Varices?

How does it create complication?

Answer 20

dilation of associated veins

may rupture and cause hemorrhaging in the body cavity –> Loosing large volume of blood –> hypovolemic shock

Question 21

What is Splenomegaly? Cause (2)?

Answer 21

1. enlargement of spleen d/t
   - Veins in spleen become engorged and fluid pushes out into the surrounding space of the spleen causing enlargement
   - Spleen passes components to liver to be processed but liver is unable to function therefore causes an accumulation of byproduct in spleen