Liver

Question 1

What is cirrhosis

Answer 1

Scarring/fibrosis of liver
Associated with chronic liver failure
Can have regression

Question 2

Causes of cirrhosis

Answer 2

Viral hep
Drugs
Alcohol
Bile duct obstruction
Non alcoholic fatty liver disease

Question 3

Histology of cirrhosis

Answer 3

Diffuse transformation of liver into regenerative parenchymal nodules surrounded by fibrous bands and variable degrees of vascular shunting

Question 4

How does cirrhosis cause portal hypertension

Answer 4

Increased resistance to portal flow at sinusoids due to:
> Vasoconstriction by vascular smooth muscle and myofibroblasts
> Scarring/parenchymal nodule formation disrupting blood flow
> Sinusoidal remodeling and arterial-portal anastomosis (intrahepatic shunt)

Increased portal venous flow due to:
> Hyperdynamic circulation
> Arterial vasodilation to compensate for lowered blood flow

Question 4

How does cirrhosis cause portal hypertension

Answer 4

Increased resistance to portal flow at sinusoids due to:

Question 5

Portal hypertension consequences

Answer 5

Ascites: increased pressure in peritoneal capillaries and RAA system activation leading to renal sodium avidity and increase in intravascular and extravascular volume causes fluid accumulation in peritoneal cavity and abdominal distension

Portosystemic venous shunts (varices) causing hematemesis, hemorrhoids and caput medusae

Congestive splenomegaly: backflow of blood into spleen, enlarging spleen, can cause anemia, leukopenia, thrombocytopenia and bleeding

Hepatic encephalopathy: impaired metabolism shunting ammonia from GIT into general circulation, altering mental state in brain, causing confusion, coma

Hepatorenal syndrome: renal vasoconstriction to compensate for lowered BP in splanchnic circulation activating RAA

Question 6

Fatty liver disease causes

Answer 6

Diabetes, obesity, starvation
Hypoxia
Alcohol

Question 7

Alcoholic liver disease complications

Answer 7

Cirrhosis
Steatosis (fatty change)
Alcoholic hepatitis (inflammation due to fatty change)
Steatofibrosis (fatty change and scarring)

Question 8

Hepatocellular carcinoma risk factors

Answer 8

Viral infection by Hep B/C
Aflatoxin from aspergillus flavus
Metabolic diseases
NAFLD

Question 9

Cancers in which organs commonly metastasize to the liver?

Answer 9

Colon, lung, breast

Question 10

Hepatitis B/C transmission

Answer 10

Unprotected sex
Needle stick injury
Injecting drugs
B: perinatal
C: hemodialysis, organ transplant