Liver Cirrhosis and Portal Hypertension

Question 1

What is the largest organ in the body?

Answer 1

Liver

Question 2

What is the double supply of the liver?

Answer 2

Portal vein
Hepatic artery

Question 3

3 mot frequent liver disease etiologies

Answer 3

1. Chronic viral hepatitis (hep B and C)
2. Alcoholic fatty liver disease
3. Non-alcoholic fatty liver disease

Question 4

Vaccine/cure for viral hepatitis?

Question 5

What proportion of adults is currently affected by NAFLD and why are we seeing this increase?

Answer 5

1/3 adults
due to prevalence of obesity

Question 6

End-stage liver disease prevalence will DOUBLE in Canada

Question 7

Main difference between primary liver cholangitis and primary sclerotic cholangitis

Answer 7

PBC: Interlobular bile duct destruction

PSC: Intra/extra hepatic bile duct destruction

Question 8

PBC and PSC: Which is more common in women, and which is more common in men?

Question 9

Autoimmune hepatitis affects more…
a) women
b) men

Answer 9

a) women

Question 10

Describe the key histological feature of autoimmune hepatitis

Answer 10

Lymphocyte infiltration of portal triad

Question 11

Most common genetic disorder in Caucasians

Answer 11

Hereditary hemochromatosis

Question 12

Female to male ratio of hereditary hemochromatosis genetic mutation carrier

Answer 12

1:10 (female:male)

Question 13

Lab test results to diagnose hereditary hemachromatosis

Answer 13

Transferrin saturation >45%
Presence of…

Question 14

What is Wilson’s disease?

Answer 14

Autosomal recessive genetic disorder disruption copper metabolism, causing accumulation of copper in various organs including the liver.

Question 15

What is alpha-1 antitrypsin deficiency?

Answer 15

Congenital lack of a primary lung antiprotease (alpha-1 antitrypsin) which causes emphysema and liver cirrhosis

Question 16

Most frequent liver cancer in the world

Answer 16

Hepatocellular carcinoma

Question 17

Most common cause of deaths by liver cirrhosis?

Answer 17

Viral hepatitis (B and C)
AFLD
NAFLD

Question 18

What is the global and local impact of liver cirrhosis?

Answer 18

Chronic liver diseases are a major cause of morbidity and martality worldwide (12th leading cause of death in the world)

In Canada, it is the 11th leading cause of death.

Question 19

Define liver cirrhosis

Answer 19

A diffuse process characterized by liver necrosis and fibrosis. It causes conversion of normal liver architecture into structurally abnormal nodules that lack normal lobular organization.

Question 20

How does cirrhosis develop

Answer 20

If the liver is affected by a disease that can cause inflammation (hepatitis), chronic inflammation can progress to fibrosis (accumulation of collagen deposits, i.e. scarring of the liver). With time, this scarring can become very severe and is called CIRRHOSIS, which can lead to end-stage liver disease and severe complications that can lead to death.

Question 21

Define fibrosis, cirrhosis, fibrogenesis

Answer 21

Fibrosis:
Fibrogenesis:
Cirrhosis

Question 22

What is the key step in pathophysiology of liver fibrogenesis

Answer 22

Disruption of the balance between ECM deposition and removal.

*Normally, ECM metabolism is a dynamic balanced process … (rewatch)

Question 23

What liver cell is responsible for ECM metabolism in the liver?

Answer 23

Hepatic stellate cells!

Question 24

What is the function of hepatic stellate cells?

Answer 24

During inflammation, they become activated and start depositing collagen in the space of Disse, causing microscopic changes in the liver.

Question 25

What is the most rapidly increasing disease in North America? What is its economic impact?

Answer 25

Liver cirrhosis (went from being ranked 14th to 8th for years of life lost in the US). It dramatically raises healthcare cost...

Question 26

Describe the diagnostic tools to understand the health of the liver

Question 27

Gold standard for diagnosing fibrosis and cirrhosis

Answer 27

Biopsy *However this condition is way to common to diagnose everyone, so there are other less invasive tests we can use to diagnose fibrosis/cirrhosis*

Question 28

What biomarkers/blood tests can we use to diagnose fibrosis and cirrhosis

Answer 28

Platelets ALT ...

Question 29

What is a great alternative to liver biopsy? Briefly describe how it works

Answer 29

Transient elastography (FibroScan)

Question 30

Simple fibrosis biomarker

Answer 30

APRI:Platelet ratio of less than 1: Low chance of cirrhosis APRI:Platelet ratio of more than 2: High chance of cirrhosis

Question 31

Complications of cirrhosis result from 2 conditions

Answer 31

Portal hypertension ?

Question 32

Common symptoms of liver cirrhosis (physical exam)

Question 33

Define portal hypertension

Answer 33

It is an increase in portal venous pressure (>12mmHg). It increases resistance of portal flow and causes opening of collateral vessels.

Question 34

Complications of portal hypertension

Answer 34

Varices Ascites Caput medusae Hemorrhoids

Question 35

What is the consequence of varices in the GI tract?

Answer 35

They increase the diameter of the lumen. They also become dangerous because they may rupture and cause death.

Question 36

What is hepatic encefalopathy?

Answer 36

Complication of liver cirrhosis. When the liver is cirrhotic, it can no longer adequately filter ammonia. Ammonia accumulates in the bloodstream and can cross the blood brain barrier, affecting ... cells and cause...?

Question 37

How do we evaluate the severity of liver cirrhosis

Answer 37

Child-Turcotte-Pugh Scale Score based on the following clinical and lab criteria: * Encephalopathy * Ascites * Bilirubin * Albumin * Prothrombin

Question 38

Survival in patients based on Child-Pugh cirrhosis classification

Question 39

Patients with liver cirrhosis should regularly be screened for... (2)

Answer 39

1. Hepatocellular carcinoma (ultrasound and alpha-fetoprotein every 6 months) 2. Screening for endoscopic signs of portal hypertension (gastroscopy/endoscopy to check for presence of varices)

Question 40

How do we manage liver cirrhosis

Answer 40

Screening for HCC and varices Treat the underlying etiology of liver disease (hepatitis, lifestyle interventions)

Question 41

Is cirrhosis reversible?

Answer 41

Cirrhosis has multiple stages of severity. If the cause of the disease, liver cirrhosis IS reversible (can regress). However, DECOMPENSATED...

Question 42

How do we treat ascites?

Answer 42

Salt restriction ?

Question 43

How do we treat hepatic encephalopathy?

Answer 43

Provide lactulose to clean intestine and ensure regular bowel movements.