Pathology of Liver Cirrhosis and Liver Failure

Question 1

What is cirrhosis?

Answer 1

It is change in liver architecture and fibrosis

Question 2

What are the key players in liver cirrhosis?

Answer 2

They are Kuppfer Cells: macrophages involved in high amount of ctokines

Micronodular: chronic alcoholism

Macronodular: viral hepatitis

Question 3

Hepatic Encephalopathy can cause:

Answer 3

neuropsychiatric disorder ( personality changes, mental status depression, intellectual decrease) due to diversion of blood from portal system into systemic circulation avoiding ammonia metabolism.

Excess ammonia alters the NT

Question 4

Other big conditions in liver failure:

Answer 4

coagulopathy, hypoalbunemia, endocrine abnormalities

(gynecomastia), and hepato-renal syndrome (portal HTN —> GI artery dilation) –>

Question 5

What are the types of portal hypertensions?

Answer 5

Pre-sinusoidal: before blood gets to the liver. Portal vein thrombosis

Intra-hepatic: liver fibrosis affecting hepato-renal veins.

Post-Sinusoid: thrombosis of the hepatic veins that empty into IVC

Complications of portal hypertension:

esophageal varices, splenomegaly, ascites

Question 6

What is hepato-renal syndrome?

Answer 6

It is when there is portal hypertension, which causes there to be GI artery dilation, and then there is afterward feeling of hypovolemia –> renal vasoconstriction and hypo-perfusion.

Question 7

Budd-Chiari Syndrome

Answer 7

obstruction hepatic veins causing liver enlargement, pain and ascites. Liver is swollen and oozing with blood.

Question 8

What can cause budd-chiari syndrome?

Answer 8

Budd-Chiari can be caused by cancer drugs, toxins, GVH disease.

Question 9

What are the complications of portal hypertension?

Answer 9

Esophageal varices, splenomegaly, ascites.

Question 10

What is spontaneous bacterial peritonitis?

Answer 10

It is a lethal/serious complication of ascites. You need paracentesis and specific antibiotics