Week 3 Pre-Learning: Complications of Cirrhosis

Question 1

What is portal hypertension?

Answer 1

• Structural changes in the liver lead to compressed and damaged veins, which impedes blood flow

Question 2

Why does portal hypertension occur?

Answer 2

• The hepatic portal vein which brings blood from the stomach, intestines, pancreas, and spleen to the liver is now obstructed, creating an increase in venous pressure

Question 3

Why does portal hypertension do to the spleen, platelets, and WBCs? (3)

Answer 3

• Blood back flows into the spleen, causing splenomegaly
• Thrombocytopenia occurs due to trapping of platelets and WBCs
  – this leads to signs of bleeding and excessive bruising

Question 4

What are varices? (2)

Answer 4

• Distended and tortuous collateral veins
• fragile and do not tolerate high pressure

Question 5

Where are varices commonly formed? (3)

Answer 5

• lower esophagus (esophageal varices)
• Abdominal wall (gastric varices)
• Rectum (hemorrhoidal varices)

Question 6

What can varices lead to? (3)

Answer 6

• hematemesis
• melena
• esophageal varicosities commonly rupture, creating a life-threatening GI bleed

Question 7

Review: What is ascites?

Answer 7

• accumulation of fluid in the peritoneal or abdominal cavity

Question 8

Why does ascites develop? (5)

Answer 8

• Portal HTN
• Increased flow of hepatic lymph
• Decreased serum colloidal oncotic pressure
• Hyperaldosteronism
• Impaired water excretion

Question 9

What are the signs and symptoms of ascites and edema? (5)

Answer 9

• abdominal distention
• dependent edema
• weight gain
• signs of dehydration (sunken eyeballs, dry skin, dry tongue)
• hypokalemia (not absorbed in the kidney, so we lose K+)

Plasma proteins are not there to pull in fluid, so they are volume depleted even though they are heavy

Question 10

In liver cirrhosis, the process of converting ammonia to urea is impacted for 2 reasons, causing hepatic encephalopathy. What are these 2 reasons?

Answer 10

1. Ammonia rich blood being shunted past the liver via collateral veins
2. Dysfunctional hepatocytes cannot convert the ammonia to urea

Question 11

What occurs when the conversion of ammonia to urea is impacted? (2)

Answer 11

• leads to high levels of ammonia in the blood, which is neurotoxic
• manifestations range from sleep disturbances to coma

Question 12

What are unique manifestations of hepatic encephalopathy? (2)

Answer 12

• asterixis (flapping tremors)
• Fetor hepaticus (breath smells like eggss or garlic)

also slurred speech, confusion, etc.

Question 13

There are multiple causes of pancytopenia in cirrhosis. What is pancytopenia?

Answer 13

low RBC, WBC and platelets

Question 14

What are the causes of pancytopenia in cirrhosis? (5)

Answer 14

1. Portal HTN leads to splenomegaly (enlarged spleen) where RBC, WBC and platelets are trapped
2. An enlarged spleen reduces the amount of circulating platelets and RBCs
3. A dysfunctional liver is unable to produce clotting factors
4. A dysfunctional liver is unable to exfrete bile, which is required for vitamin K absorption (fat soluble vitamin)
5. Esophageal varices also lead to bleeding and risk for hemorrhage