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24 Cards in this Set
- Front
- Back
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define cirrhosis. what is it in response to cirrhosis? |
the irreversible end result of the fibrous scarring & hepatocellular regeneration |
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what happens to the liver in cirrhosis?
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normal hepatic lobular structure is replaced by interconnecting bands of fibrous tissue surrounding nodules which form from areas of regenerating hepatocytes |
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how big are the regenerative nodules in a pt w/ alcoholic cirrhosis? chronic active hepatitis? |
alcoholic: <3 mm (micro-nodular)
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how is liver fxn impaired w/ cirrhosis?
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fibrous scarring & disruption of normal hepatic architecture damages & distorts the vascular bed which results in portal HTN & intrahepatic shunting. |
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what do the clinical & laboratory findings in cirrhosis result from?
what do you see? |
portal hypertension & heptocellular dysfunction |
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what are the most common cause of liver cirrhosis in the western world? |
alcohol consumption & hep C virus infection |
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what is the most common cause in Developing countries? |
Hep B |
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what are the other 6 causes of cirrhosis besides HCV/HBV and alcohol consumption?
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drugs & toxins
AI chronic active hepatitis Biliary cirrhosis chronic hepatic congestion genetically determined metabolic diseases cryptogenic |
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what is primary biliary cirrhosis? what gender is more commonly affected? age? |
progressive immune-mediated destructive lesions of inter-lobular bile ducts.
Females from 30-65 yo
(assoc w/ Sjogren, CREST, & scleroderma) |
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what is a major early symptoms of primary biliary cirrhosis? |
FATIGUE & PRURITIS (d/t bile)!!!!!! |
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what is the tx for primary biliary cirrhosis? |
ursodeoxycholic acid --> replaces endogenous toxic bile acid. this will improve pruritis, slows disease progression & thereby delays the need for liver transplant- prolonging life. |
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what are the major complications of cirrhosis? |
hepatocellular dysfunction & portal hypertension: |
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what is the most important cause of portal hypertension?
what is normal portal pressure gradient? |
cirrhosis; *disrupted portal blood flow--> portal hypertension--> formation of venous collaterals btwn portal & systemic circulation (portal v & azygos v) *develops when pressure > 10mmhg (rupture if > 12mmhg)
normal: 3-6 mmHg |
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what percentage of pts with cirrhosis have a variceal hemorrhage every year?
How can it be prevented? |
10-30%
endoscopic screening prophylactic non-selective beta-blockers (propranolol, nadolol-corgard) (^*alt long acting nitrates-isosorbide mononitrate) |
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where is variceal hemorrhage most common? what is the mortality rate? |
large esophageal |
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how do you tx variceal hemorrhage? |
endoscopic band ligation preceeded by administration of octreotide/somatostatin which among other things reduces splanchnic blood flow
*followed by blood transfusion is substantial loss |
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what is the MC cause of ascites?
How is it treated?
Untx what can it lead to? |
cirrhosis
tx: diuretics (slow), paracentesis
spontaneous bacterial peritonitis (ascite fluid infection w/ pneumococcus or enterobacteriaceae) |
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what is hepatorenal syndrome?
what are the causes? |
functional renal failure--> histologically normal kidneys** regain fxn when liver fxn resolved
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what are the two types of hepatorenal syndrome? |
type 1: rapid progressive renal failure occurs w/n 2 weeks & assoc poor prognosis |
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what does the decline in renal function typically follow in pts w/ cirrhosis & ascites (hepatorenal syndrome)? |
infection |
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what percentage of pts die d/t hepatorenal syndrome?
what is the accepted tx? |
95% usually FATAL! |
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What is hepatopulmonary syndrome?
what completely reverses hepatopulmonary syndrome? |
abnormal arterial oxygenation in the absence of pulmonary architectural damage & presence of cirrhosis
reversed w/ liver transplant |
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what is the MC indication for liver transplantation in the US?
What percent of liver transplant pts survive 3+ yrs w/ good quality of life? |
chronic liver disease resulting from hepatitis C virus infection
70-80% |
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what determines organ allocation for liver transplantation? |
MELD system (model for end stage liver disease). This is a prognostic model that predicts mortality based on variables, therefore prioritizing pts w/ more advanced liver disease. |
