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7 Cards in this Set
- Front
- Back
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Cirrhosis
Epidemiology |
12th most common cause of death (USA)
Most common of liver-related deaths |
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Cirrhosis
Aetiologies |
Common:
Alcohol abuse, viral hepatitis, non-alcoholic steatohepatitis (NASH) Less common: Biliary disease, metabolic (Haemochromatosis, Wilsons, a1AT), cryptogenic (15%) |
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Cirrhosis
Aetiologies (Mneumonic) |
A: Autoimmune
B: Biliary diseases, Hepatitis B C: Cryptogenic, HCV D: Drugs, HDV E: Ethanol F: Fat G: Genetic (Wilson’s) H: Haemochromatosis |
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Cirrhosis
3 main morphological features |
1) Bridging Fibrous septa:
- Delicate bands or broad scars linking portal tracts with one another and portal tracts with terminal hepatic veins. - Fibrosis is key feature of progressive liver damage 2) Parenchymal nodules: Containing hepatocytes encircled by fibrosis, - With diameters from <0.3cm to several centimetres. - Nodularity results from cycles of hepatocyte regeneration and scarring 3) Disruption of architecture of entire liver: - Parenchymal injury and consequent fibrosis are diffuse, extending throughout liver. *Note: focal injury without scarring does not constitute cirrhosis, nor does diffuse nodular transformation without fibrosis. i.e. Both nodules and fibrosis must be present. |
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Cirrhosis
Mechanism Tip: 3 central pathogenic processes |
Central pathogenic processes:
1. Death of heptocytes 2. ECM deposition 3. Vascular reorganisation Liver parenchymal damage and scarring -> Vascular architecture disrupted -> New vascular arrangements occcur in fibrotic septa = Shunting of blood from parenchyma Predominant mechanism of fibrosis: Proliferation of hepatic stellate cells + Activation into highly fibrogenic cells (myofibroblasts) Process mediated by cytokines (from Kupffer cells, lymphocytes, etc.) Surviving hepatocytes -> Confined by fibrous septa -> Stimulated to regenerate + proliferate as spherical nodules within NET OUTCOME: - Fibrotic, nodular liver - Blood delivery to hepatocytes is severely compromised - Delivery of substances into plasma severely compromised as well |
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Cirrhosis: Clinical features
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40% asymptomatic until late in course of disease.
Presentation = non-specific: anorexia, weight loss, weakness, liver failure signs (late disease) Incipent/overt hepatic failure if there is increased metabolic load (e.g. systemic infection, GIT hemorrhage) Pulmonary: Severely impaired oxygenation (hepatopulmonary syndrome) |
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Cirrhosis: 3 main causes of death
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1) Progressive liver failure
2) Complication related to portal hypertension 3) Development of hepatocellular carcinoma |
