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28 Cards in this Set
- Front
- Back
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define cirrhosis. what is it in response to cirrhosis?
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the irreversible end result of the fibrous scarring & hepatocellular regeneration
in response to long standing inflammatory, metabolic, toxic, & congestive insults from a wide variety of conditions |
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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?
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alcoholic: <3 mm
chronic active hepatitis: >3mm |
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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?
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portal hypertension & heptocellular dysfunction
portal HTN: ascities, gastroesophageal varices, hypersplenism (thromocytopenia/leukopenia) hepatocellular dysfunction: 1) impaired protein synthesis & hyperbilirubinemia |
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what does the impaired protein synthesis result in in cirrhotic pts? what about hyperbilirubinemia in your cirrhotic pts?
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protein synthesis: hypoalbuminemia & prolonged prothrombin time
hyperbilirubinemia: jaundice, dec BUN, and inc Ammonia. |
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what are the most common cause of liver cirrhosis in the western world?
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alcohol consumption & hep C virus infection
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what is the most common cause in Developing countries?
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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?
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characteristic destructive lesions of bile ducts. Females from 30-65 yo
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what is a major early symptoms of primary biliary cirrhosis?
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FATIGUE & PRURITIS!!!!!!
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what is the tx for primary biliary cirrhosis?
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ursodeoxycholic acid which 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?
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hepatocellular dysfunction & portal hypertension:
-- variceal hemorrhage -- ascities (spontaneous bacterial peritonitis) -- hepatic encephalopathy -- hepatorenal syndrome -- hepatopulmonary syndrome also hepatocellular CA |
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what is the most important cause of portal hypertension? what is normal portal pressure gradient?
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cirrhosis; 3-6 mmHg
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what percentage of pts with cirrhosis have a variceal hemorrhage every year?
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10-30%
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where is variceal hemorrhage most common? what is the mortality rate?
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large esophageal
30-50% |
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how do you tx variceal hemorrhage?
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endoscopic band ligation preceeded by administration of cotreotide/sst which amoung other things reduces splanchnic blood flow
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how do you prevent variceal hemorrhage? what about primary prophylaxis?
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endoscopic screening to identify pts at high risk for variceal bleeding. nonselective B-blockers --> primary prophylaxis bc they reduce portal blood flow & resistance and reduces protal pressure. alt: nitrates-isosorbide mononitrate.
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what si the MC cause of ascites?
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cirrhosis
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what is hepatorenal syndrome? what are the causes?
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functional renal failure
causes: 1) serious liver disease from any cause 2) almost always present w/ liver dysfunction & ascites |
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what are the characteristics of hepatorenal syndrome?
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kidneys are histologically normal & able to regain normal function w/ recovery of liver fxn.
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what are the two types of hepatorenal syndrome?
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type 1: rapid progressive renal failure occurs w/n 2 weeks & assoc poor prognosis
type 2: occurs more slowly & is assoc w/ a better prognosis |
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what does the decline in renal function typically follow in pts w/ cirrhosis & ascites?
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infection
vigorous attempt to reduce ascites w/ diuretics large volume paracentesis |
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what percentage of pts die d/t hepatorenal syndrome? what is the accepted tx?
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95%
liver transplantation- everything in the kidney reverses |
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what completely reverses hepatopulmonary syndrome?
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liver transplant
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what percentage of pts undergoing liver transplantation usually survive at least 3 years with good quality of life?
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70-80%
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what is the MC indication for liver transplantation in the US?
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chronic liver disease resulting from hepatitis C virus infection
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what determines organ allocation for liver transplantation?
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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.
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