Case 5 – Cirrhosis – Flashcards
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What are manifestations of liver injury?
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- cell necrosis - fatty change - mixed necrosis and fatty change
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What are clinical effects of liver injury?
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- mild injury with complete recovery - severe injury leading to hepatic failure - chronic or progressive injury causes scarring which impairs liver function
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What are common types of liver injury?
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- viral hepatitis - fatty liver - alcoholic liver disease or alcoholic hepatitis - cirrhosis
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What is alcoholic liver disease?
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A group of structural and functional changes in the liver resulting from excessive alcohol consumption - severity depends on amount and duration of alcohol consumption
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What are the 3 stages of progression in alcoholic liver disease?
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1. Alcoholic fatty liver 2. Alcoholic hepatitis 3. Alcoholic cirrhosis
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What happens in the alcoholic fatty liver stage of liver disease?
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- mildest form - liver function gradually returns to normal if subject stops drinking
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What happens in the alcoholic hepatitis stage of liver disease?
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- causes degenerative changes and necrosis of liver cells - more severe alcoholic injury - healing with scarring
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What happens in the alcoholic cirrhosis stage of liver disease?
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- most advanced stage - diffuse scarring throughout liver - disturbs liver function - impedes blood flow through liver
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What is fatty liver?
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- fat accumulates in liver secondary to injury - common in heavy dirnkers and alcoholics - may also be caused by chemicals and solvents - can also be seen in obese and diabetics - impaired liver function but injury is still reversible
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What is cirrhosis?
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- an irreversible diffuse scarring of the liver that results in the replacement of normal liver cells with hard, fibrous scar tissue
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What are causes of cirrhosis?
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- alcoholic liver disease - chronic hepatitis - severe liver necrosis - repeated liver injury: drugs and chemicals - longstanding bile duct obstruction
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What are clinical manifestations of cirrhosis?
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- liver failure - portal hypertension
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What are some changes in the body that occur in liver failure?
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- hepatocellular jaundice - feminization - palmar erythema and spider angiomata
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What is hepatocellular jaundice?
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jaundice resulting from failure of liver cells to take up or conjugate bilirubin - yellow-brown colored skin and sclera
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What is feminization?
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In males, liver damage interferes with inactivation of estsrogens - gynecomastia: male breast enlargement - testicular atrophy - loss of sex drive
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What is palmar erythema and spider angiomata?
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Elevated level of circulating estrogen causes dilation of arterioles - produces a characteristic reddening
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What is portal hypertension?
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Increased blood pressure in the portal venous system as a result of restricted blood flow through the liver
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What are results of portal hypertension?
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- Ascites - Hypoalbuminemia = reduced osmotic pressure = peripheral edema - anastomoses where portal and systemic veins are closely associated - blood is shunted away from high pressure portal system into low pressure veins of systemic circulation - Esophageal varices
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What are esophageal varices?
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- esophageal veins become distended due to underlying portal hypertension
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What are symptoms of esophageal varices?
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Often asymptomatic until they reupture THEN massive hemorrhage, hematemesis, abdominal pain
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How are esophageal varices treated?
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Sengstaken-Blakemore tube for active bleeding - endoscopic banding or scleotherapy - portal decompression
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What is portal decompression?
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- methods to control portal hypertension - portal-systemic anastomoses to control varices (shunts) - transjugular intrahepatic protosystemic shunt (TIPS) - alternative to open operative procedure
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What is hepatic encephalopathy?
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- decreased ability to process amino groups from protein metabolism --> ammonia accumulates - deterioration of brain functin characterized by impaired consciousness, confusion, disorientation, and eventually coma
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What is asterixis?
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- flapping tremor of the hand when the arm and hand are extended
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What blood coagulation abnormalities are a result of liver failure?
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malabsorption of vitamin K reduced synthesis of clotting factors
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What are symptoms of cirrhosis of the liver?
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- jaundice - loss of appetite, nausea, vomiting - wasting - blood coagulation disorders - gynecomastia and testicular atrophy - plasma protein deficiencies (ascites and edema) - pruritis - palmar eythema - spider angioma - splenomegaly
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How is cirrhosis treated?
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- directed at the cause, prevent further damage to the liver - alcohol intake isprohibited, malnutrition prevention, vitamin and mineral supplements, diuretics - liver transplant if possible
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What are the most common causes of cirrhosis in the US?
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- hepatitis C - alcoholic liver disease - hep C plus alcoholic liver disease
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What is viral hepatitis?
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- produced by a group of viruses that specifically attack the liver - typical course involves 4-6 week period of symptoms followed by restoration of normal function and complete recovery
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What are symptoms of viral hepatitis?
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- weakness and fatigue - nausea, anorexia - fever - jaundice
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What is hepatitis A?
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- acute and usually mild condition that resolves with minimal therapeutic intervension - excreted through nose, throat, stools - self limited
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How is hepatitis A transmitted?
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- person to person contact - fecal contamination of food or water
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How is hepatitis A prevented?
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Hepatitis A vaccine Hepatitis A immune globulin: given after exposure
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How is hepatitis B transmitted?
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ALL body fluids - often sexual contact or contaminated needles
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How do people recover from Hepatitis B?
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In most, symptoms subside after 4-6 weeks - 10% become carriers and may develop chronic liver disease
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How is hepatitis B prevented?
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- Hepatitis B vaccine - Hepatitis B immune globulin: given after exposure
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How is hepatitis C transmitted?
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blood and body fluids - no immunization
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How do people recover from Hepatitis C?
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75% become carriers and many develop chronic liver disease - scarring and cirrhosis develop
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How is hepatitis C treated?
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No cure - treatment aims at controlling symptoms and improving long-term liver function - anti-viral agents - steroids to reduce inflammation
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What is hepatitis D?
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An incomplete viral particle that is incapable of infecting on its own - only infects persons with acute or chronic HBV infection - usually transmitted by needles in US
