patho and complications associated with cirrhosis
preventative and treatment for ascites, portal HTN, varices, hepatic encephalopathy, SBP, and HRS
Causes and treatment for pancreatitis
This is a draft cheat sheet. It is a work in progress and is not finished yet.
What is Cirrhosis?
Significant damage to the liver, resulting in healthy tissue being replaced with scar tissue
Direct Damage to Hepatocytes Results In:
Collagen and fibrotic tissue deposited within sinusoids, making blood flow difficult
Remodeling of hepatic lobules
Increased resistance within hepatic lobule:
Due to fibrotic scar tissue within the sinusoid and increased vasoconstriction
Splanchnic blood vessels dilate, resulting in increased blood volume
Causes of Cirrhosis
Wilson's disease, cystic fibrosis, hemochromatosis, chronic biliary obstruction, autoimmune biliary cirrhosis, nonalcoholic steatohepatitis (NASH)
MTX, amiodarone, dronedarone, APA (high doses)
Alcohol and infections account for ~80% of cirrhosis cases
Pathophysiology of Cirrhosis
Scar tissue and fibroids are laid down in the sinusoidal space, resulting in an increased pressure due to blocked blood flow.
Scar tissue and fibroids will infiltrate the hepatocytes, disrupting the tissue and architecture of the liver.
An imbalance exists between vasoconstrictors and vasodilators. Vasoconstrictors are working in the liver, which causes blood to back up into the intra-abdominal vessels and blood pooling into the intra-abdominal space.
Vasodilators work in the intra-abdominal vessels (splenic vasculature), which causes more blood to pool in the abdomen, but can't progress through the liver due to the vasoconstrictors.
Outcome of Cirrhosis
Liver is unable to perform normal functions
Not able to effectively remove toxins, pathogens, or debris from the blood
Decreased production of albumin, clotting factors (which can result in bleeding complications), and bile (may lead to digestive issues)
Think CYP Enzymes
Impaired processing of drugs, hormones, and ammonia (the natural breakdown of protein taken from the GI tract)