Cheatography
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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: |
Inflammatory response |
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Collagen and fibrotic tissue deposited within sinusoids, making blood flow difficult |
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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 |
Hepatic Fibrosis |
Causes of Cirrhosis
Alcohol |
Primary |
Infections |
Viral hepatitis |
Disease states |
Wilson's disease, cystic fibrosis, hemochromatosis, chronic biliary obstruction, autoimmune biliary cirrhosis, nonalcoholic steatohepatitis (NASH) |
Medications |
MTX, amiodarone, dronedarone, APA (high doses) |
Alcohol and infections account for ~80% of cirrhosis cases
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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 |
Filtration |
Not able to effectively remove toxins, pathogens, or debris from the blood |
Production |
Decreased production of albumin, clotting factors (which can result in bleeding complications), and bile (may lead to digestive issues) |
Metabolism |
Think CYP Enzymes |
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Impaired processing of drugs, hormones, and ammonia (the natural breakdown of protein taken from the GI tract) |
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