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Cirrhosis & Pancreatitis Cheat Sheet (DRAFT) by

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.

Hepatic Blood Flow

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
 
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
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
 

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
 
Impaired processing of drugs, hormones, and ammonia (the natural breakdown of protein taken from the GI tract)
                                                       

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