Cirrhosis FTB iNCOMPLETE (Add Questions)

When cells are ——— or ———- and ——- off, usually that ————— ———— that was previously full of living cells becomes ————, meaning it becomes ———- with heaps and heaps of ———— and forms ———— ———-.

• injured

• damaged

• die

• dead tissue

• fibrotic

• thickened

• protein

• scar tissue

So when your——— is ————- forced to process ———— like in ———- ————— ————, or subject to a ———- ———- for a ——— time like in ———-, or anything else that causes a ——- - ——- or ———— ——— of ——- cell or —————- ————- and ————, your ——— can become seriously ——— and ————— to the point where it’s no longer —————-, at which point it becomes ———— and in the ———- we call this process ————-.

• liver

• constantly

• alcohol

• alcoholic liver disease

• viral attack

• long

• HBV

• long-term

• chronic state

• liver

• hepatocyte destruction

• inflammation

• liver

• scarred

• damaged

• reversible fibrotic

• live

• cirrhosis

Because it’s usually ————-, ———— is often referred to as “——— - ———” or “—— - ——-” ——— ————.

When liver cells are ————-, they start to come ———- and form what are called ———- ———. You can think of these as ———— of ———— ————- cells. These are one of the classic signs of cirrhosis and are why a ————- ———- is more ———- as opposed to a ————, healthy liver.

• irreversible

• cirrhosis

• end-stage

• late-stage

• liver damage

• injured

• together

• regenerative nodules

• colonies

• living liver

• cirrhotic liver

• bumpy

• smooth

Also with ———- ————- tissue, you’ll see that in ————- these ———- of cells or —————, is ———- ———- and ———.

Here’s a classic histology image of cirrhotic tissue, this ———- of cells in the middle is the —————- ————, and these ——— ———- surrounding it are the ————- of ———- from the process of —————-.

• cirrhotic liver

• between

• clumps

• nodules

• fibrotic tissue

• collagen

• clump

• middle

• regenerative nodule

• blue stains

• bands

• protein

• fibrosis

If we zoom out a bit and look at it with the naked eye, we’ll again see these ———-, which have ———— ——— ——— in ———-.

How do these ———— of ————- ———- form though? Well ————- is a process mediated by special cells called ———- cells, that sit ———— the ————- and —————, known as the —————- ———-.

• nodules

• fibrotic protein bands

• between

• bands

• fibrotic tissue

• fibrosis

• stellate

• between

• sinusoid

• hepatocyte

• perisinusoidal space

Here’s a pretty basic layout of the basic ————- ——— of the liver, you’ve got the ——— ——— and —————- ——— that ———— into a ————, which then goes into the ———- ————-, and these are all ————- with ————-.

Along with these though you’ve also got a ———— ———-, and all ———— constitute a ———- ———-.

• functional unit

• portal vein

• hepatic artery

• combine

• sinusoid

• central vein

• lined

• hepatocytes

• bile duct

• three

• portal triad

So the ———— ————, which literally means “————- the ————— ———”, and ——— cells are about here. And usually in ———— tissue, these guys’ main function is to ———- ———— ——- and are otherwise considered ————, or sort of ———-. When the ———- are ———- though, they ———— ———— ———— that “—————-” and ———— the ————- cells.

• perisinusoidal space

• around

• sinusoidal space

• stellate

• healthy

• function

• store vitamin A

• quiescent

• dormant

• hepatocytes

• injured

• secrete paracrine factors

• activates

• changes

• stellate

When ————-, the ————- cells ———- ———— ———, ————, and start —————- ————- —————- ————- ———-, or ——— - ———-, which then causes them to produce —————, which is the main ingredient in ————- ————, —————-, and ———- ————.

As this ———- tissue builds up, it starts to ————- the ——— ———— and —————-.

• activated

• stellate

• lose vitamin A

• proliferate

• secreting transforming growth factor beta1

• TGF-beta

• collagen

• extracellular matrix

• fibrosis

• scar tissue

• fibrotic

• compress

• central veins

• sinusoids

It’s thought that in a healthy, normal state, these cells play key roles in the natural ——— - ——— process, but when the liver cells are ————- ——, the ———— cells are ———— ————— and so they constantly produce ————- and ———- that lead to ————-.

And this is when ————- due to —————- start to crop up.

• wound-healing

• constantly injured

• stellate

• constantly activated

• collagen

• factors

• fibrosis

• complications

• cirrhosis

As the ———- ——— and ————- become ———— and ——- on the ——— ———-, their ——- starts to ——- up, leading to ————- (or ———-) ——————, which is this ————— pressure in the ———- ——-.

.—————- ———- ———— pressure means that ———- in ————- ———— is ——— likely to get ————— into ——— and ——— tissues into ————- ———— ————- like the ———— ———-.

• central veins

• sinusoids

• compressed

• push

• fluid

• pressure

• build

• intrasinusoidal

• portal

• hypertension

• higher

• portal veins

• higher portal vein

• fluid

• blood vessels

• more

• pushed

• tissues

• across

• large open spaces

• peritoneal cavity

That’s why ———— leads to ————— ——— ————, a condition called ———-, and can result in other complications like —————- —————- and ——————, where the spleen becomes —————- because all this ——— and ———— can’t get ——— the ————, and ——- up into the spleen.

In the same way, your ————— ———— starts diverting ———- ———- from the ——— because of the ————— ———- ————-, this is known as a ———— —————.

• cirrhosis

• excess peritoneal fluid

• ascites

• congestive splenomegaly

• hypersplenism

• enlarged

• fluid

• blood

• into

• liver

• backs

• circulatory system

• blood away

• liver

• high liver pressures

• portosystemic shunt

.———— ——— follows the path of —————- ————- and ——- ————— from the ———- ——— and towards the ————— ————- of ————.

Though not fully understood, these changes in ————- ————- ultimately trigger ———— —————-, so ————— ————— in the ———— ——————, which ————— ———— ————- through the ————, leading to —————- —————- ———— ————-, where ————- ———— follows ———- ————.

• blood flow

• least resistance

• shunts away

• portal system

• systemic system

• circulation

• portal flow

• trigger renal vasoconstriction

• increased resistance

• renal circulation

• decreases blood flow

• kidneys

• decreased filtration hepatorenal failure

• kidney failure

• liver failure

The ————- ———-, ———- ———, and ————— of —————- from the ———- ———- essentially ———— the number of ———— ———— ———, and the number of ———— ———- ————— in general.

As you have less and less of these ———— ————- ————- ————, your liver becomes less and less able to do its job of ——————.

• fibrotic tissue

• pressure buildup

• diversion

• blood

• hepatic circulation

• reduces

• functional sinusoidal veins

• functional portal triads

• basic liver functional units

• detoxification

When your liver isn’t ————- your ————, these ———— can get into the ———— and start causing ———— ————, a condition known as ————- —————-.

Although there are several —————- that are thought to contribute to the ————— of these ———— —————-, the best understood factor is ———— in the ———-, which is produced mainly in the —————- ————; usually the liver plays a vital role in —————- ————- and stopping it from going into the ————— ————-.

• detoxifying

• blood

• toxins

• brain

• mental deficits

• hepatic encephalopathy

• neurotoxins

• development

• mental changes

• ammonia

• blood

• gastrointestinal tract

• removing ammonia

• systemic circulation

As more of these and other ——— get into the ———-, patients might develop ———-, where they have ————- or ———— ——— when ————-, and as even more ———— ———- up, eventually patients can progress to a ————.

Also, since the liver plays a big role in ————— ———— into ————— ——— that can be removed from the ———- and —————, patients can also experience —————- due to ————— ————— in the blood, like —————, ————— ————-, and ————- —————-.

• toxins

• brain

• asterixis

• tremoring

• jerky hands

• outstretched

• toxins build

• coma

• metabolising oestrogen

• inactive metabolites

• blood

• excreted

• complications

• increased oestrogen

• gynecomastia

• spider angiomata

• palmar erythema

And, since the liver usually ————- ————, ————- ————- ————- in the blood from ——— - —————- liver can lead to ————-.

Another important job of the liver is producing —————-, so again, if the liver’s not ———— right, you can have a ———— amount of ———— in the blood, or ————-.

• conjugates bilirubin

• increased unconjugated bilirubin

• less-functional

• jaundice

• albumin

• functioning

• decreased

• albumin

• hypoalbuminemia

Finally, the liver helps in making ———— ——- or ———- that help ———- your blood, so when you aren’t producing these ———— ———-, you can develop issues related to your ability to ———- blood, which you need in order to stop ——— ——— after an ————.

To recap the general symptoms of cirrhosis, ———— on, with a ————— amount of ———- and ———-, we call it ————— ———-, meaning the liver can still do a lot of its job.

• clotting factors

• proteins

• coagulate

• coagulation factors

• coagulate

• blood loss

• injury

• early

• small

• scarring

• fibrosis

• compensated cirrhosis

In this case, somebody with cirrhosis might not have any ————, or have ————- ———- like ———— ———-, ————-, or ————-.

Later on, though, with —————- ————, the liver progresses to —————- ————, and can’t ————- properly.

At this point many of the described —————- start to develop, like ———— and ———- or ———- ————- ————, ————— ————- leading to ————-, and easy ————— from ———— —————- ————.

• symptoms

• nonspecific symptoms

• weight loss

• weakness

• fatigue

• extensive scarring

• decompensated cirrhosis

• function

• symptoms

• jaundice

• pruritus

• itchy skin

• ascites

• hepatic encephalopathy

• confusion

• bruising

• low coagulation factors

For ————-, the “———- ———” is a ————- ———-, taking a ———- ————— of the ———— tissue examine under a ————-.

Common lab findings include —————— ————- —————, as well as —————- ————- ———— like ————- ——————, (AST) and ———— ——————- (ALT), where ————- is usually more elevated than ————, ————— ————— (ALP), and —————- —————— —————-, and ——————-, or ————— ———— —————.

• diagnosis

• gold standard

• liver biopsy

• tiny sample

• liver

• microscope

• elevated serum bilirubin

• elevated liver enzymes

• aspartate aminotransferase

• alanine aminotransferase

• AST

• ALT

• alkaline phosphatase

• gamma glutamyl transpeptidase

• thrombocytopenia

• low platelet count

As to —————, generally the —————- in cirrhosis is —————-, so first of all it’s important to prevent —————- ————- ————- by identifying the —————- ———— and ————— that, for example stopping ————— ————- or ———— treatment for those with ————— ———. With ————- cirrhosis, though, where the liver stops —————-, a ———— ———- might be needed.

• treatment

• scarring

• irreversible

• continued liver damage

• underlying cause

• treating

• alcohol consumption

• antiviral

• hepatitis C

• advanced

• functioning

• liver transplant

.————— is most often used for —————- prevention/—————-, and for —————— ————————- ————————-

• Ursodiol

• gallstone

• dissolution

• primary biliary cholangitis

.—————— ————— —————- ————- and ——— - —————- ————- ————- ——————- can leas to —————- of the liver

• alcoholic fatty liver disease

• non-alcoholic fatty liver disease

• cirrhosis

Liver cirrhosis can develop into (—————-) —————— —————

• neoplasm

• hepatocellular carcinoma

.————— ——- and ————- are two types of ———— ————— that are well known for leading to the development of cirrhosis.

• hepatitis B

• C

• viral hepatitis

The degree of liver damage —————- correlates with the ————- in ————— time

• positively

• increase

• prothrombin

.————- —————— is the final and ————— form of —————- ————- ———— that presents with a ——————-, ————— ——————- liver with a “———-" appearance.

• alcoholic cirrhosis

• irreversible

• alcoholic liver disease

• micronodular

• irregularly shrunken

• hobnail

The ———— seen in liver cirrhosis is mediated by the ————- cells in the liver.

• fibrosis

• stellate

.—————- time ———— in cirrhosis.

• prothrombin

• increases

Cirrhosis is the most common cause of ————- ————

• portal hypertension

.————- ———- ————— - ———— is the mediator released by ———- cells that causes ————— seen in cirrhosis. 

• transforming growth factor-beta

• stellate

• fibrosis

.————— ———— ————— is a ————- therapy given in patients with cirrhosis due to ————— production of —————- —————. 

• fresh frozen plasma

• transfusion

• decreased

• coagulation factors

Deficiency of ————- in cirrhosis causes ————-

• albumin

• oedema