Cirrhosis Lecture Notes

These flashcards cover key terms, definitions, and concepts related to cirrhosis as described in the lecture notes.

Cirrhosis

The end result of most chronic liver diseases, characterized by extensive fibrosis and the formation of regenerative nodules, leading to impaired liver function and architectural distortion.

Epidemiology of Cirrhosis

Cirrhosis accounts for approximately 35,000 deaths annually in the U.S. and is the ninth leading cause of death, reflecting its significant public health impact.

Alcohol-induced cirrhosis

Also known as Laënnec’s cirrhosis, this type results from chronic, heavy alcohol consumption leading to direct hepatotoxicity, inflammation, and often associated malnutrition.

Biliary cirrhosis

Scarring of the liver tissue, particularly around the bile ducts, due to chronic biliary obstruction and inflammation (cholangitis); can be primary (autoimmune) or secondary (e.g., from gallstones or strictures).

Palmar edema

Often, the finding is palmar erythema (reddened palms), a common sign associated with alcoholic cirrhosis, caused by altered hormone metabolism leading to vasodilatation. Actual palmar edema (swelling) can occur with generalized fluid retention.

Postnecrotic cirrhosis

Micronodular cirrhosis characterized by broad bands of scar tissue in the liver, typically following a bout of severe hepatic necrosis, often due to previous acute viral hepatitis (e.g., Hepatitis B or C) or drug-induced liver injury.

Autoimmune cirrhosis

A type of cirrhosis more common in women, caused by an abnormal immune response that targets and inflames liver cells, leading to chronic liver damage and fibrosis (e.g., Autoimmune Hepatitis progressing to cirrhosis).

Portal hypertension

An increase in pressure within the portal venous system due to increased resistance to blood flow through the liver, primarily caused by fibrosis and regenerative nodules in cirrhosis.

Ascites

Accumulation of protein-rich fluid in the abdominal cavity, commonly associated with liver disease. It results from increased hydrostatic pressure in hepatic sinusoids, reduced oncotic pressure (due to low albumin), and increased renal sodium and water retention.

Hepatic encephalopathy

A neuropsychiatric syndrome characterized by neurological disturbances, ranging from subtle cognitive changes to coma, due to the accumulation of ammonia and other neurotoxins in the blood that the diseased liver cannot adequately detoxify.

Thrombocytopenia

A decrease in the platelet count (<150,000/ ext{µL}), often observed in patients with significant liver disease, primarily due to hypersplenism (splenic sequestration of platelets) secondary to portal hypertension.

Asterixis

A flapping tremor of the hand that occurs when the wrist is extended, commonly seen in hepatic encephalopathy due to impaired neurological motor control.

Stage 1 Hepatic Encephalopathy

Characterized by subtle changes in behavior, diminished attention span, impaired writing (e.g., disturbed handwriting), and poor coordination, along with the presence of asterixis.

Stage 2 Hepatic Encephalopathy

Characterized by increased lethargy, apathy, moderate disorientation, and inappropriate behavior, with more pronounced asterixis.

Stage 3 Hepatic Encephalopathy

Characterized by marked somnolence, stupor (can be aroused with difficulty), significant confusion, and marked disorientation, often with hyperreflexia.

Stage 4 Hepatic Encephalopathy

Characterized by coma, unresponsiveness to painful stimuli, and often decerebrate posturing.

Nonalcoholic steatohepatitis (NASH)

A severe form of nonalcoholic fatty liver disease (NAFLD), characterized by fat accumulation in liver cells, leading to inflammation, hepatocellular injury, and potentially fibrosis and cirrhosis. It is now often termed Metabolic Dysfunction-Associated Steatohepatitis (MASH).

Wilson’s disease

A rare, autosomal recessive genetic disorder leading to excessive accumulation of copper in the liver, brain, eyes (Kayser-Fleischer rings), and other organs due to impaired copper excretion.

Hemochromatosis

A genetic disorder characterized by excessive accumulation of iron in the liver, heart, pancreas, joints, and other organs, leading to organ damage and dysfunction.

Cholangitis

Inflammation of the bile ducts, often the common bile duct, typically due to chronic biliary obstruction caused by gallstones, strictures, or tumors.

Dietary Management for Ascites

Strict sodium restriction (typically less than 2000 ext{ mg} or 2 ext{ g}/day) and careful fluid management are crucial to reduce fluid retention and buildup in the abdominal cavity, often combined with diuretic therapy.

Diuretics for Ascites

Medications such as spironolactone (an aldosterone antagonist, promoting sodium and water excretion) and furosemide (a loop diuretic, inhibiting sodium and chloride reabsorption) are used to excrete excess fluid and reduce ascites.

Lactulose for Hepatic Encephalopathy

A non-absorbable disaccharide laxative used to treat hepatic encephalopathy. It works by acidifying the colon, which traps ammonia ( ext{NH}3) as ammonium ( ext{NH}4^+), preventing its absorption, and by promoting its excretion via its cathartic effect.

Beta-blockers for Portal Hypertension

Non-selective beta-blockers (e.g., propranolol, carvedilol) are used to reduce pressure in the portal venous system by causing splanchnic vasoconstriction and decreasing cardiac output, primarily preventing complications like variceal bleeding.

Liver Transplantation

A surgical procedure to replace a diseased liver with a healthy one from a deceased or living donor, often the definitive and curative treatment for end-stage cirrhosis and its complications.

Cryptogenic cirrhosis

Cirrhosis of unknown cause, diagnosed when all other potential etiologies (e.g., viral hepatitis, alcohol, autoimmune disease, metabolic disorders) have been thoroughly excluded.

Cardiac cirrhosis

Liver fibrosis and potentially cirrhosis resulting from severe and prolonged right-sided heart failure (e.g., from tricuspid regurgitation or constrictive pericarditis), leading to chronic hepatic venous congestion and centrilobular necrosis.

Alpha-1 antitrypsin deficiency cirrhosis

A genetic disorder causing the liver to produce an abnormal form of alpha-1 antitrypsin, which accumulates in hepatocytes, leading to liver damage, inflammation, fibrosis, and eventual cirrhosis. It is also associated with lung disease (emphysema).