Liver Cirrhosis

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Questions and Answers

Which of the following is NOT a typical cause of liver cirrhosis?

Asthma (correct)

Metabolic dysfunction-associated steatohepatitis (MASH)

Chronic viral infections

Alcohol

What is the primary pathological change in liver cirrhosis?

Hepatocellular necrosis

Hepatic fibrosis and regenerative nodules (correct)

Increased bile acid synthesis

Decreased blood flow to the liver

In alcohol-related liver cirrhosis, fibrosis is predominantly observed in which zone of the liver?

Zone 2

Zone 3 (correct)

Zone 1 (periportal zone)

Zone 4

Which condition is associated with hepatic venous outflow obstruction leading to cirrhosis?

Budd Chiari syndrome Signup and view all the answers

What is a common clinical manifestation of decompensated cirrhosis?

Jaundice Signup and view all the answers

Sarcopenia in liver cirrhosis is primarily characterized by a decrease in which type of tissue?

Muscle tissue Signup and view all the answers

Which of the following is a risk factor for the development of hepatocellular carcinoma in cirrhotic patients?

Chronic Hepatitis B infection Signup and view all the answers

In the context of hepatic fibrosis, what are activated HSCs primarily responsible for?

Collagen deposition Signup and view all the answers

What is the primary clinical feature used to diagnose cirrhosis?

Characteristic morphological changes of the liver Signup and view all the answers

Which of the following is NOT a manifestation of portal hypertension?

Hepatocellular carcinoma Signup and view all the answers

What typically signifies decompensated cirrhosis?

Presence of clinical complications of liver failure Signup and view all the answers

What is the clinical significance of splenomegaly in cirrhosis?

It causes gastrointestinal pain and hypersplenism. Signup and view all the answers

Which of the following statements about ascites is true?

It results from the accumulation of endogenous vasodilators due to PH. Signup and view all the answers

What does sarcopenia in liver cirrhosis indicate?

Reduction in muscle mass due to malnutrition. Signup and view all the answers

Which factor is the earliest consequence of cirrhosis?

Portal hypertension Signup and view all the answers

In clinically compensated cirrhosis, which of the following is typically absent?

Complications of hepatic decompensation Signup and view all the answers

What is the significance of endoscopy in patients with varices?

It confirms variceal presence and identifies specific bleeding causes. Signup and view all the answers

What is the average transition rate from compensated cirrhosis to decompensated cirrhosis?

5-7% per year Signup and view all the answers

Which of the following factors is associated with poor prognosis in cirrhosis?

Refractory ascites Signup and view all the answers

What does the Child-Pugh classification assess in patients with liver disease?

Five parameters including ascites and encephalopathy Signup and view all the answers

What is the risk of developing HCC in patients with alcohol-associated and viral hepatitis-related cirrhosis?

3-5% per year Signup and view all the answers

How does HVPG measurement contribute to the management of portal hypertension (PH)?

It can establish the presence and cause of PH. Signup and view all the answers

Which of the following conditions signifies a significantly lower mortality risk in cirrhosis patients?

Absence of varices Signup and view all the answers

Which of the following is NOT a parameter included in the Child-Pugh classification?

Kidney function Signup and view all the answers

Which type of anemia is commonly found in cirrhosis patients due to acute GI bleeding?

Normocytic normochromic anemia Signup and view all the answers

What is the primary cause of thrombocytopenia in cirrhosis patients?

Hypersplenism Signup and view all the answers

Which laboratory finding is indicative of Wilson disease in a patient with cirrhosis?

Increased 24-hour urine copper excretion Signup and view all the answers

What clinical manifestation is most associated with hepatocellular carcinoma (HCC) in patients with cirrhosis?

Erythrocytosis due to increased thrombopoietin Signup and view all the answers

Which immunoglobulin level is commonly elevated in patients with cirrhosis?

IgG Signup and view all the answers

During the decompensation stage of liver cirrhosis, which of the following metabolic changes is expected?

Increased serum creatinine Signup and view all the answers

Which of the following conditions involves the presence of autoantibodies in cirrhosis diagnosis?

Autoimmune-related cirrhosis Signup and view all the answers

What is the role of serum alpha-fetoprotein (AFP) in assessing cirrhosis patients?

Screening for hepatocellular carcinoma Signup and view all the answers

What is a characteristic clinical manifestation of acute-on-chronic liver failure?

Jaundice Signup and view all the answers

Which of the following is an indicator of sarcopenia in liver cirrhosis?

Decreased strength Signup and view all the answers

In decompensation stages of liver cirrhosis, which symptom is most frequently observed?

Fluid retention Signup and view all the answers

What is a significant risk factor for the development of hepatocellular carcinoma in cirrhotic patients?

Chronic liver infection Signup and view all the answers

Which factor is NOT typically involved in the clinical manifestations of cirrhosis?

Increased energy levels Signup and view all the answers

What is the role of hepatic stellate cells during liver cirrhosis?

Contribute to fibrosis Signup and view all the answers

During the pathogenesis of cirrhosis, which process is primarily affected leading to impaired liver function?

Fibrogenesis Signup and view all the answers

Which of the following best describes a common complication of liver cirrhosis?

Esophageal varices Signup and view all the answers

Study Notes

Clinical Presentation of Cirrhosis

Detectable morphological liver changes include shrunken, enlarged, or normal size, sharp edge (irregular, smooth, or nodular surface), and firm consistency.
Symptoms stem from complications: portal hypertension (PH), hepatic decompensation (liver failure), and hepatocellular carcinoma (HCC).
Prognosis and treatment are influenced by the severity of these complications.

Portal Hypertension (PH)

PH is an early consequence of cirrhosis, crucial in developing several cirrhosis-related complications.
Develops irrespective of liver disease severity.
Clinical manifestations include:
- Portal-systemic shunting (PSS) leading to upper/lower GI bleeding, dilated abdominal wall veins, and caput medusa.
- Splenomegaly with possible left hypochondrial pain and hypersplenism.
- Ascites due to fluid transudation from intravascular compartments to the peritoneal cavity.

Hepatic Decompensation

Clinical cirrhosis is classified as compensated (absence of complications) or decompensated (presence of liver failure).
Compensated cirrhosis shows no past or present hepatic decompensation episodes.

Causes of Liver Cirrhosis

Viral hepatitis: B, C, and D.
Alcohol consumption.
Metabolic diseases:
- Non-alcoholic steatohepatitis (NASH)
- Hemochromatosis, Wilson disease, and more.
Prolonged cholestasis: Primary biliary cholangitis, primary sclerosing cholangitis.
Hepatic venous outflow obstruction: Budd-Chiari syndrome, cardiac cirrhosis.
Other: Autoimmune hepatitis, drugs (e.g., methotrexate, amiodarone), syphilis, cryptogenic causes.

Pathogenesis of Cirrhosis

Result of hepatic injury leading to fibrosis and regenerative nodules.
Fibrosis follows hepatocellular necrosis; fibrosis location varies with the cause (e.g., viral hepatitis in zone 1, alcoholism in zone 3).
Activated hepatic stellate cells (HSCs) deposit collagen, causing irreversible fibrosis.
Common blood findings include elevated bilirubin and GGT, with immunoglobulins often elevated due to impaired liver clearance.

Laboratory Findings

Anemia may present as normocytic, microcytic, or macrocytic due to varying causes.
Thrombocytopenia arises from hypersplenism and bone marrow suppression.
Other monitored parameters: renal function, serum electrolytes, serum alpha-fetoprotein (AFP).

Diagnosis

Specific tests for etiology include viral markers for hepatitis, transferrin and ferritin levels for hemochromatosis, and serum ceruloplasmin for Wilson disease.
Endoscopy to locate varices and sources of GI bleeding.
Regular HCC screening every six months through ultrasound and possible AFP testing.
Hepatic venous pressure gradient (HVPG) measurement helps evaluate PH.

Prognosis

Compensated cirrhosis: median survival time exceeds 12 years; significantly lower mortality without varices.
Transition to decompensated cirrhosis occurs at 5-7% per year, dropping median survival to about two years.
Poor prognostic indicators: refractory ascites, variceal bleeding, low MAP, high alcohol consumption, prothrombin time, bilirubin, alkaline phosphatase, low albumin, hyponatremia, infections.

Risk for HCC

Patients with cirrhosis have a 3-5% annual risk of developing HCC, particularly with alcohol and viral hepatitis-associated cirrhosis.

Prognostic Scoring Systems

Child-Pugh classification: assesses ascites, encephalopathy, serum albumin, bilirubin, and prothrombin time for short-term prognosis.
Model for End-stage Liver Disease (MELD): another scoring system for assessing liver disease severity.

General Function of Hepatic Cells

Sinusoidal endothelial cells (SECs) facilitate fluid and nutrient exchange.
Hepatic stellate cells (HSCs) are important for collagen deposition and are quiescent in a normal liver, activated during injury.

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Description

This quiz covers the clinical features and complications associated with cirrhosis, including morphological changes of the liver and related symptoms. Explore vital information on the prognosis and treatment of cirrhosis. Dive into the complexities of liver health and the impact of major complications.