Questions and Answers
Which of the following symptoms is directly related to decreased bile production due to declining liver function?
What is a common symptom associated with portal hypertension, but not directly caused by it?
Which of the following is a symptom of declining liver function, NOT portal hypertension?
What symptom is characterized by small yellow nodules, especially around the eyes?
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Which of the following is NOT a consequence of portal hypertension?
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What is the primary cause of portal hypertension?
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Which condition results in a yellowish appearance of the skin and whites of the eyes due to excess bilirubin?
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What are esophageal varices primarily caused by?
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What is a significant complication of cirrhosis that affects brain function?
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Which of the following can lead to complications such as rectal varices and ascites in cirrhosis patients?
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Study Notes
Hepatic Injury
- Definition: Irreversible replacement of normal liver tissue with non-functional scar tissue, typically irreversible.
Cirrhosis
- Irreversible scarring of the liver, leading to decreased blood flow and liver function.
- Leading cause of portal hypertension.
- MC cause: Alcoholic hepatitis.
- Other causes: Viral hepatitis (Hep B & Hep C), Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), parasitic infection, malignancy.
Portal Hypertension
- Abnormally high BP in the branches of the portal vein.
- Presentation: Enlarged abdomen, abdominal discomfort, confusion, and internal bleeding.
- MC cause: Cirrhosis.
- Complications: Esophageal varices, ascites, liver failure.
Esophageal Varices
- Engorged, tortuous, and fragile varicose vessels of the lower esophagus.
- Caused by retrograde flow into the lower esophageal vessels due to portal hypertension.
- Complications: Mass hematemesis, gastrointestinal bleeding.
Hepatic Encephalopathy
- Deterioration of brain function due to buildup of toxic substances normally removed by the liver.
- Caused by excess amounts of ammonia, an end product of normal protein breakdown.
- Symptoms: Confusion, drowsiness, coma.
Jaundice
- Yellowish appearance of the skin and whites of the eyes due to excess bilirubin in the bloodstream.
- Causes: Prehepatic (e.g., sickle cell anemia, thalassemia), intrahepatic (e.g., hepatitis, cirrhosis, hepatocellular carcinoma), posthepatic (e.g., cholelithiasis, pancreatitis, pancreatic cancer).
Epidemiology
- Twice as common in males.
- Autopsy of livers in the US reveals 5% of the population has cirrhosis.
- 25,000 deaths per year in the US.
Prognosis
- Without transplant, patient usually dies within 5-15 years due to complications of cirrhosis.
Complications
- Portal hypertension, esophageal varices, rectal varices, ascites, kidney failure, hepatic encephalopathy.
- Decreased bile production, vitamin D absorption, and vitamin K absorption.
- Tendency for bleeding, splenomegaly, anemia.
Signs and Symptoms
- May have no symptoms for several years.
- Recognizable symptoms in 2 categories: symptoms related to declining liver function and symptoms related to portal hypertension.
- MC symptoms: weakness, malaise, fatigue, weight loss, ascites, loss of appetite.
- Symptoms related to declining liver function: greasy, foul-smelling steatorrhea, fatigue, loss of appetite, weight loss, dark urine, generalized edema, malabsorption.
- Symptoms related to portal hypertension: jaundice, ascites, hepatomegaly and splenomegaly, digital clubbing, caput medusa, xanthelasma, and spider telangiectasia.
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Description
This quiz covers the symptoms and complications of hepatic injury, including cirrhosis, portal hypertension, esophageal varices, and hepatic encephalopathy. Learn about the causes, presentations, and effects of liver disease on the body.
