Cirrhosis: Pathology review
1,132,888views
00:00 / 00:00
Videos
Notes
Cirrhosis: Pathology review
Gastrointestinal system
Peritoneum and peritoneal cavity disorders
Peritonitis
Pneumoperitoneum
Upper gastrointestinal tract disorders
Cleft lip and palate
Congenital diaphragmatic hernia
Esophageal web
Tracheoesophageal fistula
Pyloric stenosis
Sialadenitis
Parotitis
Oral candidiasis
Ludwig angina
Aphthous ulcers
Temporomandibular joint dysfunction
Dental abscess
Gingivitis and periodontitis
Dental caries disease
Oral cancer
Warthin tumor
Barrett esophagus
Achalasia
Plummer-Vinson syndrome
Mallory-Weiss syndrome
Boerhaave syndrome
Gastroesophageal reflux disease (GERD)
Zenker diverticulum
Diffuse esophageal spasm
Esophageal cancer
Eosinophilic esophagitis (NORD)
Gastritis
Gastric dumping syndrome
Peptic ulcer
Gastroparesis
Cyclic vomiting syndrome
Gastroenteritis
Gastric cancer
Lower gastrointestinal tract disorders
Gastroschisis
Imperforate anus
Omphalocele
Meckel diverticulum
Intestinal atresia
Hirschsprung disease
Intestinal malrotation
Necrotizing enterocolitis
Intussusception
Tropical sprue
Small bowel bacterial overgrowth syndrome
Celiac disease
Short bowel syndrome (NORD)
Lactose intolerance
Whipple's disease
Protein losing enteropathy
Microscopic colitis
Crohn disease
Ulcerative colitis
Bowel obstruction
Intestinal adhesions
Volvulus
Gallstone ileus
Abdominal hernias
Femoral hernia
Inguinal hernia
Small bowel ischemia and infarction
Ischemic colitis
Familial adenomatous polyposis
Peutz-Jeghers syndrome
Gardner syndrome
Juvenile polyposis syndrome
Colorectal polyps
Colorectal cancer
Carcinoid syndrome
Irritable bowel syndrome
Gastroenteritis
Diverticulosis and diverticulitis
Appendicitis
Anal fissure
Anal fistula
Hemorrhoid
Rectal prolapse
Liver, gallbladder and pancreas disorders
Crigler-Najjar syndrome
Biliary atresia
Gilbert's syndrome
Dubin-Johnson syndrome
Rotor syndrome
Jaundice
Cirrhosis
Portal hypertension
Hepatic encephalopathy
Hemochromatosis
Wilson disease
Budd-Chiari syndrome
Non-alcoholic fatty liver disease
Cholestatic liver disease
Hepatocellular adenoma
Autoimmune hepatitis
Alcohol-induced liver disease
Alpha 1-antitrypsin deficiency
Primary biliary cirrhosis
Primary sclerosing cholangitis
Hepatitis
Neonatal hepatitis
Reye syndrome
Benign liver tumors
Hepatocellular carcinoma
Gallstones
Biliary colic
Acute cholecystitis
Ascending cholangitis
Chronic cholecystitis
Gallstone ileus
Gallbladder cancer
Cholangiocarcinoma
Acute pancreatitis
Pancreatic pseudocyst
Chronic pancreatitis
Pancreatic cancer
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Gastrointestinal system pathology review
Congenital gastrointestinal disorders: Pathology review
Esophageal disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Malabsorption syndromes: Pathology review
Diverticular disease: Pathology review
Appendicitis: Pathology review
Gastrointestinal bleeding: Pathology review
Colorectal polyps and cancer: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Pancreatitis: Pathology review
Gallbladder disorders: Pathology review
Jaundice: Pathology review
Viral hepatitis: Pathology review
Cirrhosis: Pathology review
Assessments
Cirrhosis: Pathology review
USMLE® Step 1 questions
0 / 16 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
Memory Anchors and Partner Content
Transcript
Content Reviewers
Yifan Xiao, MDContributors
Antonia Syrnioti, MD
Sam Gillespie, BSc
Ursula Florjanczyk, MScBMC
At the family medicine clinic, a 52- year- old male immigrant from Africa, named Jamar, came in for a checkup for the first time in a decade. On questioning, he admits to an extensive history of alcohol abuse. Physical examination reveals gynecomastia, palmar erythema and spider angiomata, as well as a palpable spleen.
Next, a 70- year- old Caucasian female, named Eleanor, with a history of chronic hepatitis C infection, is brought to the emergency department by paramedics due to altered mental status. She is completely disoriented and unable to provide an adequate history. Neurologic examination also reveals asterixis.
Lab tests of both show increased aspartate aminotransferase, or AST, and alanine aminotransferase or ALT. There’s also decreased albumin and increased prothrombin time. The difference is that Jamar has an AST level twice as high as ALT, in contrast with Eleanor, who has an ALT higher than AST. Eleanor, in particular, also has high serum levels of ammonia.
Both Jamar and Eleanor have cirrhosis. This is when chronic inflammation damages the liver causing it to become fibrotic. Normally, the liver is highly regenerative but scar tissue can replace liver cells which prevents regeneration and when this goes on for too long, it reaches the point where the damage is no longer reversible. If enough of the liver is replaced by scar tissue in advanced cirrhosis, a liver transplant might be needed. . Now, if we zoom into a hepatic lobule, we can see that it’s made of sheets of hepatocytes with sinusoids between them. The sinusoids are made of branches of the portal vein and hepatic artery, and together with the bile duct, form the portal triad which runs towards the central vein.
Now, there’s a space around each sinusoid, called the perisinusoidal space which contains stellate cells. When the hepatocytes are injured, they cluster together and form regenerative nodules. Here, they secrete paracrine factors that activate the stellate cells, which then proliferate, and start secreting transforming growth factor beta1, or TGF-beta. This causes them to produce collagen. The collagen builds up around the nodules and helps form scar tissue, leading to fibrosis.
Sources
- "Fundamentals of Pathology" H.A. Sattar (2017)
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "The Immunobiology and Pathophysiology of Primary Biliary Cirrhosis" Annual Review of Pathology: Mechanisms of Disease (2013)
- "Epidemiology of Alcoholic Liver Disease" Seminars in Liver Disease (2004)
- "Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease" Mayo Clinic Proceedings (2001)
- "Current concepts in the assessment and treatment of Hepatic Encephalopathy" QJM (2009)
- "Oxidative Stress and Epigenetic Instability in Human Hepatocarcinogenesis" Digestive Diseases (2013)
- "Involvement of DNA Damage Response Pathways in Hepatocellular Carcinoma" BioMed Research International (2014)
- "Hereditary Hemochromatosis — A New Look at an Old Disease" New England Journal of Medicine (2004)
Copyright © 2023 Elsevier, except certain content provided by third parties
Cookies are used by this site.
USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.
