Cirrhosis

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Cirrhosis

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Preguntas

Preguntas del estilo USMLE Step 1

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A 61-year-old man is brought to the emergency department by his partner after a 2-day history of abdominal pain, fever, and altered mental status. He is oriented only to self and is unable to name the city in which he lives or the current year. The patient has a history of chronic alcohol use and was found to have cirrhosis several years ago. His other medical conditions include hypertension, hypercholesterolemia, and type II diabetes mellitus. His temperature is 39.0°C (102.2°F), pulse is 109/min, and blood pressure is 130/84 mmHg. Physical examination reveals jaundice and palmar erythema. The abdomen is tense, distended, and tender to palpation. Shifting dullness to percussion is present. Which of the following is the most likely cause of this patient’s clinical presentation?

External References

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Alcoholic cirrhosis p. 69, 398

cholelithiasis and p. 403

Alcoholism p. 589

cirrhosis and p. 396

Amenorrhea

cirrhosis p. 396

Anemia

cirrhosis p. 396

Anorectal varices

cirrhosis as cause p. 396

Ascites

cirrhosis p. 396

Asterixis p. 80, 533

cirrhosis p. 396

Cirrhosis p. 396

α1-antitrypsin deficiency p. 399

alcoholic p. 69, 398

bacterial peritonitis (spontaneous) p. 397

cholelithiasis and p. 403

cystic fibrosis p. 58

encephalopathy with p. 398

esophageal varices and p. 384

fructose intolerance p. 78

granulomatous disease p. NaN

gynecomastia p. 667

hemochromatosis p. 402

hepatocellular carcinomas p. 399

hyperbilirubinemia in p. 400

loop diuretics for p. 624

non-alcoholic fatty liver disease p. 398

pleural effusion p. 699

portal hypertension p. 396

serum markers for p. 397

Wilson disease p. 402

Edema (generalized)

cirrhosis p. 396

Gynecomastia p. 667

cirrhosis p. 396

Hepatic cirrhosis p. 699

Hepatic encephalopathy p. 398

cirrhosis p. 396

Hepatitis

cirrhosis p. 396

Hepatocellular carcinomas p. 399

cirrhosis and p. 396

“Hobnail” liver in alcoholic cirrhosis p. 398

Hyperbilirubinemia

cirrhosis and p. 396

Hypoalbuminemia

alcoholic cirrhosis as cause p. 398

Hyponatremia p. 609

cirrhosis and p. 396

Jaundice p. 400

alcoholic cirrhosis and p. 399

cirrhosis p. 396

Liver disease

cirrhosis p. 69, 78

Peripheral edema

cirrhosis and p. 396

Petechiae

with cirrhosis p. 396

Portal hypertension p. 396

cirrhosis and p. 396

Purpura

cirrhosis p. 396

Spider angiomas

cirrhosis p. 396

Splenomegaly

cirrhosis p. 396

Testicular atrophy

cirrhosis p. 396

Thrombocytopenia p. 413

cirrhosis p. 396

Transcript

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Content Reviewers

When cells are injured or damaged and die off, usually that dead tissue that was previously full of living cells becomes fibrotic, meaning it becomes thickened with heaps and heaps of protein and forms scar tissue.

So when your liver is constantly forced to process alcohol like in alcoholic liver disease, or subject to a viral attack for a long time like in HBV, or anything else that causes a long-term or chronic state of liver cell or hepatocyte destruction and inflammation, your liver can become seriously scarred and damaged to the point where it’s no longer reversible, at which point it becomes fibrotic and in the liver we call this process cirrhosis.

Because it’s usually irreversible, cirrhosis is often referred to as “end-stage” or “late-stage” liver damage.

When liver cells are injured, they start to come together and form what are called regenerative nodules. You can think of these as colonies of living liver cells. These are one of the classic signs of cirrhosis and are why a cirrhotic liver is more bumpy as opposed to a smooth, healthy liver.

Also with cirrhotic liver tissue, you’ll see that in between these clumps of cells or nodules, is fibrotic tissue and collagen.

Here’s a classic histology image of cirrhotic tissue, this clump of cells in the middle is the regenerative nodule, and these blue stains surrounding it are the bands of protein from the process of fibrosis.

If we zoom out a bit and look at it with the naked eye, we’ll again see these nodules, which have fibrotic protein bands in between.

How do these bands of fibrotic tissue form though? Well fibrosis is a process mediated by special cells called stellate cells, that sit between the sinusoid and hepatocyte, known as the perisinusoidal space.

Here’s a pretty basic layout of the basic functional unit of the liver, you’ve got the portal vein and hepatic artery that combine into a sinusoid, which then goes into the central vein, and these are all lined with hepatocytes.

Along with these though you’ve also got a bile duct, and all three constitute a portal triad.

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