explain the potentially life threatening conditions that cirrhosis can cause even before it has led to complete failure of the liver
- hepatocellular carcinoma
malignancy of the hepatosites.
rare to get primary cancer bc liver cells do not divide (too many functions) but with cirrhosis they can divide and its possible to get multiple primary cancers forming- many patients will die from this before liver completely fails - portal hypertension
scarring and change of normal structure
arterial circuit is high pressure so still able to get through the system and supply those carinomas that are dividing
however, the venous circuit because its under low pressure it becomes congested forming varices (dilaed veins)-
complications of portal hypertension
venous congestion which causes
-varices: dillated veins (typically oesophageal which are prone to rupturing)
-ascites: fluid collects in spaces within abdomen
-hemorrhoids
-splenomegaly: enlargment of spleen
-caput medusae
-anastomoses between portal and systemic circulation
pathogenesis of ascites
portal hypertension
congestion in portal venous system
increased hydrostatic pressure
allows fluid into the tissue (ascites)
explain how the effects of liver failure can worsen or exacerbate the conditions caused by cirrhosis
liver failure stops producing plasma proteins, including albumin (main plasma protein)- this reduces osmotic pressure of the plasma
as well as the fact that hydrostatic pressure has increased due to the portal hypertension
this increases oedema and ascites occuring
- reduced plasma protein production and osmotic pressure causing oedema
- bleeding tendency- liver fails and stops making clotting factors (can spontaneously hemmhorage/bruise
how can cirrhosis cause death
- hepatocellular carcinoma
- portal hypertension
- liver failure
list the main causes of cirrhosis
- Chronic:
– Chronic alcohol consumption
– NAFLD
– Autoimmune disease
– Genetic disease (Haemochromatosis, Wilson’s)
– Hep B & C
– Obstruction (gall stones, tumours, stricture)
– Congestive heart disease
– Secondary/metastatic Cancer
list the major effects that liver failure has on the body (not including oedema and bleeding)
the liver is our major metabolism organ:
metabolism of nutrients is reduced- breaking down functional tissue causing weight loss and wasting away
-metabolism of toxic substances is reduced- poisoning can occur, jaundice
-metabolism of hormones, disruption to endocrine system
-hepatoerenal syndrome
-hepatopulmonary syndrome
what is required for the digestion, absorption and metabolism of nutrients?
liver required for metabolism
digestion: fat- need bile and pancreatic lipase
other nutrients- pancreatic enzymes, brush border ezymes in the small intestine
absorpition:
all nutrients- absorbed across the wall of small intestine
can you live without stomach?
yes
can you live without gallbladder?
yes
what are nessecary for digestion, absorption and metabolism
-liver functioning
-bile from liver
-pancreatic enzymes
-small intestine
if any of these are removed, we see malabsorption
risk factors for cancer of the tube/accessory organs
smoking
increase in incidence of age
alcohol
chronic inflammation
genetics
what are the possible consequences of
- cancer
- chronic blood loss/anaemia
- acute bleed (can kill)
- perforation (kill)
- scarring (obstruction)
explain pathogenesis of cancers that develop in the tube and accessory organs
- squamous cell carcinoma (upper osephagus) and adenocarcinoma (lower esophagus) due to chronic gastric reflux. tells us metaplasia occurred before dysplasia
- adenoma benign tumour in the bowel, genetically unstable and becomes adenocarcinoma
