Chapter 10 Selected Diseases and Disorders of the Digestive System
10p19 Cirrhosis: Systemic Effects and Clinical Manifestations
Cirrhosis: Systemic Effects and Clinical Manifestations
Pathophysiology and Systemic Manifestations
- Vascular Changes and Portal Hypertension
- Damage to blood vessels causes engorged and leaky vessels.
- Results in portal hypertension, leading to:
- Ascites: Fluid accumulation in the abdominal cavity.
- Edema from fluid leakage into tissues.
- Splenomegaly (enlarged spleen) due to blood congestion.
- Blood Volume and Kidney Response
- Hypovolemia triggers renin-angiotensin-aldosterone system (RAAS):
- Increased aldosterone and ADH retention of water and salt.
- Worsens portal hypertension and ascites.
- Reduced plasma proteins (like albumin):
- Causes fluid shifts into tissues, worsening edema and ascites.
- Liver Cellular Dysfunction
- Loss of hepatocyte function:
- Reduced gluconeogenesis.
- Decreased bile production → poor fat absorption and deficiency of fat-soluble vitamins (D, E, K).
- Impaired protein synthesis, affecting clotting factors, leading to bleeding.
- Bilirubin Metabolism and Jaundice
- Inability to conjugate bilirubin results in hyperbilirubinemia.
- Yellow pigmentation of skin and eyes (jaundice).
- Hepatic Encephalopathy
- Failure to detoxify ammonia and other toxins.
- Build-up causes:
- Tremors.
- Confusion.
- Lethargy.
- Coma and/or death.
- Impaired Hormone Metabolism
- Estrogen notInactivated properly.
- Causes gynecomastia in men (breast development).
- Irregular menses in women.
- Impotence in men.
Clinical Signs & Symptoms (Summary Table)
Conclusion
- Cirrhosis causes widespread organ dysfunction due to fibrosis, vascular changes, and cellular impairment.
- Symptoms develop gradually but can be life-threatening if untreated.
- Management involves addressing symptoms, preventing complications, and possibly liver transplantation.
