End-Stage Liver Disease

by Carlo Raj, MD

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    Our topic of End stage liver disease, and we're going to further detail of cirrhosis, the final common pathway resulting in pretty severe sequelae. I will be every once in a while pausing and making sure that we focus on certain concepts that students tend to miss because they overlook it. Cirrhosis. Final common pathway, progression to irreversible injury due to severe fibrosis which means you are going to find tons of collagen you've heard of trichome stain maybe even reticular stain, and this is specifically for finding fibrosis. We'll talk about the clinical consequences in great detail. Lots to come. Exam. When you hear stigmata of cirrhosis we'll walk in each one of these. Palmer erythema due to increase estrogen. spider angiomata, you've heared *Tangiactasia due to increased estrogen. paper money skin, extremely thin. bilateral parotid enlargement in addition to other complications we will walk through. *gland often associated. Here, we have a cirrhotic liver. You've noticed that there is a complete loss of that fleshy almost like a pink-like appearance the liver should have. In cirrhosis, there will be increase in fibrotic nodules. Either micro or macro nodules. With all this fibrosis, and the nodules, it looks like, peanut brittle. Extremely rough on top. The nodules here represent either micro or macro nodules. With extensive fibrosis and a shrunken liver. So, imagine now that the liver is dead. What kind of sequelae are we looking for? Let's begin. The consequences. Let's begin with synthetic dysfunction. Remember that the liver is responsible for producing the most abundant protein in our body, albumin. You lose that albumin, hypoalbuminemia due to the lack of synthesis, you lose your oncotic pressure what your patient look like? protruding stomach, what's going on with that? Edema, right? Edema. Next. Not only is the albumin...

    About the Lecture

    The lecture End-Stage Liver Disease by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.

    Included Quiz Questions

    1. Estrogen
    2. Testosterone
    3. Epinephrine
    4. Nor-epinephrine
    5. Histamine
    1. Tremors
    2. Palmar erythema
    3. Spider angiomata
    4. Bilateral parotid enlargement
    5. Gynecomastia
    1. Enlarged liver
    2. Shrunken liver
    3. Micronodules
    4. Marconodules
    5. Firm in consistency
    1. Decreased oncotic pressure
    2. Decreased hydrostatic pressure
    3. Lymphatic obstruction
    4. Decreased sodium and water retention
    5. Inflammation
    1. Factor XII
    2. Factor II
    3. Factor vII
    4. Factor IX
    5. Factor X
    1. Pooling and sequestration of platelets
    2. Destruction of platelets
    3. Consumption of platelets
    4. Decreased formation of platelets
    5. Decreased release of platelets from bone marrow to peripheral blood
    1. Hepatocellular carcinoma
    2. Cholangiocarcinoma
    3. Pancreatic adenocarcinoma
    4. Gall bladder carcinoma
    5. Gastric carcinoma
    1. Filariasis
    2. Right-sided heart failure
    3. Cirrhosis
    4. Nephrotic syndrome
    5. Portal vein thrombosis
    1. Portal hypertension
    2. Sarcoidosis
    3. Henoch-Schonlein Purpura
    4. Secondary peritoneal carcinomatosis
    5. Primary peritoneal mesothelioma
    1. Transhepatic intrajugular porto-systemic shunt
    2. Whipple's procedure
    3. Endoscopic retrograde cholangio-pancreatography
    4. Magnetic resonance cholangiopancreatography
    5. Transhepatic cholangiography
    1. Bilirubin
    2. PT > 100 secs
    3. INR > 7.7
    4. PT/INR
    5. Creatinine

    Author of lecture End-Stage Liver Disease

     Carlo Raj, MD

    Carlo Raj, MD

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